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Locatello LG, Licci G, Maggiore G, Gallo O. Non-Surgical Strategies for Assisting Closure of Pharyngocutaneous Fistula after Total Laryngectomy: A Systematic Review of the Literature. J Clin Med 2021; 11:jcm11010100. [PMID: 35011841 PMCID: PMC8745591 DOI: 10.3390/jcm11010100] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Pharyngocutaneous fistula (PCF) is a frequent complication after total laryngectomy, with an incidence of up to 65%. Many conservative or invasive approaches are available and the choice among them is usually made on a case-by-case basis. The aim of the present review is to critically summarize the available evidence of the effectiveness of the non-surgical management of PCF. Methods: A systematic review and a meta-analysis of the literature were conducted, according to the PRISMA guidelines. Studies investigating botulinum toxin therapy, scopolamine transdermal patch, hyperbaric oxygen therapy (HBOT), and negative pressure wound therapy (NPWT) were assessed. Complete fistula closure after the initiation of non-surgical treatment was the main outcome. Results: After the application of selection criteria, a total of seven articles and 27 patients were included in the present review. All the eligible studies were descriptive case series, while only one article used a standard group as a comparison. The mean age was 63.3 and 14 patients (51.9%) had previously received RT. The reported comorbidities were diabetes, ischemic heart disease, hypertension, dyslipidemia, COPD, and atrial fibrillation. With a mean healing time of 25.0 days, the overall success rate was 92.6%. Conclusions: Non-surgical treatment of PCF is only based on the experience of small series. Although success rates seem promising, the absence of properly designed comparative studies does not allow us, at present, to identify ideal candidates for these non-invasive management strategies for PCF.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy; (G.L.); (G.M.); (O.G.)
- Correspondence: ; Tel.: +39-055-7947989
| | - Giuseppe Licci
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy; (G.L.); (G.M.); (O.G.)
| | - Giandomenico Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy; (G.L.); (G.M.); (O.G.)
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134 Florence, Italy; (G.L.); (G.M.); (O.G.)
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
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Galili E, Averbuch Zehavi E, Zadik Y, Caspi T, Meltzer L, Merdler I, Kuten J, Tal D. Long-term scopolamine treatment and dental caries. Clin Oral Investig 2019; 23:2339-2344. [DOI: 10.1007/s00784-018-2688-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 10/01/2018] [Indexed: 11/28/2022]
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3
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Morise BT, Chagas ALD, Barros NR, Miranda MCR, Borges FA, Gemeinder JLP, Silva RG, Paulino CG, Herculano RD, Norberto AMQ. Scopolamine loaded in natural rubber latex as a future transdermal patch for sialorrhea treatment. INT J POLYM MATER PO 2018. [DOI: 10.1080/00914037.2018.1506984] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- B. T. Morise
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - A. L. D. Chagas
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
- Institute of Chemistry, São Paulo State University (UNESP), Araraquara, Brazil
| | - N. R. Barros
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
- Institute of Chemistry, São Paulo State University (UNESP), Araraquara, Brazil
| | - M. C. R. Miranda
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - F. A. Borges
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
- Institute of Chemistry, São Paulo State University (UNESP), Araraquara, Brazil
| | - J. L. P. Gemeinder
- Institute of Chemistry, São Paulo State University (UNESP), Araraquara, Brazil
| | - R. G. Silva
- Institute of Chemistry, São Paulo State University (UNESP), Araraquara, Brazil
| | - C. G. Paulino
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - R. D. Herculano
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - A. M. Q. Norberto
- Faculty of Medicine, São Paulo University (USP), Ribeirão Preto, Brazil
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Franco JB, Cacita N, Freua KA, Ortega KL, de Melo Peres MPS. Treatment of drooling with scopolamine in pediatric ICU: A case series report. SPECIAL CARE IN DENTISTRY 2018; 38:362-366. [PMID: 30238487 DOI: 10.1111/scd.12326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/03/2018] [Accepted: 07/13/2018] [Indexed: 11/27/2022]
Abstract
