Radiotherapy reduces sialorrhea in amyotrophic lateral sclerosis

Eur J Neurol. 2007 Dec;14(12):1373-7. doi: 10.1111/j.1468-1331.2007.01983.x. Epub 2007 Oct 17.


Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder. Sialorrhea is a frequent problem in ALS patients with bulbar symptoms, because of progressive weakness of oral, lingual and pharyngeal muscles. This prospective study aimed to investigate the putative effect of palliative single-dose radiotherapy on problematic sialorrhea in patients with ALS. Twenty patients with ALS and problematic drooling were included; 14 were given radiotherapy with a single fraction of 7.5 Grey (Gy). Five patients were treated with botulinum toxin A (BTX-A) injections (20 U) into the parotid glands; two of these were later given radiotherapy. Symptom assessment, clinical examination and measurements of salivary flow (ml/min) were performed before and after treatment (1-2 weeks, 3 months). Salivary secretion was significantly reduced after radiation treatment, with a mean reduction of 60% (1 week) and 51% (2 weeks). Three months post-treatment, 21% reduction of the salivary secretion was observed compared with salivation before treatment. Mean salivary flow was not reduced after BTX-A treatment in five patients. No serious side-effects were observed with either of the two treatment modalities. Single-dose radiotherapy (7.5 Gy) significantly reduces sialorrhea and is an effective and safe palliative treatment in patients with ALS.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amyotrophic Lateral Sclerosis / complications*
  • Amyotrophic Lateral Sclerosis / physiopathology*
  • Botulinum Toxins, Type A / administration & dosage
  • Female
  • Humans
  • Male
  • Middle Aged
  • Parotid Gland / physiopathology
  • Parotid Gland / radiation effects
  • Preoperative Care
  • Prospective Studies
  • Radiation Dosage
  • Radiotherapy / methods*
  • Salivary Glands / physiopathology
  • Salivary Glands / radiation effects*
  • Sialography
  • Sialorrhea / etiology*
  • Sialorrhea / physiopathology
  • Sialorrhea / radiotherapy*
  • Tomography, X-Ray Computed
  • Treatment Outcome


  • Botulinum Toxins, Type A