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Papandreou A, Mahony A, Breaks A, Absoud M, Fairhurst C. Comparative Efficacy and Side Effect Profiles of Interventions for Pediatric Saliva Control: A Cohort Study. J Pediatr 2024; 265:113803. [PMID: 37898423 DOI: 10.1016/j.jpeds.2023.113803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/05/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To compare efficacy and side effect profile data on conservative, behavioral, pharmacological, and surgical treatments used for pediatric saliva control. STUDY DESIGN A cohort study of children (n = 483) referred to a specialty Saliva Control service between May 2014 and November 2019 was performed, using quantitative data from pretreatment and post-treatment questionnaires (the Drooling Impact Scale [DIS], Drooling Rating Scale [DRS]) and recording of side effects. Overall, 483 children were included; treatment choices were based on published international guidelines. RESULTS The greatest improvement was seen after intraglandular botulinum toxin A (BTX-A) injections (n = 207; 551 courses; mean DIS change, 34.7; 95% CI = 29.2-35.7) or duct transpositional surgery (n = 31; mean change in DIS, 29.0; 95% CI, 22.3-35.7). Oral anticholinergics were associated with good outcomes, with no significant statistical difference between glycopyrronium bromide (n = 150; mean DIS change, 21.5; 95% CI, 19.1-24.0) or trihexyphenidyl (n = 87; mean DIS change, 22.4; 95% CI, 18.9-25.8). Inhaled ipratropium bromide was not as efficacious (n = 80; mean DIS change, 11.1; 95% CI, 8.9-13.3). Oromotor programs were used in a selected group with reliable outcomes (n = 9; mean DIS change, 13.0). Side effects were consistent with previous studies. Overall, in cases of milder severity, enterally administered therapies provided a good first-line option. With more severe problems, BTX-A injections or saliva duct transpositional surgery were more effective and well tolerated. CONCLUSIONS We describe a large, single-center pediatric saliva control cohort, providing direct comparison of the efficacy and side effect profiles for all available interventions and inform clinical practice for specialists when considering different options. BTX-A injections or saliva duct transpositional surgery seem to be more effective for saliva control that is more severe.
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Affiliation(s)
- Apostolos Papandreou
- Department of Pediatric Neurosciences, Evelina London Children's Hospital, Guys and Saint Thomas' Hospitals, London, UK
| | - Aoife Mahony
- Children's Health Ireland Tallaght, and Enable Ireland, Dublin, Ireland
| | - Anne Breaks
- Department of Speech and Language Therapy, Evelina London Children's Hospital, Guys and Saint Thomas' Hospitals, London, UK
| | - Michael Absoud
- Department of Pediatric Neurosciences, Evelina London Children's Hospital, Guys and Saint Thomas' Hospitals, London, UK
| | - Charlie Fairhurst
- Department of Pediatric Neurosciences, Evelina London Children's Hospital, Guys and Saint Thomas' Hospitals, London, UK.
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Chen CR, Su YC, Chen HC, Lin YC. Botulinum Toxin for Drooling in Adults with Diseases of the Central Nervous System: A Meta-Analysis. Healthcare (Basel) 2023; 11:1956. [PMID: 37444790 DOI: 10.3390/healthcare11131956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: The purpose of this study was to determine whether the drooling of adult patients with diverse central nervous system diseases can be treated with botulinum toxin type A. (2) Methods: The Cochrane Library, MEDLINE, and Embase were all searched for studies that fit the inclusion criteria. The patients in the studies had to be adults (>18 years old), and the studies had to be randomized placebo-controlled trials, controlled trials, or prospective studies. Each study had to have enough quantifiable data available for meta-analysis. The primary outcome measure was the Drooling Severity and Frequency Scale (DSFS). (3) Results: The meta-analysis comprised three studies. A statistically significant difference in DSFS score between the treatment and control groups was observed in the meta-analysis, with an overall standardized mean difference of -0.9377 (95% CI, -1.2919 to -0.5836; p < 0.0001). A total of seven studies were ineligible for inclusion in the meta-analysis and were only assessed as qualitative data. All qualitative studies showed a significant reduction in DSFS score a few weeks or months after the injection of botulinum toxin. (4) Conclusions: Botulinum toxin type A is safe and effective as a treatment for drooling in adult patients with central nervous system diseases.
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Affiliation(s)
- Chih-Rung Chen
- School of Medicine, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
| | - Yu-Chi Su
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Hui-Chuan Chen
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
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Lovardi E, De Ioris MA, Lettori D, Geremia C, Staccioli S, Bella GD, Scrocca R, Scarselli A, Aversa M, De Peppo F, Campana A, Castelli E. Glycopyrrolate for drooling in children with medical complexity under three years of age. Ital J Pediatr 2022; 48:2. [PMID: 34998418 PMCID: PMC8742944 DOI: 10.1186/s13052-021-01195-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background The aim of the study is to determine that Glycopirrolate is safe and effective in decreasing drooling in children with medical complexity under 3 years of age. Medical treatment is based on anticholinergic drugs as transdermal scopolamine, benzotropine and GLY. GLY (Glycopyrronium bromide) is a synthetic quaternary ammonium anticholinergic agent with poor blood–brain barrier penetration and consequently has limited central effects. Actually, the oral GLY formulation was approved by the United States Food and Drug Administration (FDA) to treat drooling in children aged 3–16 years. Five studies reported on GLY use for the treatment of drooling in children with cerebral palsy and other conditions with neurological impairment; four are prospective studies while one a retrospective review. Methods this is a case report of eighteen children (sex ratio 11/8, median age 17 months, range 2–36 months) under three years of age, followed by a multidisciplinary team at the Bambino Gesù Children Hospital. The median follow-up was of 31.5 months (range 1–69 months). Response to treatment was assessed according to the Drooling Impact Scale administered at time 0 and after 1 month. All patients have an important neurological impairment: nine patients have a cerebral palsy (Gross Motor Function Classification System class V) and nine a genetic/malformative syndrome. Twelve patients have a tracheostomy and two need mechanical ventilation. Gastrostomy is present in 16 out of 18 patients. All patients received Glycopirrolate. The median starting daily dose was 0.065 mg/kg/die (range 0.02–0.21 mg/kg/die) three times a day. The drooling impact scale was administered at time O and after 1 month. Results Four out 18 patients stopped treatment for adverse event, lack of efficacy or parental decision. The mean Drooling Impact Scale at time 0 was 89 (range 81–100) and after 1 month 61(range 43–78); the difference was statistically significant (P < 0.001). The overall response to treatment was 94%. Conclusions This is the first study to determine the safety and effectiveness of Glycopyrrolate in decreasing drooling in a specific subset of patients. No major side effects were observed. Further comparative studies are needed to confirm our results.
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Affiliation(s)
- Eleonora Lovardi
- Neurorehabilitation Unit, Department of Neurosciences, Bambino Gesù Children Hospital, IRCCS, Rome, Italy. .,Child Neuropsychiatric Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.
| | | | - Donatella Lettori
- Neurorehabilitation Unit, Department of Neurosciences, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | - Susanna Staccioli
- Neurorehabilitation Unit, Department of Neurosciences, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Gessica Della Bella
- Neurorehabilitation Unit, Department of Neurosciences, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | | | - Marcella Aversa
- Intensive Care Unit, Department of Anesthesia and Intensive Care, Rome, Italy
| | - Francesco De Peppo
- Department of Pediatric Surgery and Transplantation Center, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Andrea Campana
- Pediatrics, University Department of Pediatrics, Rome, Italy
| | - Enrico Castelli
- Neurorehabilitation Unit, Department of Neurosciences, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
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Effectiveness and safety of botulinum toxin in comparison with surgery for drooling in paediatric patients with neurological disorders: a systematic review. Br J Oral Maxillofac Surg 2021; 60:e691-e701. [DOI: 10.1016/j.bjoms.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 10/27/2021] [Indexed: 11/21/2022]
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Allen J, Zareen Z, Doyle S, Whitla L, Afzal Z, Stack M, Franklin O, Green A, James A, Leahy TR, Quinn S, Elnazir B, Russell J, Paran S, Kiely P, Roche EF, McDonnell C, Baker L, Hensey O, Gibson L, Kelly S, McDonald D, Molloy EJ. Multi-Organ Dysfunction in Cerebral Palsy. Front Pediatr 2021; 9:668544. [PMID: 34434904 PMCID: PMC8382237 DOI: 10.3389/fped.2021.668544] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
Abstract
Cerebral Palsy (CP) describes a heterogenous group of non-progressive disorders of posture or movement, causing activity limitation, due to a lesion in the developing brain. CP is an umbrella term for a heterogenous condition and is, therefore, descriptive rather than a diagnosis. Each case requires detailed consideration of etiology. Our understanding of the underlying cause of CP has developed significantly, with areas such as inflammation, epigenetics and genetic susceptibility to subsequent insults providing new insights. Alongside this, there has been increasing recognition of the multi-organ dysfunction (MOD) associated with CP, in particular in children with higher levels of motor impairment. Therefore, CP should not be seen as an unchanging disorder caused by a solitary insult but rather, as a condition which evolves over time. Assessment of multi-organ function may help to prevent complications in later childhood or adulthood. It may also contribute to an improved understanding of the etiology and thus may have an implication in prevention, interventional methods and therapies. MOD in CP has not yet been quantified and a scoring system may prove useful in allowing advanced clinical planning and follow-up of children with CP. Additionally, several biomarkers hold promise in assisting with long-term monitoring. Clinicians should be aware of the multi-system complications that are associated with CP and which may present significant diagnostic challenges given that many children with CP communicate non-verbally. A step-wise, logical, multi-system approach is required to ensure that the best care is provided to these children. This review summarizes multi-organ dysfunction in children with CP whilst highlighting emerging research and gaps in our knowledge. We identify some potential organ-specific biomarkers which may prove useful in developing guidelines for follow-up and management of these children throughout their lifespan.