Drooling is a condition that affects patients with difficulties in swallowing, being common in patients with mental, neurological or dysphagic deficiency. This condition is difficult to diagnose, as it is often confused with sialorrhea, and in many cases we have a hyposalivation scenario. Its diagnosis is subjective, which is why scales should be used for the standardization of the evaluation of the degree of drooling before and after the proposed treatment, as the Thomas-Stonell and Greenberg scale. It causes problems such as perioral infections, rashes, wet clothing, leading to social embarrassment, and may be a risk factor for respiratory infections caused by asymptomatic aspiration of saliva. It presents several treatments, among them the pharmacological one, that is dependent of the clinical picture of each patient that must be evaluated daily. This article refers to a series of reports of cases of children in mechanical ventilation by tracheostomy, hospitalized, with clinical diagnosis of drooling, and clinical improvement with the use of scopolamine by gastrostomy, without intercurrences during its use. The objective of this study is to show other professionals the importance of drooling management, and to expose the adopted behavior in the described cases, providing reduction of respiratory infections and improvement of the clinical and social complications resulting from drooling.
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Affiliation(s)
- Juliana Bertoldi Franco
- Hospital Auxiliar de Suzano, Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, Brazil.,Division of Dentistry, Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil
| | - Nadia Cacita
- Division of Dentistry, Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil
| | - Karina Albuquerque Freua
- Division of Dentistry, Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil
| | - Karem López Ortega
- Department of Oral Pathology, School of Dentistry, University of São Paulo, São Paulo, Brazil
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5
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Odachi K, Narita Y, Machino Y, Yamada T, Nishimura Y, Ota Y, Tamaru S, Tomimoto H. Efficacy of transdermal scopolamine for sialorrhea in patients with amyotrophic lateral sclerosis. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1365401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Kiyomi Odachi
- Department of Neurology, Matsusaka Central General Hospital, 102, Kawai-Machi-Komou, Matsusaka City, Mie 515-8566, Japan
| | - Yugo Narita
- Department of Nursing, Mie University, Tsu, Japan
| | - Yuka Machino
- Department of Neurology, National Mie Hospital, Tsu, Japan
| | - Tomomi Yamada
- Department of Medical Innovation, Osaka University Hospital, Suita, Japan
| | - Yuki Nishimura
- Clinical Research Support Center, Mie University Hospital, Tsu, Japan
| | - Yasuyuki Ota
- Clinical Research Support Center, Mie University Hospital, Tsu, Japan
| | - Satoshi Tamaru
- Clinical Research Support Center, Mie University Hospital, Tsu, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
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6
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Miller RG, Rosenberg JA, Gelinas DE, Mitsumoto H, Newman D, Sufit RL, Borasio GD, Bradley WG, Bromberg MB, Brooks BR, Kasarskis EJ, Munsat TL, Oppenheimer EA. Practice Parameter: The Care of the Patient with Amyotrophic Lateral Sclerosis (An Evidence-Based Review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurorehabil Neural Repair 2016. [DOI: 10.1177/154596839901300202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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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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8
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Lawson GA, Kreymerman P, Nahai F. An unusual complication following rhytidectomy: iatrogenic parotid injury resulting in parotid fistula/sialocele. Aesthet Surg J 2012; 32:814-21. [PMID: 22942108 DOI: 10.1177/1090820x12455798] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Rhytidectomy is a common surgical procedure performed by today's aesthetic surgeons. Newer trends and techniques leading to deeper and more aggressive dissection have placed the parotid gland at increased risk for injury during this procedure. Despite there being a relative abundance of literature on traumatic parotid injury, there is a relative paucity of information on iatrogenic parotid injury after rhytidectomy. In addition, there is no consensus on management of these complications. In this article, the authors discuss 3 case reports, review the relevant literature, and propose a treatment algorithm. Early diagnosis and appropriate treatment are essential to properly manage this complication.
