Patients may experience problems with their oropharyngeal secretions due to difficulty in swallowing. Sialorrhea (drooling) is embarrassing to the patient; it is often socially disabling. The patient should be reminded to swallow before trying to open the mouth or speak and to be aware of frequent swallowing to keep mouth free of saliva and to avoid insidious aspiration of saliva into the airway.

Pharmacologic Interventions:

• Glycopyrrolate (Robinul)
• Atropine (Sal-Tropine)
• Amitriptyline HCL (Elavil)
• Hyoscyamine Sulfate tablets (Levsin)
• Botulinum Toxin type A injection into parotid glands is undergoing investigation to prove the clinical efficacy of this therapeutic approach
• Radiation treatment of the salivary glands.

Nonpharmacologic Treatments:

• Suction machines
• In-Exsufflator: cough machine effective in extracting excess mucus from airway

Frequently, emotional control appears to be deficient; resulting in spontaneous or unmotivated crying and laughing this is called emotional lability or a pseudobulbar affect. This emotional lability is not an indication of a severe emotional disorder like depression, but an abnormal affective display due to a dysregulation of the motoric components of emotional control. It occurs at some time in as many as 50% of patients with ALS. The symptom can be very disturbing for the patient and the caregivers in social situations. Physicians should make patient and family members aware that this is part of the disease, that it is not true indication of the patient's emotional state, and that responds well to medication.

Treatment

• Antidepressant medications