80 % of patients suffering from amyotrophic lateral sclerosis present bulbar involvement and 50 % have salivary symptoms, which are often poorly managed. They present either with drooling or thick secretions. This elevates the risk of bronchoaspiration leading to pneumonia, second cause of death in this population. It is hence paramount to treat, while enhancing the patient's quality of life. The first line of treatment is a salivary drying agent such as an atropine-based medication. These treatments have a low adverse effect rate, are reversible and easy to dose. Management of thick secretions is possible with mucolytics. Taking into account the severity of the bulbar involvement, the second line of treatment, once controversial, is salivary gland injections of botulinium toxin.
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