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Affiliation(s)
- George A Lawson
- Forsyth Plastic Surgery, Winston-Salem, North Carolina 27103, USA.
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9
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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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10
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Hatzis GP, Finn R. Using botox to treat a mohs defect repair complicated by a parotid fistula. J Oral Maxillofac Surg 2007; 65:2357-60. [PMID: 17954340 DOI: 10.1016/j.joms.2006.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 07/28/2006] [Accepted: 10/05/2006] [Indexed: 10/22/2022]
Affiliation(s)
- Gregory P Hatzis
- Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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11
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Meningaud JP, Pitak-Arnnop P, Chikhani L, Bertrand JC. Drooling of saliva: A review of the etiology and management options. ACTA ACUST UNITED AC 2006; 101:48-57. [PMID: 16360607 DOI: 10.1016/j.tripleo.2005.08.018] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Revised: 07/20/2005] [Accepted: 08/17/2005] [Indexed: 10/25/2022]
Abstract
Drooling of saliva appears to be the consequence of a dysfunction in the coordination of the swallowing mechanism, resulting in excess pooling of saliva in the anterior portion of the oral cavity and the unintentional loss of saliva from the mouth. Drooling can produce significant negative effects on physical health and quality of life, especially in patients with chronic neurological disabilities. Various approaches to manage this condition have been described in the literature, including oral motor therapy, behavior modification via biofeedback, orofacial regulation therapy, drug therapy, radiotherapy, and surgical treatments. Minimally invasive modalities, such as injection of botulinum toxin, photocoagulation, and acupuncture, have also been reported. This article provides a comprehensive and thorough overview of drooling, with an emphasis on understanding its etiologies and modalities of treatment.
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Affiliation(s)
- Jean-Paul Meningaud
- Department of Maxillofacial Surgery, Teaching Pitié-Salpêtrière Hospital, Paris, France.
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12
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Neverlien PO, Sorumshagen L, Eriksen T, Grinna T, Kvalshaugen H, Lind AB. Glycopyrrolate treatment of drooling in an adult male patient with cerebral palsy. Clin Exp Pharmacol Physiol 2000; 27:320-2. [PMID: 10779132 DOI: 10.1046/j.1440-1681.2000.03099.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. The aim of the study was to assess the effect of glycopyrrolate on drooling in an adult male patient with cerebral palsy. 2. After a thorough medical examination and consent in writing by the responsible guardian, a baseline sum score for frequency and seriousness of drooling was established over a 2 week period in addition to data on shifts of handkerchiefs, urination, defecation and observation of behaviour. Glycopyrrolate (1 mg) tablets were then administered, starting with one tablet daily the third week and increasing the daily dose by one tablet per week until a maximum of four tablets during week six and 4 days of week seven when the daily dose was reduced to two tablets for 3 days. For the four weeks 8-11 three tablets were given daily. In week 12 the dose was reduced to two tablets and for the weeks 13-15 no tablets of glycopyrrolate were given. 3. For as long as the patient received three to four tablets of glycopyrrolate daily, drooling was markedly reduced and handkerchiefs were not necessary on some days. After the tablets were withdrawn drooling increased to approximately the same level as it was before treatment. No adverse medical, psychological, or social effects were observed. 4. For shorter periods, glycopyrrolate can be given in controlled doses provided that an adequate medical assessment has been undertaken.
