Development of A Local Pathway for Pharmacological Management of Sialorrhea in PD

By Dr Mark Simms, ST7 Care of the Elderly, Royal Cornwall Hospitals NHS Trust


An estimated 1490 people live with Parkinson’s in NHS Kernow CCG:

  • 0.28% of the registered population, with 48.6% Male and 51.4% Female

  • Average of 26 patients with Parkinson's per GP practice

  • 0.85% of 0ver 60s.

The demographics in Cornwall with high proportion of elderly mean this estimate is likely to be conservative.

Of those I have met in clinic, many complain that excess drooling is an issue & this is supported by national data. Severity ranges from it being a nuisance through to completely disabling both in terms of the practicalities of changing bed clothes, clothing etc as well as that caused by reduced mobility secondary to social stigma and embarrassment.

Management of this symptom was highly variable, with some having already tried various different treatment options, not necessarily in any specific order, whilst others were not aware that anything could help.

Having discussed this locally and after the last Masterclass meeting with Sue Thomas, it was apparent that the issue was a national one and that a pathway for excess drooling was being drawn up secondary to the recent approval by NICE of Xeomin for use in excessive drooling in Parkinson’s Disease.

With limited resources in Cornwall we needed a bespoke pathway accessible by GP and specialist teams in secondary care, insuring the right treatments are equally available in the right order to our population of patient.

Working alongside the national pathway I helped create a local team including specialists from neurology, elderly care, maxillofacial surgery, speech and language, physiotherapy community pharmacist, and GP prescribing committee members.

It was our role to identify the problem, along with the local resources available to us and to disseminate a practicable accessible guideline. This poster details our journey so far along with plans for the future.

More Parkinson's Academy Care pathways Projects

'The things you can't get from the books'

Parkinson's Academy, our original and longest running Academy, houses 20 years of inspirational projects, resources, and evidence for improving outcomes for people with Parkinson's. Led by co-founder and educational director Dr Peter Fletcher, the Academy has a truly collegiate feel and prides itself on delivering 'the things you can't get from books' - a practical learning model which inspires all Neurology Academy courses.