Children with cerebral palsy are a diverse group and those with a severe motor deficit have a reduced life expectancy. Lung disease remains an important cause of morbidity and mortality for this group. Further information about the causes of death is needed, particularly for those children that die at home.
In this study sample of children with CP, MRI was useful in revealing underlying brain abnormalities, most of which were due to events in the third trimester or the perinatal period.
Conductive education may benefit the motor development of children with cerebral palsy and provide greater parental support. A randomized control study with adequate subject numbers is necessary to confirm this tentative conclusion.
Drooling is a major problem for children and adults with cerebral palsy and other neurological conditions. Medication is a major treatment option for these individuals. The focus of this review is to review glycopyrrolate, one of the frequently used medications for poor saliva control. Glycopyrrolate is a quaternary ammonium compound structurally related to atropine. The pharmacology, mode of action and pharmocokinetics are discussed, efficacy studies are reviewed, and safety and tolerability are described. Mention is made of the limited amount of information that is available on patient satisfaction and quality of life. Glycopyrrolate has an important place in the treatment of chronic drooling and possible uses for this medication are described. Further research would be helpful comparing glycopyrrolate with other anticholinergic medication and alternative treatments for drooling including botulinum toxins and surgical procedures. Keywords: dribbling, poor saliva control, cerebral palsy, Parkinson Disease Management issues for chronic severe droolingDrooling, sometimes known as dribbling or poor saliva control, is a distressing problem. Drooling may be odorous; the secretions can cause chronic irritation of the facial skin; dehydration can occur if severe; and excessive drooling may damage clothing, books, and computer equipment. The care required for the individual increases the demands on family members.1 Poor saliva control may result in loss of self esteem. It is a major factor in impeding the successful integration of children and young adults into school, the community, and later the workplace. For adults with neurological conditions such as Parkinson Disease, the impact can be distressing, and individuals that drool have more difficulties with eating, speaking, and with social interactions than individuals with the same condition that do not drool. 2Many factors influence salivary flow including emotional state, environmental temperature, state of hydration, and the presence of food in the mouth. Quantification of salivary flow rate or drooling is challenging. Therefore, few studies documenting prevalence of the condition are available. Drooling has been reported as occurring in between 10% and 78% of children with cerebral palsy, and in 38% of a recent population-based cohort of 385 children from the Victorian Cerebral Palsy Register (manuscript in preparation). It also occurs in many individuals with intellectual disability and in other more unusual neurological and head and neck conditions. 3 For those attending special education settings, the number may be higher and was reported to be present in 58% of children with cerebral palsy. 4 Poor saliva control also occurs in acquired neurological conditions including Parkinson Disease, where it is estimated
SUMMARY Thirty‐nine patients who had undergone transposition of the submandibular ducts and unilateral ligation of a parotid duct for saliva control were followed up six years after surgery. Overall improvement was documented according to a drooling quotient, drooling severity and drooling frequency measures. Despite this superficially favourable outcome, a significant proportion of patients (39 per cent) or their caregivers had not found the surgery helpful. Complications included ranula formation, complaints of dry mouth, difficulty with swallowing, and changes in the consistency of oral secretions. More knowledge is needed of the likely outcomes of this procedure in individual patients, so that appropriate advice can be given and complications minimised. RÉSUMÉ Devenir à long terme du contrôle chirurgical du bavage Trente‐neuf patients ayant béneftcié d'une transposition des canaux sous‐maxillaires et d'une ligature unilatéral du canal de Sténon pour un contrôle de la salivation, furent suivis jusqu'à six ans aprés la chirurgie. Un bénéfice global fut notéà partir du quotient de bavagé, et des mesures de gravite et de fréquence du bavage. En dépit de cette évolution globalement favourable, une proportion significative de patients (39 pour cent) ou des personnes les prenant en charge, n'estimaient pas que la chirugie avail été bénéfique. ZUSAMMENFASSUNG Langzeitergebnisse nach chirurgischer Intervention zur Speichelfluflkontrolle 39 Patienten, bei denen eine Transposition de Submandibularisgänge und eine einseitige Ligatur eines Parotisganges zur Speichelflußkontrolle durchgeführt worden waren, wurden bis zu sechs Jahre postoperativ nachuntersucht. Die allgemcine Besserung wurde anhand eines Speichelflußquoticntcn, des Schweregrades und der Häufigkeit des Specichelflusses dokumentiert. Trotz des scheinbar günstigen Outcomes empfanden cine signifikante Anzahl von Patienten (39 Prozent) odern ihre Betreuer den ehirurgischen Eingriff als nicht erfolgreich. Zu den Komplikationen zählten: Ranulabildung, Beschwerden durch trockenen Mund, Schwierigkeiten beim Schlucken und Veränderungen der Speichelkonsistenz. Hs sind weitere Erfahrungen über mögliche Ergebnisse dieser Methode erforderlich, um genauc Beratungen durchführen und die Komplikationen auf ein Minimum beschränken zu könnon. RESUMEN Curso a largo plazo de la cirugia para el control de la saliva Treinta y nueve pacientes a los que se habia practicado la tranpposición de los conductos submaxilares y la ligadura unilateral del conducto parotídeo para el control de la saliva fueron seguidos hasta seis años después de la intervención. La mejoria en conjunto se documentó de acuerdo con el cociente de babeo, la gravedad de éste y la medición de su frecuencia. A pesar de este resultado superficialmente favorable una proporción significativa de pacientes (39 por ciento) o sus cuidadores no encontraron que la cirugia fuese útil. Las complicaciones consistieron en formación de ránula, boca seca, dificultad de deglueión y cambios en la consistencia de las secreciones buc...
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