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Affiliation(s)
- John Allen
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | | | - Samantha Doyle
- Department of Clinical Genetics, Birmingham Women's Hospital, Birmingham, United Kingdom
| | - Laura Whitla
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zainab Afzal
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Maria Stack
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Orla Franklin
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Andrew Green
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Adam James
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Timothy Ronan Leahy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Shoana Quinn
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Basil Elnazir
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - John Russell
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Sri Paran
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Patrick Kiely
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Edna Frances Roche
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Ciara McDonnell
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Louise Baker
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | | | - Louise Gibson
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Stephanie Kelly
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Denise McDonald
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Eleanor J. Molloy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Department of Neonatology, The Coombe Women and Infants University Hospital, Dublin, Ireland
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Varley LP, Gooney M, Denieffe S, Murphy A. Sialorrhoea Management Practices in Residential Older Adults Care Settings: A Qualitative Study. J Nurs Manag 2020; 29:989-997. [PMID: 33316108 DOI: 10.1111/jonm.13236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/27/2020] [Accepted: 12/09/2020] [Indexed: 01/26/2023]
Abstract
AIM The aim of this research was to explore both older adults' and health care professionals' experience and views of sialorrhoea management practices in older adult residential care settings. BACKGROUND Sialorrhoea is quite a bothersome symptom among patients with certain neurological conditions. The complexity of sialorrhoea and its complications can be quite challenging for health care professionals. In the management of sialorrhoea, a multidisciplinary approach is proposed as an effective way of sialorrhoea management. METHODS Thematic analysis of collected data via semi-structured qualitative interviews with five focus groups involving 28 multidisciplinary health care members and 1 patient. RESULTS The older adult and multidisciplinary health care professionals' view of the management of sialorrhoea in residential care settings were established under three main themes: 1) 'Sialorrhoea compromising patient's dignity', 2) 'Ad hoc local management' and 3) 'Further integration of care required'. CONCLUSION At present, there have been no comprehensive multidisciplinary sialorrhoea management strategies to meet the various needs of older adults with sialorrhoea. IMPLICATION FOR NURSING MANAGEMENT It is important to minimize the negative impact of sialorrhoea on the patients. The recognition of issues associated with sialorrhoea provides constructive scope for the health care professionals to further investigate and develop more effective integrated sialorrhoea care protocols.
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Affiliation(s)
- Li Ping Varley
- Department of Nursing, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - Martina Gooney
- Department of Nursing and Health Care, Waterford Institute of Technology, Ireland
| | - Suzanne Denieffe
- School of Humanities, Waterford Institute of Technology, Ireland
| | - Annette Murphy
- Department of Nursing, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
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Bard-Pondarré R, Roumenoff F, Julien C, Grguric G, Porte M, Boulay C, Bourg V, Chaléat-Valayer E. Validity, reliability and responsiveness to change of the French version of the drooling impact scale. Disabil Rehabil 2020; 44:788-794. [PMID: 32552097 DOI: 10.1080/09638288.2020.1777471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND work still needs to be done to measure the impact of sialorrhea on quality of life and define the efficacy of different therapies. The Drooling Impact Scale showed good validity and sensitivity to change, especially after botulinum toxin injection. The aim of this study is to present its French translation and to explore its validity, reliability and responsiveness to change in a group of children with Cerebral Palsy. METHODS multicentre study at six rehabilitation centres in France. Children with Cerebral Palsy aged 4-18 years with sialorrhea problems were included (n = 55), either in a control group (n = 33) or in the intervention group (n = 22, with 3 drug treatment and 19 botulinum toxin injections). The French Drooling Impact Scale was administered twice, 1 month apart. RESULTS The French Drooling Impact Scale total score at inclusion was meanly 53.9 (Standard Deviation 11.9) in the stable control group and 66.0 (16.1) in the intervention group (p = 0.0058). The validity of the scale was established, as well as an adequate internal consistency (Cronbach's α = 0.71); correlations between each item and the total score were found between 0.5 and 0.71 except for item 5 (r = 0.38) and item 7 (0.41). The test-retest reliability in stable children was good (Lin coefficient = 0.83, bias correction factor = 0.92 and Pearson correlation coefficient = 0.89). There was a high responsiveness to change, mean change was -40.0 in the intervention group and -3.6 in the stable group (p < 0.0001), with Standard Error of Measurement = 2.6. CONCLUSION the French Drooling Impact Scale has shown sufficient clinometric properties to be used now by clinicians or researchers.IMPLICATIONS FOR REHABILITATIONThe Drooling Impact scale has now its French version.The French version of the Drooling Impact Scale has shown its validity and a good test-retest reliability.The responsiveness to change was explored in a group of children undergoing saliva-control interventions and the scale was able to show a big change.The authors recommend to use this questionnaire in a semi-directed interview conducted by a health professional.
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Affiliation(s)
| | | | - Christell Julien
- Hospices Civils de Lyon, Pôle Information Médicale, Evaluation, Recherche, Unité d'Evaluation Médico-Economique, Lyon, France
| | - Gwen Grguric
- Hospices Civils de Lyon, Pôle Information Médicale, Evaluation, Recherche, Unité d'Evaluation Médico-Economique, Lyon, France
| | - Mélanie Porte
- CHU de Nîmes, Hôpital Carémeau - Service de rééducation et réadaptation fonctionnelle, Place du Pr Robert Debré, Nîmes, France
| | | | - Véronique Bourg
- CHU - Hôpital Nord, Boulevard de la Chantourne, La Tronche, France
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Reid SM, Westbury C, Guzys AT, Reddihough DS. Anticholinergic medications for reducing drooling in children with developmental disability. Dev Med Child Neurol 2020; 62:346-353. [PMID: 31495925 DOI: 10.1111/dmcn.14350] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 11/29/2022]
Abstract
AIM To determine: the effectiveness of three anticholinergic medications in reducing drooling in children with developmental disabilities (such as cerebral palsy, intellectual disability, and autism spectrum disorder), the frequency and nature of side effects, and their impact on treatment discontinuation. METHOD After prescription of benzhexol hydrochloride, glycopyrrolate, or scopolamine patches at a tertiary saliva control clinic, all carers of 110 consecutive, eligible patients were recruited over a 5-year period. They provided data for 52 weeks, or until drug discontinuation, on compliance, drooling, adverse effects, and reasons for cessation. We evaluated and compared best drooling response, side effects, and drug cessation rates using survival analysis, and the effect of baseline variables on the discontinuation rate using proportional hazards regression. RESULTS Among 110 participants (71 males, 39 females; mean age 8y 5mo [SD 4y 3mo], range 1y 11mo-18y 11mo), benzhexol, glycopyrrolate, and scopolamine were prescribed 81, 62, and 17 times respectively, with respective response rates of 85%, 75%, and 65%. Poor head control and poor oromotor function were predictive of poor response. Side effects frequently prompted drug cessation in males more than females (hazard ratio 1.8 [95% confidence interval 1.0-3.2], p=0.048). Glycopyrrolate had the fewest side effects. INTERPRETATION Benzhexol, glycopyrrolate, and scopolamine reduce drooling, but improvement is offset by adverse side effects. Overall, glycopyrrolate performs best. WHAT THIS PAPER ADDS In drooling, glycopyrrolate produced the greatest improvement with fewer side effects compared with benzhexol and scopolamine. Poor head control and poor oromotor function were associated with poor response. Medication side effects were common and often led to treatment discontinuation. Behavioural issues instigated cessation of benzhexol more often in males than females.
