CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(05): 282-287
DOI: 10.1590/0004-282X20170033
ARTICLES

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

Tratamento da sialorreia com sulfato de atropina via sublingual em crianças e adolescentes com paralisia cerebral
Bruno L. Scofano Dias
1   Rede SARAH de Hospitais de Reabilitação; Rio de Janeiro RJ, Brasil.
,
Alexandre R. Fernandes
2   Universidade Federal Fluminense; Niterói RJ, Brasil.
,
Heber de S Maia Filho
2   Universidade Federal Fluminense; Niterói RJ, Brasil.
› Institutsangaben

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.

RESUMO

O sulfato de atropina bloqueia os receptores muscarínicos nas glândulas salivares reduzindo a produção de saliva. Não há estudos publicados relativos ao seu uso para tratamento da sialorreia em crianças com paralisia cerebral.

Objetivo

Relatar o efeito do sulfato de atropina sublingual no tratamento da sialorreia em crianças com paralisia cerebral a partir da comparação dos resultados da Drooling Impact Scale em ensaio clínico aberto não controlado.

Resultados

Vinte e cinco crianças foram avaliadas. A diferença das pontuações médias nas escalas pré-tratamento e pós-tratamento atingiu significância estatística. Houve baixa frequência de efeitos colaterais em relação a outros anticolinérgicos.

Conclusão

O uso de sulfato de atropina sublingual parece ser seguro e está relacionado a uma redução na pontuação da Drooling Impact Scale, o que sugere eficácia no tratamento da sialorreia em crianças com paralisia cerebral. Nossos resultados devem ser replicados em estudos randomizados, placebo controlados, com maior número de participantes.