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13
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Marchese Ragona R, Blotta P, Pastore A, Tugnoli V, Eleopra R, De Grandis D. Management of parotid sialocele with botulinum toxin. Laryngoscope 1999; 109:1344-6. [PMID: 10443847 DOI: 10.1097/00005537-199908000-00032] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Miller RG, Rosenberg JA, Gelinas DF, Mitsumoto H, Newman D, Sufit R, Borasio GD, Bradley WG, Bromberg MB, Brooks BR, Kasarskis EJ, Munsat TL, Oppenheimer EA. Practice parameter: The care of the patient with amyotrophic lateral sclerosis (An evidence-based review). Muscle Nerve 1999; 22:1104-18. [PMID: 10417794 DOI: 10.1002/(sici)1097-4598(199908)22:8<1104::aid-mus15>3.0.co;2-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- R G Miller
- American Academy of Neurology, 1080 Montreal Ave., St. Paul, MN 55116
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15
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The Use of Scopolamine in the Treatment of Detrusor Instability. J Urol 1996. [DOI: 10.1097/00005392-199612000-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Abstract
Movement disorders are a well-recognized feature of some patients with cerebral palsy and often require treatment. However, treatments have been symptomatic and empiric, and there have been few pharmacologic studies. The major movement disorders in cerebral palsy are dystonia and the hyperkinesias choreoathetosis and myoclonus. They may occur in combination, often accompanied by spasticity and sometimes by epilepsy. Some drugs are useful treatments for all of these problems, but others may improve one while worsening another. Pitfalls in management include not diagnosing metabolic/degenerative disorders, which may mimic cerebral palsy, or not recognizing reversible complications of cerebral palsy, which may exacerbate symptoms. This review attempts to summarize empiric drug use and recommendations for therapy, drug studies in extrapyramidal cerebral palsy, and prospects for new drugs or models for the problem. Many new pharmacologic agents are available for study in cerebral palsy. Better methods of detecting basal ganglia injury after perinatal injury in asymptomatic infants may allow early intervention in the biologic process of recovery and adaptation.
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Affiliation(s)
- M R Pranzatelli
- Department of Pharmacology, George Washington University, Washington, DC, USA
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18
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Abstract
The pharmacologic armamentarium used to treat dyskinesias in childhood is increasing. Anticonvulsant drugs as a class are still some of the broadest-spectrum antidyskinetic agents, probably because the class includes so many differently acting drugs or because dyskinesias are manifestations of subcortical electrical events. This group is enhanced by recent developments in gamma-aminobutyric acid and glutamate receptor pharmacology, which promise new antidyskinetic drugs. Other drugs acting at receptors for monoamines (dopamine, norepinephrine, and serotonin), acetylcholine, opioids, or histamine may provide symptomatic improvement. Fewer pharmacotherapies address the underlying pathophysiology of movement disorders. Of these, drugs or biologicals for immunomodulation are the most developed, but the group also includes antioxidants, cofactors, metabolic inhibitors, and chelators. There is potential for drugs that block the neurotoxic effects of glutamate to treat movement disorders and reverse or prevent brain injury. Peripheral blockade of focal dyskinesias through botulinum toxin offers a useful alternative to drugs in some patients.
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Affiliation(s)
- M R Pranzatelli
- Department of Pediatrics, Neurology, and Pharmacology, George Washington University, Washington, DC, USA
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Abstract
Transdermal scopolamine patches (1.5 mg) were used to control drooling in a two-year-old boy with severe spastic quadriparetic cerebral palsy and developmental delay. He responded well to the continuous scopolamine therapy, with a decrease in drooling, and a secondary decrease in respiratory distress and frequency of suctioning. No significant side-effects were noted.
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Dworkin JP, Nadal JC. Nonsurgical treatment of drooling in a patient with closed head injury and severe dysarthria. Dysphagia 1991; 6:40-9. [PMID: 1884637 DOI: 10.1007/bf02503462] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The purpose of this investigation was to measure the effectiveness of the antimuscarinic drug atropine sulfate in the treatment of chronic drooling in a patient with a history of severe closed head injury and resultant widespread oral neuromuscular and higher cortical disturbances. Results of the A-B-A-B-A-B withdrawal paradigm, chosen to demonstrate the functional relationship between drug therapy and the degree of drooling, revealed that administration of atropine sulfate reduced by more than 50% of baseline levels the amount of resting secretion, intraoral accumulation, and pharyngeal-laryngeal pooling of saliva, with negligible side effects. These results are discussed and compared to the alternative drug and surgical approaches to treatment that have been the primary focus of recent research on drooling.