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Affiliation(s)
- Susan M Reid
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Christine Westbury
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Angela T Guzys
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Dinah S Reddihough
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Russo EF, Calabrò RS, Sale P, Vergura F, De Cola MC, Militi A, Bramanti P, Portaro S, Filoni S. Can muscle vibration be the future in the treatment of cerebral palsy-related drooling? A feasibility study. Int J Med Sci 2019; 16:1447-1452. [PMID: 31673235 PMCID: PMC6818199 DOI: 10.7150/ijms.34850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/05/2019] [Indexed: 01/20/2023] Open
Abstract
Background: Drooling is an involuntary loss of saliva from the mouth, and it is a common problem for children with cerebral palsy (CP). The treatment may be pharmacological, surgical, or speech-related. Repeated Muscle Vibration (rMV) is a proprioceptive impulse that activates fibers Ia reaching the somatosensory and motor cortex. Aim: The aim of the study is to evaluate the effectiveness of rMV in the treatment of drooling in CP. Design, setting and population: This was a rater blinded prospective feasibility study, performed at the "Gli Angeli di Padre Pio" Foundation, Rehabilitation Centers (Foggia, Italy), involving twenty-two CP patients affected by drooling (aged 5-15, mean 9,28 ± 3,62). Children were evaluated at baseline (T0), 10 days (T1), 1 month (T2) and 3 months (T3) after the treatment. Methods: The degree and impact of drooling was assessed by using the Drooling Impact Scale (DIS), the Drooling Frequency and Severity Scale (DFSS), Visual Analogue Scale (VAS) and Drooling Quotient (DQ). An rMV stimulus under the chin symphysis was applied with a 30 min protocol for 3 consecutive days. Results: The statistical analysis shows that DIS, DFSS, VAS, DQ improved with significant differences in the multiple comparisons between T1 vs T2, T1 vs T3 and T1 vs T4 (p≤0.001). Conclusion This study demonstrates that rMV might be a safe and effective tool in reducing drooling in patients with CP. The vibrations can improve the swallowing mechanisms and favor the acquisition of the maturity of the oral motor control in children with CP.
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Affiliation(s)
- Emanuele F Russo
- Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, Foggia, Italy
| | | | - Patrizio Sale
- Rehabilitation Unit, Department of Neurosciences, University of Padua
| | - Filomena Vergura
- Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, Foggia, Italy
| | - Maria C De Cola
- Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, Foggia, Italy
| | - Angela Militi
- Dipartimento di Scienze Biomediche odontoiatriche e delle immagini Morfologiche e Funzionali, University of Messina, Italy
| | | | | | - Serena Filoni
- Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, Foggia, Italy
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Pharmacological interventions for treating sialorrhea associated with neurological disorders: A mixed treatment network meta-analysis of randomized controlled trials. J Clin Neurosci 2018; 51:12-17. [DOI: 10.1016/j.jocn.2018.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/04/2018] [Indexed: 11/19/2022]
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Parr JR, Todhunter E, Pennington L, Stocken D, Cadwgan J, O’Hare AE, Tuffrey C, Williams J, Cole M, Colver AF. Drooling Reduction Intervention randomised trial (DRI): comparing the efficacy and acceptability of hyoscine patches and glycopyrronium liquid on drooling in children with neurodisability. Arch Dis Child 2018; 103:371-376. [PMID: 29192000 PMCID: PMC5890631 DOI: 10.1136/archdischild-2017-313763] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/22/2017] [Accepted: 10/02/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Investigate whether hyoscine patch or glycopyrronium liquid is more effective and acceptable to treat drooling in children with neurodisability. DESIGN Multicentre, single-blind, randomised controlled trial. SETTING Recruitment through neurodisability teams; treatment by parents. PARTICIPANTS Ninety children with neurodisability who had never received medication for drooling (55 boys, 35 girls; median age 4 years). EXCLUSION CRITERIA medication contraindicated; in a trial that could affect drooling or management. INTERVENTION Children were randomised to receive a hyoscine skin patch or glycopyrronium liquid. Dose was increased over 4 weeks to achieve optimum symptom control with minimal side-effects; steady dose then continued to 12 weeks. PRIMARY AND SECONDARY OUTCOMES Primary outcome: Drooling Impact Scale (DIS) score at week-4. SECONDARY OUTCOMES change in DIS scores over 12 weeks, Drooling Severity and Frequency Scale and Treatment Satisfaction Questionnaire for Medication; adverse events; children's perception about treatment. RESULTS Both medications yielded clinically and statistically significant reductions in mean DIS at week-4 (25.0 (SD 22.2) for hyoscine and 26.6 (SD 16) for glycopyrronium). There was no significant difference in change in DIS scores between treatment groups. By week-12, 26/47 (55%) children starting treatment were receiving hyoscine compared with 31/38 (82%) on glycopyrronium. There was a 42% increased chance of being on treatment at week-12 for children randomised to glycopyrronium relative to hyoscine (1.42, 95% CI 1.04 to 1.95). CONCLUSIONS Hyoscine and glycopyrronium are clinically effective in treating drooling in children with neurodisability. Hyoscine produced more problematic side effects leading to a greater chance of treatment cessation. TRIAL REGISTRATION NUMBERS ISRCTN 75287237; EUDRACT: 2013-000863-94; Medicines and Healthcare Products Regulatory Agency: 17136/0264/001-0003.
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Affiliation(s)
- Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK,The Great North Children’s Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Emma Todhunter
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - Lindsay Pennington
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Deborah Stocken
- Biostatistics Research Group, Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Jill Cadwgan
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK,The Great North Children’s Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Anne E O’Hare
- Salvesen Mindroom Centre, University of Edinburgh, Edinburgh, UK
| | | | - Jane Williams
- Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Mike Cole
- Biostatistics Research Group, Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Allan F Colver
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
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12
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Jun JS, Seo HG, Lee ST, Chu K, Lee SK. Botulinum toxin treatment for hypersalivation in anti-NMDA receptor encephalitis. Ann Clin Transl Neurol 2017; 4:830-834. [PMID: 29159196 PMCID: PMC5682120 DOI: 10.1002/acn3.467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/18/2017] [Accepted: 08/20/2017] [Indexed: 12/14/2022] Open
Abstract
Hypersalivation is one of the intractable symptoms of anti‐N‐methyl‐d‐aspartate receptor (NMDAR) encephalitis. While anticholinergic medications partially improve the hypersalivation, they can aggravate the autonomic dysfunctions associated with anti‐NMDAR encephalitis. Thus, we investigated the efficacy and safety of botulinum toxin type A injection on hypersalivation refractory to anticholinergics in six patients with anti‐NMDAR encephalitis. Hypersalivation was well‐controlled without remarkable adverse reaction over 16 weeks after botulinum toxin type A, although two patients were reinjected at 12 weeks due to reaggravation of hypersalivation. Our findings suggest that botulinum toxin type A might be a better choice than anticholinergics for management of hypersalivation in patients with anti‐NMDAR encephalitis.
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Affiliation(s)
- Jin-Sun Jun
- Department of Neurology Seoul National University Hospital Seoul South Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine Seoul National University Hospital Seoul South Korea
| | - Soon-Tae Lee
- Department of Neurology Seoul National University Hospital Seoul South Korea
| | - Kon Chu
- Department of Neurology Seoul National University Hospital Seoul South Korea
| | - Sang Kun Lee
- Department of Neurology Seoul National University Hospital Seoul South Korea
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13
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Williams RE, Adams HR, Blohm M, Cohen-Pfeffer JL, de Los Reyes E, Denecke J, Drago K, Fairhurst C, Frazier M, Guelbert N, Kiss S, Kofler A, Lawson JA, Lehwald L, Leung MA, Mikhaylova S, Mink JW, Nickel M, Shediac R, Sims K, Specchio N, Topcu M, von Löbbecke I, West A, Zernikow B, Schulz A. Management Strategies for CLN2 Disease. Pediatr Neurol 2017; 69:102-112. [PMID: 28335910 DOI: 10.1016/j.pediatrneurol.2017.01.034] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
Abstract
CLN2 disease (neuronal ceroid lipofuscinosis type 2) is a rare, autosomal recessive, pediatric-onset, rapidly progressive neurodegenerative lysosomal storage disorder caused by tripeptidyl peptidase 1 (TPP1) enzyme deficiency, and is characterized by language delay, seizures, rapid cognitive and motor decline, blindness, and early death. No management guidelines exist and there is a paucity of published disease-specific evidence to inform clinical practice, which currently draws upon experience from the field of childhood neurodisability. Twenty-four disease experts were surveyed on CLN2 disease management and a subset met to discuss current practice. Management goals and strategies are consistent among experts globally and are guided by the principles of pediatric palliative care. Goals and interventions evolve as the disease progresses, with a shift in focus from maintenance of function early in the disease to maintenance of quality of life. A multidisciplinary approach is critical for optimal patient care. This work represents an initial step toward the development of consensus-based management guidelines for CLN2 disease.
