Megan Brooks

June 26, 2014

STOCKHOLM, Sweden — Rhinorrhea in patients with Parkinson's disease (PD) may respond to anticholinergic nasal spray, hints a small pilot study.

"All of our patients responded very well without any significant side effects," Rachana Gandhi, MD, from the Department of Neurology, Cleveland Clinic Florida in Weston, Florida, told Medscape Medical News.

Rhinorrhea is a common nonmotor symptom of PD, with a reported prevalence between 24% and 50%. Yet, "it's not well recognized or studied," Dr. Gandhi said.

"A persistent runny nose is not only bothersome, but can also lead to postnasal drip and coughing. Eating may make it worse, so many patients avoid social meal and gatherings," she explained. "Many of our patients as well as family members found it emotionally disturbing."

While many medications are available for rhinorrhea, "none of them is actually well studied, which prompted us to do a pilot study to assess efficacy of anticholinergic spray in PD patients," Dr. Gandhi said.

She presented the study at the recent International Parkinson and Movement Disorder Society (MDS) 18th International Congress of Parkinson's Disease and Movement Disorders.

Symptom Relief, Improved Quality of Life

The study included 5 patients (4 men, 1 woman) who were at least 60 years of age and who had rhinorrhea and a diagnosis of PD for less than 7 years. Two of the 5 patients developed rhinorrhea within the first year of being diagnosed with PD.

Rhinorrhea was assessed before and after 4 weeks of receiving an anticholinergic nasal spray (ipratropium bromide, Atrovent, Boehringer Ingelheim) using the validated SNOT-22 questionnaire for chronic rhinosinusitis symptoms.

"This small pilot study shows that local application of an anticholinergic nasal spray resulted in effective control of rhinorrhea and the symptoms related to it," Dr. Gandhi said. "Not all patients reached the normal range, but significant improvement was reported by the patients, leading to a better quality of life."

Three patients had a SNOT-22 score greater than 20, and after using the nasal spray they experienced an average clinical improvement of 66%. The overall improvement was 58%, the authors report.

Table. Change in SNOT-22 Score After Treatment

Patient SNOT-22 Before Treatment SNOT-22 After Treatment Improvement (%)
1 17 11 35
2 11 5 55
3 41 20 51
4 42 12 71
5 22 5 77


The SNOT-22 is a "helpful clinical tool for assessing patients with PD complaining of rhinorrhea," Dr. Gandhi said.

Tarannum Khan, MD, who worked on the study, told Medscape Medical News, "rhinorrhea is a common problem but PD as an etiology of rhinorrhea is only recently recognized so many general clinicians are still not aware of it as well as most patients. Autonomic neuropathy is a possible cause."

Dr. Khan cautioned that while there was "clear improvement" with anticholinergic nasal spray, the study was "very small" and not placebo controlled. "We are looking to do a broader study," she said.

The study had no commercial funding and the authors have disclosed no relevant financial relationships.

International Parkinson and Movement Disorder Society (MDS) 18th International Congress of Parkinson's Disease and Movement Disorders


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