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Affiliation(s)
- J P Dworkin
- University of Texas Medical Branch, Galveston
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21
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Reddihough D, Johnson H, Staples M, Hudson I, Exarchos H. Use of benzhexol hydrochloride to control drooling of children with cerebral palsy. Dev Med Child Neurol 1990; 32:985-9. [PMID: 2269408 DOI: 10.1111/j.1469-8749.1990.tb08121.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The use of benzhexol hydrochloride to control drooling was evaluated in a group of 20 children with cerebral palsy. Drooling was measured before treatment and then repeatedly until an optimal dosage of benzhexol hydrochloride was attained. 17 of the 20 children showed an improvement in drooling, and side-effects were minimal. This type of medication appears to be useful in the treatment of drooling.
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Affiliation(s)
- D Reddihough
- Department of Child Development and Rehabilitation, Royal Children's Hospital, Parkville, Victoria, Australia
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Talmi YP, Finkelstein Y, Zohar Y. Reduction of salivary flow with transdermal scopolamine: a four-year experience. Otolaryngol Head Neck Surg 1990; 103:615-8. [PMID: 2123321 DOI: 10.1177/019459989010300415] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Scopoderm transdermal therapeutic system (TTS) is applied to prevent nausea and vomiting associated with motion sickness. Dry mouth is the most common side effect, appearing in up to two thirds of the patients treated. We have used this side effect to the benefit of patients with sialorrhea or with difficulties swallowing normally secreted amounts of saliva. More than 100 patients with tumors of the aerodigestive tract before and after surgery, and patients after parotidectomies, after tracheotomies, with peritonsillar abscesses, tonsillitis and pharyngitis, and neurologic disorders were thus treated. Reduced secretion of saliva was seen in 50% to 100% of the treatment groups. Other side effects were minimal and we recommend the use of scopoderm TTS for reduction of salivary flow.
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Affiliation(s)
- Y P Talmi
- Department of Otolaryngology, Hasharon Hospital, Golda Medical Center, Petah Tikvah, Israel
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23
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Talmi YP, Finkelstein Y, Zohar Y. Reduction of salivary flow in amyotrophic lateral sclerosis with Scopoderm TTS. Head Neck 1989; 11:565. [PMID: 2584013 DOI: 10.1002/hed.2880110617] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Abstract
Sialorrhea is a distressing problem in children with cerebral palsy, in children with other neurologic disorders, and in normal children. The constant need for clothing or bib changes in handicapped patients frequently results in further social isolation and causes normal children to be viewed as "impaired." The surgical treatment of sialorrhea at Children's Hospital Medical Center, Cincinnati, Ohio, has evolved over the past 5 years. Since 1981, 70 surgical procedures have been performed for drooling at this institution; follow-up information is available on 52 patients. The surgical procedures performed included submandibular rerouting alone, submandibular duct rerouting with bilateral tympanic neurectomy with bilateral submandibular gland excision, and bilateral submandibular gland excision with bilateral parotid duct ligation. Our review indicates that bilateral submandibular gland excision with parotid duct ligation is the only procedure in which consistent control of sialorrhea can be expected. Postoperative complications after this procedure were minimal and only one parent complained that the child had a dry mouth after the procedure. Postoperative hospitalization after bilateral submandibular gland excision and bilateral parotid duct ligation was not significantly different from that required after any of the other procedures. In conclusion, this surgical procedure appears to be the most effective surgical treatment for sialorrhea and precludes the need for multiple operative procedures for this problem.
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Affiliation(s)
- S R Shott
- Department of Pediatric Otolaryngology, Children's Hospital Medical Center, Cincinnati, OH 45229-2899
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