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Affiliation(s)
- Ruth E Williams
- Children's Neurosciences Centre, Evelina London Children's Hospital, London, United Kingdom.
| | - Heather R Adams
- Department of Neurology, University of Rochester School of Medicine, Rochester, New York
| | - Martin Blohm
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Emily de Los Reyes
- Department of Pediatric Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | - Jonas Denecke
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Charlie Fairhurst
- Children's Neurosciences Centre, Evelina London Children's Hospital, London, United Kingdom
| | - Margie Frazier
- Batten Disease Support and Research Association (BDSRA), Columbus, Ohio
| | - Norberto Guelbert
- Metabolic Diseases Section, Children's Hospital of Cordoba, Cordoba, Argentina
| | - Szilárd Kiss
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York
| | - Annamaria Kofler
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - John A Lawson
- Department of Neurology, Sydney Children's Hospital, Randwick, Australia
| | - Lenora Lehwald
- Department of Pediatric Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | - Mary-Anne Leung
- Children's Neurosciences Centre, Evelina London Children's Hospital, London, United Kingdom
| | - Svetlana Mikhaylova
- Department of Medical Genetics, Russian Children's Clinical Hospital, Moscow, Russia; Department of Molecular and Cell Genetics, Russian National Research Medical University, Moscow, Russia
| | - Jonathan W Mink
- Department of Neurology, University of Rochester School of Medicine, Rochester, New York
| | - Miriam Nickel
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Katherine Sims
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nicola Specchio
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Meral Topcu
- Department of Pediatric Neurology, Hacettepe University, Ankara, Turkey
| | | | - Andrea West
- Batten Disease Family Association (BDFA), Farnborough, United Kingdom
| | - Boris Zernikow
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, Germany; Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health-School of Medicine, Witten/Herdecke University, Germany
| | - Angela Schulz
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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14
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Gastrointestinal Dysfunctions in Parkinson's Disease: Symptoms and Treatments. PARKINSONS DISEASE 2016; 2016:6762528. [PMID: 28050310 PMCID: PMC5168460 DOI: 10.1155/2016/6762528] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/16/2016] [Indexed: 12/21/2022]
Abstract
A diagnosis of Parkinson's disease is classically established after the manifestation of motor symptoms such as rigidity, bradykinesia, and tremor. However, a growing body of evidence supports the hypothesis that nonmotor symptoms, especially gastrointestinal dysfunctions, could be considered as early biomarkers since they are ubiquitously found among confirmed patients and occur much earlier than their motor manifestations. According to Braak's hypothesis, the disease is postulated to originate in the intestine and then spread to the brain via the vagus nerve, a phenomenon that would involve other neuronal types than the well-established dopaminergic population. It has therefore been proposed that peripheral nondopaminergic impairments might precede the alteration of dopaminergic neurons in the central nervous system and, ultimately, the emergence of motor symptoms. Considering the growing interest in the gut-brain axis in Parkinson's disease, this review aims at providing a comprehensive picture of the multiple gastrointestinal features of the disease, along with the therapeutic approaches used to reduce their burden. Moreover, we highlight the importance of gastrointestinal symptoms with respect to the patients' responses towards medical treatments and discuss the various possible adverse interactions that can potentially occur, which are still poorly understood.
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15
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Blommaert D, van Hulst K, Hoogen FJAVD, Erasmus CE, Wortmann SB. Diagnosis and Management of Drooling in Children With Progressive Dystonia: A Case Series of Patients With MEGDEL Syndrome. J Child Neurol 2016; 31:1220-6. [PMID: 27229007 DOI: 10.1177/0883073816650037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/20/2016] [Indexed: 11/16/2022]
Abstract
Drooling is a common problem in children with progressive dystonia. The authors noted a 58% incidence of drooling in 22/38 children with MEGDEL, a rare neurodegenerative cause of dystonia and report on the clinical course of four patients. Drooling of varying severity and subsequent respiratory problems were treated at the authors' multidisciplinary saliva-control outpatient clinic. One patient improved on antireflux medication, the second after medication with drooling as side effect was changed. Two other patients underwent salivary gland surgery, one of whom significantly improved; the other died shortly after surgery. The heterogeneity of the cases presented shows the need for stepwise and personalized treatment. The authors recommend the following: (1) optimize the treatment of the underlying neurological condition and replace medication that stimulates saliva secretion; (2) treat constipation, scoliosis, and gastroesophageal reflux if there is still a risk of chronic aspiration of saliva; (3) perform more intense/invasive treatment (botulinum toxin, salivary gland surgery).
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Affiliation(s)
- Dorian Blommaert
- Department of Paediatrics, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Karen van Hulst
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands
| | | | - Corrie E Erasmus
- Department of Paediatric Neurology, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Saskia B Wortmann
- Department of Paediatrics, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, Netherlands Department of Paediatrics, Salzburger Landeskliniken, Paracelsus Medical University, Salzburg, Austria
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16
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Abstract
Many children with mental retardation and developmental disabilities suffer from the consequences of chronic drooling. Behavioral treatment for drooling should be considered before other, more intrusive treatments such as medication and surgery are implemented. However, empirical studies on behavioral procedures are scarce. This article reviews 19 behavioral studies published since 1970. Treatment procedures are (a) instruction, prompting, and positive reinforcement; (b) negative social reinforcement and declarative procedures; (c) cueing techniques; and (d) self-management procedures. Although these procedures yield positive results, critical examination of experimental methodology of the studies reveals several methodological shortcomings. Guidelines for clinical use of behavioral treatment for drooling are presented, and recommendations are given for future research in this area.
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17
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Chaléat-Valayer E, Porte M, Buchet-Poyau K, Roumenoff-Turcant F, D'Anjou MC, Boulay C, Bernard JC, Touzet S. Management of drooling in children with cerebral palsy: A French survey. Eur J Paediatr Neurol 2016; 20:524-31. [PMID: 27155820 DOI: 10.1016/j.ejpn.2016.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 03/29/2016] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
AIM To characterise children with cerebral palsy (CP) and pathological drooling in France, and to describe care pathways, assessment and treatment. METHOD A transversal, observational, descriptive survey of the practices and opinions of 400 health professionals potentially involved in the care of children with CP, was carried out nationally across France in 2013. RESULTS The response rate was 36%. Seventy-five questionnaires were returned and analysed (52%). A small proportion of children were specifically treated for drooling (<25%). Assessments were carried out in 75% of cases and 91% of professionals prescribed treatments. Use of assessment tools varied widely. The most common treatment was oro-facial rehabilitation (95% of professionals), followed by anticholinergic drugs (Scopolamine(®)) (94%) botulinum toxin injections (BT) (66%) and surgery (34%). Scopolamine was considered to be less effective than BT and to have more side effects. CONCLUSION The rate of pathological drooling in children with CP is likely underestimated and under treated in France. There is a lack of knowledge regarding assessment tools. Aside from rehabilitation, current practice is to prescribe medication as the first-line treatment, however professionals consider that BT is more effective and has less side effects.
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Affiliation(s)
- E Chaléat-Valayer
- Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, 69322 Lyon Cedex 05, France.
| | - M Porte
- Centre Hospitalier Universitaire de Nîmes, 30029, France.
| | - K Buchet-Poyau
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon F-69003, France.
| | - F Roumenoff-Turcant
- Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, 69322 Lyon Cedex 05, France.
| | - M C D'Anjou
- Coordination SSR Pédiatrique Hôpital Nord, Saint Etienne 42055, France.
| | - C Boulay
- Service de Neurologie Pédiatrique, CHU Timone Enfants, 13385 Marseille, France.
| | - J C Bernard
- Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, 69322 Lyon Cedex 05, France.
| | - S Touzet
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon F-69003, France; Universite de Lyon, EA 7425 Health Services and Performance Research (HESPER), Lyon F-69008, France.
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18
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Montgomery J, McCusker S, Lang K, Grosse S, Mace A, Lumley R, Kubba H. Managing children with sialorrhoea (drooling): Experience from the first 301 children in our saliva control clinic. Int J Pediatr Otorhinolaryngol 2016; 85:33-9. [PMID: 27240493 DOI: 10.1016/j.ijporl.2016.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 03/09/2016] [Accepted: 03/11/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Sialorrhoea (drooling) is defined as the involuntary escape of saliva from the mouth. It is considered normal in young children but may cause social problems in older children. Sialorrhoea is frequently seen in children with cerebral palsy, with rates between 10% and 58% and in other neurodevelopmental diseases. Management of these children can be challenging and often requires an individual and stepwise approach. This is a large case series of children managed at the saliva control clinic in Glasgow, Scotland. METHODS A chart review of all children attending the saliva control clinic between 2006 and June 2012 was performed. This was to ensure that all children would have long term follow up (3 years minimum). Drooling severity was assessed on the child's first attendance at clinic, and at review following a treatment option, using the Teacher Drooling Scale (TDS). RESULTS The total number of children attending this clinic was 301, of which 274 had adequate records for inclusion in the study. 176 (64%) were male. The mean age was 7.3 (median 5) years. In terms of development 35 (13%) of children were developing normally and 50 (18%) had general developmental delay. There were 105 (38%) children with cerebral palsy. The final management of sialorrhoea in these children was simple reassurance and advice for 34 (12%), speech and language therapy for 62 (23%) anticholinergics in 90 patients (33%), botox for 30 (11%) and surgery for 71 (26%) children. The rate of non-tolerance of anticholinergics is 30%; 90 of the 298 children tried on anticholinergics had side effects leading to the treatment being stopped. The average teachers drooling score was 4.24 before clinic and 1.59 after clinic. Satisfactory results were achieved in 215 (78%) of children. CONCLUSION Our data illustrates that effective patient management requires all treatment options to be available, including speech therapy, medications, botulinum toxin and surgery. This is one of the larger case series of children attending a saliva control clinic.
