Treatment of drooling with sublingual atropine sulfate in children and adolescents with cerebral palsy

Abstract

Atropine sulfate blocks the muscarinic receptors in the salivary glands and leads to reduced saliva production. There are no published studies about its use in children with cerebral palsy. Objective To report the effect of sublingual atropine sulfate to treat drooling in children with cerebral palsy by comparing the results of the Drooling Impact Scale in a non-controlled open clinical trial. Results Twenty-five children were assessed. The difference in the mean scores of the pre- and post-treatment scales reached statistical significance. There was a low frequency of side effects compared to studies with other anticholinergics. Conclusion The use of sublingual atropine sulfate seems to be safe and there is a reduction in the Drooling Impact Scale score, which suggests efficacy in the treatment of drooling in children and adolescents with cerebral palsy. Our results should be replicated in randomized, placebo-controlled studies with larger numbers of participants.

A systematic review of noninvasive and invasive sialorrhoea management

“…A variety of anticholinergic drugs are used to manage sialorrhoea, such as hyoscine, scopolamine, glycopyrrolate/glycopyrronium, tropicamide, atropine sulphate and ipratropium bromide (Mato et al, ; Parr et al, ; Arbouw et al, ; Odachi et al, ; Lloret, Nano, Carrosella, Gamzu, & Merello, ; Zeller, Lee, Cavanaugh, & Davidson, ; Dias et al, ; Thomsen et al, ). All the studies which were reviewed confirmed the effectiveness of systemic anticholinergic drugs (Arbouw et al, ; Lloret et al, ; Mato et al, ; Odachi et al, ; Parr et al, ; Zeller et al, ).…”

“…All the studies which were reviewed confirmed the effectiveness of systemic anticholinergic drugs (Arbouw et al, ; Lloret et al, ; Mato et al, ; Odachi et al, ; Parr et al, ; Zeller et al, ). However, side effects of these drugs have been broadly reported; approximately 10%–50% of patients suffer from side effects after treatment with anticholinergic drugs (Dias et al, ; Mato et al, ; Parr et al, ; Zeller et al, ). These side effects include dry mouth, skin reaction to patches, hyperactivity or change of behaviour, sleep disturbance, constipation and urinary retention (Dias et al, ; Mato et al, ; Odachi et al, ; Parr et al, ; Zeller et al, ).…”

“…All the studies which were reviewed confirmed the effectiveness of systemic anticholinergic drugs (Arbouw et al, 2010;Lloret et al, 2011;Mato et al, 2008;Odachi et al, 2017;Parr et al, 2018;Zeller et al, 2012). However, side effects of these drugs have been broadly reported; approximately 10%-50% of patients suffer from side effects after treatment with anticholinergic drugs (Dias et al, 2017;Mato et al, 2010;Parr et al, 2018;Zeller et al, 2012 2010; Odachi et al, 2017;Parr et al, 2018;Zeller et al, 2012).…”

“…Posterior drooling happens when saliva falls posteriorly at the top of the tongue and pools in the hypopharynx, thereby increasing the risk of aspiration (Jongerius et al, 2004;Lawrence & Bateman, 2018). Anterior drooling can lead to peri-oral skin irritation and infection, clothes and furniture soiling and impaired speech capacity, which can lead to social embarrassment and shunning by others (Dias, Fernandes, & Maia Filho, 2017). There is also a physical dimension to drooling.…”

Treatment of drooling with scopolamine in pediatric ICU: A case series report

“…The dosage is two to four drops (in 1% solution), sublingual, two times a day. It is contraindicated in patients with cognitive impairment, dementia and hallucinations …”