Publikationsverlauf

Eingereicht: 12. August 2016

Angenommen: 20. Dezember 2016

Artikel online veröffentlicht:
05. September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Reddihough D, Erasmus CE, Johnson H, Mckellar GM, Jongerius PH. Botulinum toxin assessment, intervention and aftercare for paediatric and adult drooling: international consensus statement. Eur J Neurol. 2010;17(Suppl 2):109-21. https://doi.org/10.1111/j.1468-1331.2010.03131.x
  • 2 Blasco PA. Surgical management of drooling. Dev Med Child Neurol. 1992;34(4):368-9. https://doi.org/10.1111/j.1469-8749.1992.tb11444.x
  • 3 Ekedahl C, Månsson I, Sandberg N. Swallowing dysfunction in the brain-damaged with drooling. Acta Otolaryngol. 1974;78(1-2):141-9. https://doi.org/10.3109/00016487409126339
  • 4 Van De Heyning P, Marquet JF, Creten WL. Drooling in children with cerebral palsy. Acta Otorhinolaryngol Belg. 1980;34(6):691-705.
  • 5 Tahmassebi JF, Curzon MEJ. The cause of drooling in children with cerebral palsy – hypersalivation or swallowing defect? Int J Paediatr Dent. 2003;13(2):106-11. https://doi.org/10.1046/j.1365-263X.2003.00439.x
  • 6 Erasmus CE, van Hulst K, Rotteveel JJ, Willemsen MA, Jongerius PH. Clinical practice: swallowing problems in cerebral palsy. Eur J Pediatr. 2012;171(3):409-14. https://doi.org/10.1007/s00431-011-1570-y
  • 7 Erasmus CE, Van Hulst K, Rotteveel LJ, Jongerius PH, Van Den Hoogen FJ, Roeleveld N et al. Drooling in cerebral palsy: hypersalivation or dysfunctional oral motor control? Dev Med Child Neurol. 2009;51(6):454-9. https://doi.org/10.1111/j.1469-8749.2008.03243.x
  • 8 Senner JE, Logemann J, Zecker S, Gaebler-Spira D. Drooling, saliva production, and swallowing in cerebral palsy. Dev Med Child Neurol. 2004:46(12):801-6. https://doi.org/10.1111/j.1469-8749.2004.tb00444.x
  • 9 Reid SM, Johnson HM, Reddihough DS. The Drooling Impact Scale: a measure of the impact of drooling in children with developmental disabilities. Dev Med Child Neurol. 2010;52(2):e23-8. https://doi.org/10.1111/j.1469-8749.2009.03519.x
  • 10 Jongerius PH, Limbeek J, Rotteveel JJ. Assessment of salivary flow rate: biologic-variation and measure error. Laryngoscope. 2004;114(10):1801-4. https://doi.org/10.1097/00005537-200410000-00023
  • 11 Reddihough DS, Johnson H. Assessment and management of saliva control problems in children and adults with neurological impairment. J Dev Phys Disabil. 1999;11(1):17-24. https://doi.org/10.1023/A:1021804500520
  • 12 Little SA, Kubba H, Hussain SS. An evidence-based approach to the child who drools saliva. Clin Otolaryngol. 2009;34(3):236-9. https://doi.org/10.1111/j.1749-4486.2009.01917.x
  • 13 Hornibrook J, Cochrane N. Contemporary surgical management of severe sialorrhea in children. ISRN Pediatr. 2012;2012:364875. https://doi.org/10.5402/2012/364875
  • 14 Camp-Bruno JA, Winsberg BG, Green-Parsons AR, Abrams JP. Efficacy of benztropine therapy for drooling. Dev Med Child Neurol. 1989;31(3):309-19. https://doi.org/10.1111/j.1469-8749.1989.tb04000.x
  • 15 Mier RJ, Bachrach SJ, Lakin RC, Barker T, Childs J, Moran M. Treatment of sialorrhea with glycopyrrolate: a double-blind, dose-ranging study. Arch Pediatr Adolesc Med. 2000;154(12):1214-8. https://doi.org/10.1001/archpedi.154.12.1214
  • 16 Mato Montero A, Limeres Posse J, Tomás Carmona I, Fernández Feijoo J, Diz Dios P. Control of drooling using transdermal scopolamine skin patches: a case report. Med Oral Patol Oral Cir Bucal. 2008;13(1):E27-30.
  • 17 Rapoport A. Sublingual atropine drops for the treatment of pediatric sialorrhea. J Pain Symptom Manage. 2010;40(5):783-8. https://doi.org/10.1016/j.jpainsymman.2010.02.007
  • 18 Carranza-del Rio J, Clegg NJ, Moore A, Delgado MR. Use of trihexyphenidyl in children with cerebral palsy. Pediatr Neurol. 2011;44(3):202-6. https://doi.org/10.1016/j.pediatrneurol.2010.09.008
  • 19 Zeller RS, Davidson J, Lee HM, Cavanaugh PF. Safety and efficacy of glycopyrrolate oral solution for management of pathologic drooling in pediatric patients with cerebral palsy and other neurologic conditions. Ther Clin Risk Manag. 2012;8:25-32. https://doi.org/10.2147/TCRM.S27362
  • 20 Freudenreich O. Drug-induced sialorrhea. Drugs Today (Barc). 2005;41(6):411-8. https://doi.org/10.1358/dot.2005.41.6.893628
  • 21 Sockalingam S, Shammi C, Remington G. Clozapine-induced hypersalivation: a review of treatment strategies. Can J Psychiatry. 2007;52(6):377-84.
  • 22 Mustafa FA, Khan A, Burke J, Cox M, Sherif S. Sublingual atropine for the treatment of severe and hyoscine-resistant clozapine-induced sialorrhea. Afr J Psychiatry (Johannesbg). 2013;16(4):242. https://doi.org/10.1177/070674370705200607
  • 23 Hyson HC, Johnson AM, Jog MS. Sublingual atropine for sialorrhea secondary to parkinsonism: a pilot study. Mov Disord. 2002;17(6):1318-20. https://doi.org/10.1002/mds.10276
  • 24 De Simone GG, Eisenchlas JH, Junin M, Pereyra F, Brizuela R. Atropine drops for drooling: a randomized controlled trial. Palliat Med. 2006;20(7):665-71. https://doi.org/10.1177/0269216306071702
  • 25 Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D et al. A report: the definition and classification of cerebral palsy: April 2016. Dev Med Child Neurol. 2007;109(Suppl):8-14.
  • 26 CanChild Center for Childhood Disability Research. Institute for Applied Health Sciences. GMFCS – E & R: Sistema de classificação de função motora grossa: ampliado e revisto. Hamilton: CanChild Center for Childhood Disability Research; 2007 [cited 2015 Oct 17]. Available from: https://www.canchild.ca/system/tenon/assets/attachments/000/000/075/original/GMFCS-ER_Translation-Portuguese2.pdf
  • 27 Cordioli VA, Kieling C, da Silva BTC, Passos IC, Barcellos MT. Deficiências intelectuais. In: Cordioli VA, Kieling C, Silva BTC, Passos IC, Barcellos MT, editores. Referência rápida aos critérios diagnósticos do DSM-5. Porto Alegre: Artmed; 2014. p. 17-23.
  • 28 Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross H, Elger CE et al. A practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475-82. https://doi.org/10.1111/epi.12550
  • 29 Rajpal S, Ali R, Bhatnagar A, Bhandari SK, Mittal G. Clinical and bioavailability studies of sublingually administered atropine sulfate. Am J Emerg Med. 2010;28(2):143-50. https://doi.org/10.1016/j.ajem.2008.10.025