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Affiliation(s)
- Jenny Montgomery
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom.
| | - Sarah McCusker
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom
| | - Kerry Lang
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom
| | - Susan Grosse
- Department of Speech & Language Therapy, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom
| | - Alastair Mace
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom
| | - Ruby Lumley
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom
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19
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Hernández-Palestina MS, Cisneros-Lesser JC, Arellano-Saldaña ME, Plascencia-Nieto SE. [Submandibular gland resection for the management of sialorrhea in paediatric patients with cerebral palsy and unresponsive to type A botullinum toxin. Pilot study]. CIR CIR 2016; 84:459-468. [PMID: 27221328 DOI: 10.1016/j.circir.2016.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/20/2015] [Accepted: 02/10/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sialorrhoea has a prevalence of between 10% and 58% in patients with cerebral palsy. Amongst the invasive treatments, botulinum toxin-A injections in submandibular and parotid glands and various surgical techniques are worth mentioning. There are no studies in Mexico on the usefulness of surgery to manage sialorrhoea. OBJECTIVE To evaluate the usefulness of submandibular gland resection in improving sialorrhoea in patients with cerebral palsy and with a poor response to botulinum toxin. MATERIAL AND METHODS Experimental, clinical, self-controlled, prospective trial was conducted to evaluate the grade of sialorrhoea before surgery, and 8, 16 and 24 weeks after. Statistical analysis was performed using a non-parametric repetitive measure assessment, considering a p < 0.05 as significant. Complications and changes in salivary composition were evaluated. RESULTS Surgery was performed on 3 patients with severe sialorrhoea, and 2 with profuse sialorrhoea, with mean age of 10.8 years. The frequency and severity of sialorrhoea improved in the 5 patients, with mean of 76.7 and 87.5% improvement, respectively. The best results were seen after 6 months of surgery, with a statistically significant difference between the preoperative stage and 6 months after the procedure (p = 0.0039, 95% CI). No significant differences were observed in complications, increase in periodontal disease or cavities, or salivary composition. CONCLUSIONS Submandibular gland resection is an effective technique for sialorrhoea control in paediatric patients with cerebral palsy, with a reduction in salivary flow greater than 80%. It has a low chance of producing complications compared to other techniques. It led to an obvious decrease in sialorrhoea without the need to involve other salivary glands in the procedure.
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Affiliation(s)
| | - Juan Carlos Cisneros-Lesser
- Otorrinolaringología y Cirugía de Cabeza y Cuello, Instituto Nacional de Rehabilitación, Ciudad de México, México.
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20
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Shariat-Madar B, Chun RH, Sulman CG, Conley SF. Safety of Ultrasound-Guided Botulinum Toxin Injections for Sialorrhea as Performed by Pediatric Otolaryngologists. Otolaryngol Head Neck Surg 2016; 154:924-7. [PMID: 26908558 DOI: 10.1177/0194599816629612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/08/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate incidence of complications and hospital readmission as a result of ultrasound-guided botulinum toxin injections to manage sialorrhea. STUDY DESIGN Case series with chart review. SETTING Children's Hospital of Wisconsin. SUBJECTS AND METHODS A case series with chart review was performed of all cases of ultrasound-guided injection of botulinum toxin by pediatric otolaryngologists from March 5, 2010, to September 26, 2014,. Primary outcomes included complications such as dysphagia, aspiration pneumonia, and motor paralysis. Secondary outcomes included hospitalization, intubation, and nasogastric tube placement. RESULTS There were 48 patients, 111 interventions, and 306 intraglandular injections identified. Botulinum toxin type A and type B were utilized in 4 and 107 operative interventions, respectively. Type A was injected into 4 parotid and 4 submandibular glands, utilizing doses of 20 U per parotid and 30 U per submandibular gland. Type B was injected into 98 parotid and 200 submandibular glands, with average dosing of 923 U per parotid and 1170 U per submandibular gland, respectively. There were 2 instances of subjectively worsening of baseline dysphagia that self-resolved. No cases were complicated by aspiration pneumonia or motor paralysis. No patients required hospital readmission, intubation, or nasogastric tube placement. CONCLUSION Prior published data indicated 16% complication incidence with ultrasound-guided injection of botulinum toxin. Our study found a low complication rate (0.6%) with ultrasound-guided injections of botulinum toxin to manage sialorrhea, without cases of aspiration pneumonia or motor paralysis. Of 306 intraglandular injections, there were 2 cases of worsening baseline subjective dysphagia that self-resolved.
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Affiliation(s)
- Bahbak Shariat-Madar
- Children's Hospital of Wisconsin, Department of Otolaryngology/Medical College of Wisconsin, Children's Hospital Clinics Building, Milwaukee, Wisconsin, USA
| | - Robert H Chun
- Children's Hospital of Wisconsin, Department of Otolaryngology/Medical College of Wisconsin, Children's Hospital Clinics Building, Milwaukee, Wisconsin, USA
| | - Cecille G Sulman
- Children's Hospital of Wisconsin, Department of Otolaryngology/Medical College of Wisconsin, Children's Hospital Clinics Building, Milwaukee, Wisconsin, USA
| | - Stephen F Conley
- Children's Hospital of Wisconsin, Department of Otolaryngology/Medical College of Wisconsin, Children's Hospital Clinics Building, Milwaukee, Wisconsin, USA
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21
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Abstract
Drooling is the unintentional loss of saliva from the mouth, either anteriorly (visible) or posteriorly (with a risk of coughing, vomiting, aspiration and chronic respiratory disorders).(1,2) Anterior drooling is normal in infancy, but is considered neuro-developmentally abnormal if it occurs in children over the age of 4 years old, and is commonly seen in those with physical, intellectual and learning disability, and poor neuromuscular coordination and oral control.(1,3-7) For example, drooling occurs in 10-38% of children with cerebral palsy.(6,8) Drooling is usually due to failure to clear saliva rather than hyper-salivation (sialorrhoea), and a head-down posture and sucking on fingers or clothing may be contributory factors.(1,2,5-7) Here we review the challenges associated with the management of drooling in children.
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Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, Farré M. Salivary Secretory Disorders, Inducing Drugs, and Clinical Management. Int J Med Sci 2015; 12:811-24. [PMID: 26516310 PMCID: PMC4615242 DOI: 10.7150/ijms.12912] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/02/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Salivary secretory disorders can be the result of a wide range of factors. Their prevalence and negative effects on the patient's quality of life oblige the clinician to confront the issue. AIM To review the salivary secretory disorders, inducing drugs and their clinical management. METHODS In this article, a literature search of these dysfunctions was conducted with the assistance of a research librarian in the MEDLINE/PubMed Database. RESULTS Xerostomia, or dry mouth syndrome, can be caused by medication, systemic diseases such as Sjögren's Syndrome, glandular pathologies, and radiotherapy of the head and neck. Treatment of dry mouth is aimed at both minimizing its symptoms and preventing oral complications with the employment of sialogogues and topical acting substances. Sialorrhea and drooling, are mainly due to medication or neurological systemic disease. There are various therapeutic, pharmacologic, and surgical alternatives for its management. The pharmacology of most of the substances employed for the treatment of salivary disorders is well-known. Nevertheless, in some cases a significant improvement in salivary function has not been observed after their administration. CONCLUSION At present, there are numerous frequently prescribed drugs whose unwanted effects include some kind of salivary disorder. In addition, the differing pathologic mechanisms, and the great variety of existing treatments hinder the clinical management of these patients. The authors have designed an algorithm to facilitate the decision making process when physicians, oral surgeons, or dentists face these salivary dysfunctions.
