### NICE guideline for Motor Neurone Disease: treatment of saliva problems

**Developed by**: National Institute for Clinical Excellence (NICE)

**Description**:
This guideline the treatment recommendation by NICE in the United Kingdom for the treatment of saliva problems in patients with Motor Neurone Disease. This is under section 1.8 of the guideline
## Assessment
1. **Saliva Issues**
   - Assess volume and viscosity of saliva.
   - Evaluate respiratory function, swallowing, diet, posture, and oral care.

## Management
1. **Drooling (Sialorrhoea)**
   - Provide advice on:
     - Swallowing
     - Diet
     - Posture and positioning
     - Oral care
     - Suctioning 

2. **First-line Treatment**
   - **Antimuscarinic Medicine**
     - Consider a trial for sialorrhoea.

   - **Glycopyrrolate**
     - Preferable for patients with cognitive impairment due to fewer CNS side effects.

3. **Second-line Treatment**
   - **Botulinum Toxin A**
     - Refer to a specialist if first-line treatment is ineffective, not tolerated, or contraindicated.

4. **Thick, Tenacious Saliva**
   - Review current medications, especially treatments for sialorrhoea.
   - Provide advice on:
     - Swallowing
     - Diet
     - Posture and positioning
     - Oral care
     - Suctioning
   - Consider treatments with:
     - Humidification
     - Nebulisers
     - Carbocisteine