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Affiliation(s)
- Jaume Miranda-Rius
- 1. Departament d'Odontostomatologia. Facultat d'Odontologia. Universitat de Barcelona, Barcelona, Spain
| | - Lluís Brunet-Llobet
- 2. Servei d'Odontologia. Hospital Sant Joan de Déu. Universitat de Barcelona, Barcelona, Spain
| | - Eduard Lahor-Soler
- 1. Departament d'Odontostomatologia. Facultat d'Odontologia. Universitat de Barcelona, Barcelona, Spain
| | - Magí Farré
- 3. Clinical Pharmacology Unit. Hospital Universitari Germans Trias i Pujol-IGTP and Hospital del Mar Medical Research Institute (IMIM). Facultat de Medicina. Universitat Autònoma de Barcelona, Barcelona, Spain
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23
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Iro H, Zenk J. Salivary gland diseases in children. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc06. [PMID: 25587366 PMCID: PMC4273167 DOI: 10.3205/cto000109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Salivary gland diseases in children are rare, apart from viral-induced diseases. Nevertheless, it is essential for the otolaryngologist to recognize these uncommon findings in children and adolescents and to diagnose and initiate the proper treatment. The present work provides an overview of the entire spectrum of congenital and acquired diseases of the salivary glands in childhood and adolescence. The current literature was reviewed and the results discussed and summarized. Besides congenital diseases of the salivary glands in children, the main etiologies of viral and bacterial infections, autoimmune diseases and tumors of the salivary glands were considered. In addition to the known facts, new developments in diagnostics, imaging and therapy, including sialendoscopy in obstructive diseases and chronic recurrent juvenile sialadenitis were taken into account. In addition, systemic causes of salivary gland swelling and the treatment of sialorrhoea were discussed. Although salivary gland diseases in children are usually included in the pathology of the adult, they differ in their incidence and sometimes in their symptoms. Clinical diagnostics and especially the surgical treatment are influenced by a stringent indications and a less invasive strategy. Due to the rarity of tumors of the salivary glands in children, it is recommended to treat them in a specialized center with greater surgical experience. Altogether the knowledge of the differential diagnoses in salivary gland diseases in children is important for otolaryngologists, to indicate the proper therapeutic approach.
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Affiliation(s)
- Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Germany
| | - Johannes Zenk
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Germany
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24
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Checklin M, Etty-Leal M, Iseli TA, Potter N, Fisher S, Chapman L. Saliva management options for difficult-to-wean people with tracheostomy following severe acquired brain injury (ABI): A review of the literature. Brain Inj 2014; 29:1-10. [DOI: 10.3109/02699052.2014.967298] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Martin Checklin
- Gardenview House, Melbourne Health, Parkville, Victoria, Australia,
| | - Mary Etty-Leal
- Department of Pharmacy, Royal Melbourne Hospital, Melbourne, Australia, and
| | - Tim A. Iseli
- Department of Surgery, Melbourne University, Royal Melbourne Hospital, Melbourne, Australia
| | - Nicholas Potter
- Department of Surgery, Melbourne University, Royal Melbourne Hospital, Melbourne, Australia
| | - Sally Fisher
- Department of Surgery, Melbourne University, Royal Melbourne Hospital, Melbourne, Australia
| | - Lauren Chapman
- Gardenview House, Melbourne Health, Parkville, Victoria, Australia,
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25
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Abstract
Hyperhidrosis is a common and under-recognized disease in the pediatric population that has a significant impact on quality of life. Focal and generalized forms of hyperhidrosis exist, which can be idiopathic or secondary to underlying medical conditions or medications. Treatment is tailored to the specific patient needs, characteristics and goals. These include topical preparations, iontophoresis, botulinum toxin and anticholinergic medications.
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Affiliation(s)
- Jennifer R S Gordon
- Department of Dermatology, University of Texas Southwestern Austin, Austin, Texas
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Terzis JK, Anesti K. Novel use of platysma for oral sphincter substitution or countering excessive pull of a free muscle. J Plast Reconstr Aesthet Surg 2013; 66:1045-57. [DOI: 10.1016/j.bjps.2013.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 03/25/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
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Pulido-Rios MT, McNamara A, Obedencio GP, Ji Y, Jaw-Tsai S, Martin WJ, Hegde SS. In Vivo Pharmacological Characterization of TD-4208, a Novel Lung-Selective Inhaled Muscarinic Antagonist with Sustained Bronchoprotective Effect in Experimental Animal Models. J Pharmacol Exp Ther 2013; 346:241-50. [DOI: 10.1124/jpet.113.203554] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Use of botulinum neurotoxin A in uncontrolled salivation in children with cerebral palsy: a pilot study. Int J Oral Maxillofac Surg 2012; 41:1540-5. [DOI: 10.1016/j.ijom.2012.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 07/23/2012] [Accepted: 09/18/2012] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Drooling is a common problem for children with cerebral palsy (CP). This can be distressing for these children as well as for their parents and caregivers. The consequences of drooling include risk of social rejection, damp and soiled clothing, unpleasant odour, irritated chapped skin, mouth infections, dehydration, interference with speech, damage to books, communication aids, computers, and the risk of social isolation (Blasco 1992; Van der Burg 2006). A range of interventions exist that aim to reduce or eliminate drooling. There is a lack of consensus regarding which interventions are most effective for children with CP. OBJECTIVES (1) To evaluate the effectiveness and safety of interventions aimed at reducing or eliminating drooling in children with cerebral palsy. (2) To provide the best available evidence to inform clinical practice. (3) To assist with future research planning. SEARCH METHODS We searched the following databases from inception to December 2010 : Cochrane Central Register of Controlled Trials (CENTRAL); Medline via Ovid; EMBASE; CINAHL; ERIC; Psych INFO; Web of Science; Web of Knowledge; AMED; SCOPUS; Dissertation Abstracts.We searched for ongoing clinical trials in the Clinical Trials web site (http://clinicaltrials.gov.) and in the Current Controlled Trials web site (http://www.controlled-trials.com/). We hand searched a range of relevant journals and conference proceeding abstracts. SELECTION CRITERIA Only randomised controlled trials (RCTs) and controlled clinical trials (CCTs) were included. DATA COLLECTION AND ANALYSIS Data were extracted independently by MW, MS and LP and differences resolved through discussion. MAIN RESULTS Six studies were eligible for inclusion in the review. Four of these studies were trials using botulinum toxin-A (BoNT-A) and two were trials on the pharmacological interventions, benztropine and glycopyrrolate. No RCTs or CCTs were retrieved on surgery, physical, oro-motor and oro-sensory therapies, behavioural interventions, intra-oral appliances or acupuncture. In the studies eligible for review, there was considerable heterogeneity within and across interventions and a meta-analysis was not possible. A descriptive summary of each study is provided. All studies showed some statistically significant change for treatment groups up to 1 month post intervention. However, there were methodological flaws associated with all six studies. AUTHORS' CONCLUSIONS It was not possible to reach a conclusion on the effectiveness and safety of either BoNT-A or the pharmaceutical interventions, benztropine and glycopyrrolate. There is insufficient evidence to inform clinical practice on interventions for drooling in children with CP. Directions for future research are provided.
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Affiliation(s)
- Margaret Walshe
- Clinical Speech and Language Studies,Trinity College Dublin, Dublin 2, Ireland.
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Parr JR, Buswell CA, Banerjee K, Fairhurst C, Williams J, O'Hare A, Pennington L. Management of drooling in children: a survey of UK paediatricians' clinical practice. Child Care Health Dev 2012; 38:287-91. [PMID: 21392056 DOI: 10.1111/j.1365-2214.2011.01213.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Drooling is common in children with disordered oral-motor control. There is little evidence about the comparative effectiveness of different interventions used to reduce the impact of drooling. Anecdotal reports suggest clinicians' management of drooling varies widely. The aims of this survey were to establish which drooling interventions are currently used, how their effectiveness is monitored and how frequently adverse effects are reported. METHODS 151 UK paediatricians completed a questionnaire about their management of drooling. RESULTS Paediatricians saw one new child with problematic drooling and three follow-up children per month. The most common prescribing pattern was hyoscine first line (84.7%) followed by glycopyrronium bromide second line. The reported rate of adverse effects of medications was lower than expected (median 10% for hyoscine). Very few paediatricians used standardized methods of measuring the medication's effectiveness or adverse effects. CONCLUSION Paediatricians regularly see small numbers of children with problematic drooling. Their clinical management of drooling varies; this is most likely because of a lack of evidence about the most effective approach. Comparative trials of interventions and the development of evidence-based clinical guidelines would improve the management of children's drooling.
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Affiliation(s)
- J R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
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Abstract
BACKGROUND Drooling is a common problem for children with cerebral palsy (CP). This can be distressing for these children as well as for their parents and caregivers. The consequences of drooling include risk of social rejection, damp and soiled clothing, unpleasant odour, irritated chapped skin, mouth infections, dehydration, interference with speech, damage to books, communication aids, computers, and the risk of social isolation (Blasco 1992; Van der Burg 2006). A range of interventions exist that aim to reduce or eliminate drooling. There is a lack of consensus regarding which interventions are most effective for children with CP. OBJECTIVES (1) To evaluate the effectiveness and safety of interventions aimed at reducing or eliminating drooling in children with cerebral palsy. (2) To provide the best available evidence to inform clinical practice. (3) To assist with future research planning. SEARCH METHODS We searched the following databases from inception to December 2010 : Cochrane Central Register of Controlled Trials (CENTRAL); Medline via Ovid; EMBASE; CINAHL; ERIC; Psych INFO; Web of Science; Web of Knowledge; AMED; SCOPUS; Dissertation Abstracts.We searched for ongoing clinical trials in the Clinical Trials web site (http://clinicaltrials.gov.) and in the Current Controlled Trials web site (http://www.controlled-trials.com/). We hand searched a range of relevant journals and conference proceeding abstracts. SELECTION CRITERIA Only randomised controlled trials (RCTs) and controlled clinical trials (CCTs) were included. DATA COLLECTION AND ANALYSIS Data were extracted independently by MW, MS and LP and differences resolved through discussion. MAIN RESULTS Six studies were eligible for inclusion in the review. Four of these studies were trials using botulinum toxin-A (BoNT-A) and two were trials on the pharmacological interventions, benztropine and glycopyrrolate. No RCTs or CCTs were retrieved on surgery, physical, oro-motor and oro-sensory therapies, behavioural interventions, intra-oral appliances or acupuncture. In the studies eligible for review, there was considerable heterogeneity within and across interventions and a meta-analysis was not possible. A descriptive summary of each study is provided. All studies showed some statistically significant change for treatment groups up to 1 month post intervention. However, there were methodological flaws associated with all six studies. AUTHORS' CONCLUSIONS It was not possible to reach a conclusion on the effectiveness and safety of either BoNT-A or the pharmaceutical interventions, benztropine and glycopyrrolate. There is insufficient evidence to inform clinical practice on interventions for drooling in children with CP. Directions for future research are provided.
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Affiliation(s)
- Margaret Walshe
- Clinical Speech and Language Studies,TrinityCollegeDublin,Dublin 2, Ireland.
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Zeller RS, Lee HM, Cavanaugh PF, Davidson J. Randomized Phase III evaluation of the efficacy and safety of a novel glycopyrrolate oral solution for the management of chronic severe drooling in children with cerebral palsy or other neurologic conditions. Ther Clin Risk Manag 2012; 8:15-23. [PMID: 22298950 PMCID: PMC3269347 DOI: 10.2147/tcrm.s26893] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the efficacy of glycopyrrolate oral solution (1 mg/5 mL) in managing problem drooling associated with cerebral palsy and other neurologic conditions. METHOD Thirty-eight patients aged 3-23 years weighing at least 27 lb (12.2 kg) with severe drooling (clothing damp 5-7 days/week) were randomized to glycopyrrolate (n = 20), 0.02-0.1 mg/kg three times a day, or matching placebo (n = 18). Primary efficacy endpoint was responder rate, defined as percentage showing ≥3-point change on the modified Teacher's Drooling Scale (mTDS). RESULTS Responder rate was significantly higher for the glycopyrrolate (14/19; 73.7%) than for the placebo (3/17; 17.6%) group (P = 0.0011), with improvements starting 2 weeks after treatment initiation. Mean improvements in mTDS at week 8 were significantly greater in the glycopyrrolate than in the placebo group (3.94 ± 1.95 vs 0.71 ± 2.14 points; P < 0.0001). In addition, 84% of physicians and 100% of parents/caregivers regarded glycopyrrolate as worthwhile compared with 41% and 56%, respectively, for placebo (P ≤ 0.014). Most frequently reported treatment-emergent adverse events (glycopyrrolate vs placebo) were dry mouth, constipation, and vomiting. INTERPRETATION Children aged 3-16 years with problem drooling due to neurologic conditions showed a significantly better response, as assessed by mTDS, to glycopyrrolate than to placebo. CLINICALTRIALS.GOV IDENTIFIER: NCT00425087.
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Affiliation(s)
- Robert S Zeller
- Blue Bird Circle Clinic for Pediatric Neurology at Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
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Lee ZI, Cho DH, Choi WD, Park DH, Byun SD. Effect of botulinum toxin type a on morphology of salivary glands in patients with cerebral palsy. Ann Rehabil Med 2011; 35:636-40. [PMID: 22506185 PMCID: PMC3309260 DOI: 10.5535/arm.2011.35.5.636] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 07/12/2011] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate the effect of botulinum toxin type A (BTXA) on drooling and the morphologic change of the salivary gland in patients with cerebral palsy. Method Eight cerebral palsy patients suffering from severe drooling participated in this study. BTXA was injected into both submandibular and parotid glands under intravenous sedation and with ultrasound guidance (1 unit/gland/kg: maximum 100 units) in an outpatient or inpatient procedure. The severity of drooling was measured before injection and 3 weeks after injection using the Teacher Drooling Scale, the Drooling Score-severity, frequency and the Visual Analog Scale. To investigate the morphologic change of the salivary glands, the size of salivary glands were measured before injection and 3 weeks after injection using computed tomography of the neck. The measurement values were analyzed by Wilcoxon signed rank test. Results Statistically significant improvements were shown in all three parameters for assessing the severity of drooling after BTXA injections (p<0.05). Size of the salivary glands were significantly decreased at 3 weeks after BTXA injection (p<0.05). Conclusion Salivary gland injection with BTXA could be a useful treatment method to reduce drooling in patients with cerebral palsy and decreased size of salivary glands may partially explain the mechanism.
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Affiliation(s)
- Zee-Ihn Lee
- Department of Rehabilitation Medicine, Dae-gu Fatima Hospital, Deagu 701-600, Korea
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Lloret SP, Nano G, Carrosella A, Gamzu E, Merello M. A double-blind, placebo-controlled, randomized, crossover pilot study of the safety and efficacy of multiple doses of intra-oral tropicamide films for the short-term relief of sialorrhea symptoms in Parkinson's disease patients. J Neurol Sci 2011; 310:248-50. [PMID: 21636098 DOI: 10.1016/j.jns.2011.05.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 04/15/2011] [Accepted: 05/17/2011] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This proof-of-concept, pilot study aimed to explore the safety and anti-sialorrhea efficacy of single doses of intra-oral slow dissolving thin films containing tropicamide (NH004) or placebo. METHODS Nineteen non-demented, idiopathic stable or fluctuating PD patients who complained of sialorrhea received 3 doses (0.3, 1, 3mg) of tropicamide and placebo in random order, separated by 7 days. A 10-cm visual analog scale (VAS) was used to measure the patient's subjective feelings of saliva levels at baseline and at 15, 30, 45, 90 and 120 min after treatment administration. For the last 7 patients, saliva volume was measured at baseline and 75 min after treatment. Fluctuating patients were evaluated in the ON-condition. RESULTS The mean age of included patients was 67±12 years, 78% were male. Median disease duration was 8 years. The mean decrease in VAS score from baseline to 120 min were -0.55±0.54, -1.08±0.54, -1.53±0.52 and -0.81±0.51 for placebo and 0.3, 1 and 3mg tropicamide, respectively (F=0.6 p=0.6, ANOVA). Tropicamide 1mg resulted in a significant VAS score decrease (95%CI: -2.57 to -0.48). Saliva volume was reduced by 27%, 33% or 20% after tropicamide 0.3, 1 or 3mg vs 5% with placebo (p=0.5, Friedman). No adverse events were detected in any of the treatment sequences. DISCUSSION Results of this pilot, proof-of-concept study show that NH004 was safe and exerted antisialorrhea effects worthy of further exploration.
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Affiliation(s)
- Santiago Perez Lloret
- Movement Disorders Section, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina.
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Carranza-del Rio J, Clegg NJ, Moore A, Delgado MR. Use of trihexyphenidyl in children with cerebral palsy. Pediatr Neurol 2011; 44:202-6. [PMID: 21310336 DOI: 10.1016/j.pediatrneurol.2010.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 04/13/2010] [Accepted: 09/30/2010] [Indexed: 11/16/2022]
Abstract
A paucity of information exists regarding medications to treat dystonia in children with cerebral palsy. This study sought to review the benefits and tolerability of trihexyphenidyl in children with cerebral palsy, treated for dystonia or sialorrhea or both in a pediatric tertiary care hospital, through a retrospective chart review. In total, 101 patients (61 boys and 40 girls) were evaluated. The mean age at drug initiation was 7 years and 10 months (range, 1-18 years). The mean initial dose was 0.095 mg/kg/day. The dose was increased by 10-20% no sooner than every 2 weeks. The mean maximum dose reached was 0.55 mg/kg/day. Ninety-three patients (91%) tolerated the medication well, with a mean duration of treatment of 3 years and 7 months. Side effects occurred in 69% of subjects, the majority in patients aged ≥7 years, and soon after treatment initiation. Sixty-four percent continued the treatment at study end. Ninety-seven patients reported benefits, including reduction of dystonia in upper (59.4%) and lower (37.6%) extremities, sialorrhea (60.4%), and speech issues (24.7%). The majority of patients tolerated trihexyphenidyl well on a schedule of gradual dose increases, and almost all demonstrated improvements in dystonia or sialorrhea or both.
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Affiliation(s)
- Jorge Carranza-del Rio
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Abstract
Drooling is a common and potentially distressing symptom in those with motor neurone disease. A coordinated multidisciplinary approach is required to optimally manage this symptom. Both pharmacological and non-pharmacological strategies are required, and when drugs are used, off-label prescribing in terms of indication or route of administration is common. Further research needs to explore ways of enhancing swallowing ability as well as ways of optimizing drug therapies.
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Affiliation(s)
- Pauline Dand
- Pilgrims Hospices, East Kent, Canterbury, Kent, United Kingdom
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Mato A, Limeres J, Tomás I, Muñoz M, Abuín C, Feijoo JF, Diz P. Management of drooling in disabled patients with scopolamine patches. Br J Clin Pharmacol 2010; 69:684-8. [PMID: 20565460 DOI: 10.1111/j.1365-2125.2010.03659.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIM To evaluate the efficacy of scopolamine administered transdermally for the treatment of drooling in severely disabled patients. METHODS A prospective, randomized, double-blind, crossover, placebo-controlled clinical trial was designed. The study group consisted of 30 handicapped patients with persistent drooling. The exclusion criteria were the specific contra-indications of scopolamine. Severity of drooling was quantified using a modified Thomas-Stonell and Greenberg visual scale simplified into three grades: 1 = dry; 2 = mild/moderate; 3 = severe/fulsome. The frequency of drooling was estimated using the number of bibs used each day. The baseline observational phase was followed by the application of a 1.5 mg scopolamine (Scopoderm TTS; Novartis Consumer Healthcare, UK) or placebo patch every 72 h for a fortnight. This was followed by a 1 week washout period and then crossover of assignments for 2 weeks. RESULTS At baseline, 77% of patients showed grade 3 of drooling. The placebo administration showed no significant reduction in drooling. We found a significant drooling reduction (P < 0.005) in the scopolamine group in the 1 and 2 week controls (69% and 80% respectively <or= grade 3). The mean number of bibs/day decreased during the scopolamine phase from 6/day at baseline to 3/day at the 2 week control. Four patients (13.3%) dropped out because of scopolamine side effects and minor adverse reactions were observed in three other patients. No blood alterations were found during the study period. CONCLUSION Scopolamine can be useful to control drooling in severely disabled patients although it requires appropriate patient selection and is not free from adverse effects.
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Affiliation(s)
- Abigail Mato
- Special Needs Department, School of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, Spain
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40
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Cada DJ, Levien TL, Baker DE. Glycopyrrolate Oral Solution. Hosp Pharm 2010. [DOI: 10.1310/hpj4512-939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are sent in print and are also available on-line. Monographs can be customized to meet the needs of a facility. Subscribers to The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The December 2010 monograph topics are on fingolimod, ezogabine, telaprevir, clonidine extended release, and risedronate delayed release. The DUE/MUE is on fingolimod.
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Affiliation(s)
| | | | - Danial E. Baker
- College of Pharmacy, Washington State University Spokane, PO Box 1495, Spokane, Washington 99210-1495
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Rapoport A. Sublingual atropine drops for the treatment of pediatric sialorrhea. J Pain Symptom Manage 2010; 40:783-8. [PMID: 20541902 DOI: 10.1016/j.jpainsymman.2010.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 02/19/2010] [Accepted: 02/22/2010] [Indexed: 10/19/2022]
Abstract
Excess oral secretions or sialorrhea is a common problem affecting children and adults with neurological disorders, as well as those approaching the end of life because of a variety of underlying illnesses. Systemic anticholinergic medications are often prescribed in an attempt to improve quality of life and reduce complications; yet, response rates are variable, and a sizable proportion of patients discontinue these drugs as a result of intolerable side effects. This report describes the successful use of a local treatment, sublingually delivered ophthalmic atropine drops, to reduce sialorrhea in a child receiving palliative care. In addition, medical evidence for the safety and efficacy of traditionally prescribed systemic medications for the treatment of pediatric sialorrhea is reviewed.
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Affiliation(s)
- Adam Rapoport
- Max and Beatrice Wolfe Children's Centre, Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, and Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
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Walshe M, Smith M, Pennington L. Interventions for drooling in children with cerebral palsy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Pichierri S, Oliva D. Upgraded technology for contingent stimulation of mouth wiping by two persons with drooling and profound developmental disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2009; 30:793-798. [PMID: 19117722 DOI: 10.1016/j.ridd.2008.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Accepted: 11/18/2008] [Indexed: 05/27/2023]
Abstract
Many persons with developmental and physical disabilities experience drooling (i.e., loss of saliva from the mouth). Technology was recently developed to help two of these persons reduce the negative effects of drooling by increasing mouth-wiping responses. This study upgraded our initial approach and tested it with the two persons who we previously treated. Upgrading ensured that all technology components, including the stimulation sources, were on the participant's body and that stimulation for mouth wiping caused no (or limited) environmental disturbance. We also conducted a social validation assessment of the new technology and its effects, employing university students as social raters. Evidence showed that the participants used the upgraded technology successfully in settings attended by varieties of other persons. The university students involved in the social validation viewed the use of the technology as enjoyable, beneficial, and environmentally acceptable, and they largely supported it.
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Affiliation(s)
- Giulio E Lancioni
- Department of Psychology, University of Bari, Via Quintino Sella 268, 70100 Bari, Italy.
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Bomeli SR, Desai SC, Johnson JT, Walvekar RR. Management of salivary flow in head and neck cancer patients – A systematic review. Oral Oncol 2008; 44:1000-8. [DOI: 10.1016/j.oraloncology.2008.02.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Revised: 02/14/2008] [Accepted: 02/15/2008] [Indexed: 11/29/2022]
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Abstract
Hyperhidrosis is a disorder of excessive sweating beyond what is physiologically necessary for thermoregulation. Primary hyperhidrosis is localized; it can affect the axillae, palms, soles, face, and other areas and is idiopathic. The prevalence of hyperhidrosis in the United States is estimated to be 2.8% of the population, with about one-half (1.4%) of these individuals having the axillary form. Hyperhidrosis occurs in both children and adults, with the average age of onset of primary hyperhidrosis being 14-25 years. This disorder can be detrimental to a patient's social, professional, psychological, and physical well-being. Early detection and management can significantly improve a patient's quality of life, yet hyperhidrosis remains widely under diagnosed and under treated, particularly among pediatric patients. The purpose of this article is to review the treatment of pediatric hyperhidrosis, and to increase awareness and inspire further research on this important and often overlooked medical problem.
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Affiliation(s)
- Christina M Gelbard
- Department of Dermatology, University of Texas-Houston, Houston, Texas 77004, USA.
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48
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Neurorehabilitation of children with cerebral palsy. HANDBOOK OF CLINICAL NEUROLOGY 2008. [PMID: 18809046 DOI: 10.1016/s0072-9752(07)87032-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Postma AG, Heesters M, van Laar T. Radiotherapy to the salivary glands as treatment of sialorrhea in patients with parkinsonism. Mov Disord 2008; 22:2430-5. [PMID: 17960826 DOI: 10.1002/mds.21752] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This study investigated retrospectively the long-term efficacy and safety of radiotherapy (RT) to the major salivary glands as treatment of sialorrhea in patients with parkinsonism. Twenty-eight patients received a bilateral dose of 12 Gy to the parotid and part of the submandibular glands between 2001 and 2006. Severity of sialorrhea and adverse events were assessed at 1 and 6 months post-RT and finally in the first quarter of 2007. Item 6 of the activities of daily living-section of the Unified Parkinson's Disease Rating Scale was used as primary endpoint. Quality of life (QoL) pre- and post-RT was investigated using a shortened Parkinson's Disease Questionnaire-8. Sialorrhea had improved significantly at 1 month post-RT and this effect was maintained for at least 1 year. Most frequent adverse events were loss of taste and a dry mouth; however, 75% of these adverse events were transient. QoL had improved significantly on the long term. The clinical global impression scores at the final follow-up showed that 80% of patients were satisfied. It was concluded that RT is an effective and safe treatment of sialorrhea on the long term in patients with parkinsonism.
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Affiliation(s)
- Anna-Gerlind Postma
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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50
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Bilateral submandibular duct relocation by high-frequency radiosurgery. Eur Arch Otorhinolaryngol 2008; 265:1103-8. [DOI: 10.1007/s00405-008-0604-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2007] [Accepted: 01/24/2008] [Indexed: 12/01/2022]
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