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Movement Disorders : Official Journal... Dec 2007A significant number of patients with Parkinson's disease (PD) experience sialorrhea. This problem can cause social embarrassment, and because saliva pools in the mouth,... (Meta-Analysis)
Meta-Analysis Review
A significant number of patients with Parkinson's disease (PD) experience sialorrhea. This problem can cause social embarrassment, and because saliva pools in the mouth, may lead to aspiration pneumonia. Sialorrhea in PD is thought to be caused by impaired or infrequent swallowing, rather than hypersecretion. Oral medications, botulinum toxin injections, surgical interventions, radiotherapy, speech therapy, and trials of devices may be used to treat sialorrhea in PD, but few controlled trials have been published. This article reviews current knowledge regarding the frequency, etiology, assessment, and treatment of sialorrhea in PD.
Topics: Humans; Parkinson Disease; Salivary Glands; Sialorrhea
PubMed: 17659637
DOI: 10.1002/mds.21646 -
BMJ (Clinical Research Ed.) Jan 2015
Topics: Child, Preschool; Humans; Medical History Taking; Parents; Physical Examination; Posture; Referral and Consultation; Sialorrhea; Watchful Waiting
PubMed: 25632946
DOI: 10.1136/bmj.h38 -
The Annals of Pharmacotherapy May 2011To provide an understanding of the underlying pathophysiology and current treatment options for clozapine-induced sialorrhea. (Review)
Review
OBJECTIVE
To provide an understanding of the underlying pathophysiology and current treatment options for clozapine-induced sialorrhea.
DATA SOURCES
Literature was retrieved through MEDLINE (1977-February 2011) using the key search terms clozapine, sialorrhea, hypersalivation, drooling, and treatment. In addition, reference citations from identified publications were reviewed.
STUDY SELECTION AND DATA EXTRACTION
All articles published in English identified from the data source were evaluated and included in the review.
DATA SYNTHESIS
Sialorrhea is a common and disabling adverse effect of clozapine use. Current treatment options include topical and oral antimuscarinic medications and α-adrenergic agents. New areas of investigation include glycopyrrolate, botulinum toxin, and substitute benzamide derivatives. Thirteen clinical trials (2 retrospective, 5 open-label, 6 double-blind) and 13 case reports were reviewed. Overall, there are weak data on use of antimuscarinic agents, consisting mostly of small open-label or retrospective studies. Glycopyrrolate, however, demonstrated significant reduction of hypersalivation in a randomized controlled trial. Medications with activity at α-adrenergic receptors have shown positive results in case reports, retrospective evaluations, and an open-label trial, but have not been investigated in a double-blind, controlled fashion. Botulinum toxin also significantly improved sialorrhea in both a case report and double-blind study, although the trial included hypersalivation from other etiologies in addition to clozapine. Substitute benzamide derivatives have demonstrated significant improvements in randomized controlled trials; however, they are not available in the US. Overall, few treatment strategies have been evaluated in controlled settings, warranting further randomized controlled trials to identify more effective treatment options.
CONCLUSIONS
Current pharmacologic treatment options for clozapine-induced sialorrhea are limited in number and efficacy. Although few randomized controlled trials have been conducted, this review identifies potential treatment alternatives for this common and sometimes severe adverse effect.
Topics: Adrenergic alpha-Agonists; Clinical Trials as Topic; Clozapine; Double-Blind Method; Humans; Muscarinic Antagonists; Retrospective Studies; Sialorrhea
PubMed: 21540404
DOI: 10.1345/aph.1P761 -
European Journal of Pediatrics Mar 2012Cerebral palsy (CP) is the most common physical disability in early childhood. The worldwide prevalence of CP is approximately 2-2.5 per 1,000 live births. It has been... (Review)
Review
Cerebral palsy (CP) is the most common physical disability in early childhood. The worldwide prevalence of CP is approximately 2-2.5 per 1,000 live births. It has been clinically defined as a group of motor, cognitive, and perceptive impairments secondary to a non-progressive defect or lesion of the developing brain. Children with CP can have swallowing problems with severe drooling as one of the consequences. Malnutrition and recurrent aspiration pneumonia can increase the risk of morbidity and mortality. Early attention should be given to dysphagia and excessive drooling and their substantial contribution to the burden of a child with CP and his/her family. This review displays the important functional and anatomical issues related to swallowing problems in children with CP based on relevant literature and expert opinion. Furthermore, based on our experience, we describe a plan for approach of investigation and treatment of swallowing problems in cerebral palsy.
Topics: Cerebral Palsy; Deglutition Disorders; Humans; Sialorrhea
PubMed: 21932013
DOI: 10.1007/s00431-011-1570-y -
Clinical Therapeutics Apr 2012Sialorrhea, or drooling, is seen in the pediatric population, especially in patients with cerebral palsy and other neurodevelopmental disabilities. If medication use is... (Review)
Review
BACKGROUND
Sialorrhea, or drooling, is seen in the pediatric population, especially in patients with cerebral palsy and other neurodevelopmental disabilities. If medication use is warranted, anticholinergic agents are the drug of choice; however, adverse effects limit their use. Glycopyrrolate, a synthetic anticholinergic that acts at peripheral muscarinic receptors, has been used off-label for excessive drooling in children with neurodevelopmental disabilities for years. Product formulations restricted the use of glycopyrrolate. However, an oral solution was approved by the US Food and Drug Administration for children ages 3 to 16 years with neurologic disorders for chronic severe drooling in 2010; it became available for use in 2011.
OBJECTIVE
This article provides an overview of the pharmacology, clinical efficacy, and tolerability of glycopyrrolate when used for sialorrhea in children.
METHODS
To evaluate the efficacy and safety profile of glycopyrrolate for the treatment of sialorrhea in children, a comprehensive search was performed of the MEDLINE database (1966-February 25, 2012) and International Pharmaceutical Abstracts as well as references from additional review articles identified. Searches were conducted using the terms glycopyrrolate, sialorrhea, drooling, secretion, and pediatrics. The terms drug-induced and Parkinson disease-associated sialorrhea were excluded from the search. The pharmaceutical manufacturer of the oral solution was contacted for medical and study information.
RESULTS
Oral bioavailability of glycopyrrolate varies widely, with a median of 3.3%. Mean C(max) in children was determined to be 0.37 μg/mL, and mean T(max) was 3.1 hours. The clearance in children ranges from 0.6 to 1.43 L/kg/h. The t(½) ranges from 22 to 130 minutes and 19 to 99 minutes in infants and children, respectively. Six studies describing the use of glycopyrrolate for drooling in children were identified. A double-blind, crossover trial of 27 patients (age range, 4-19 years) demonstrated a reduced mean drooling score (modified Teacher's Drooling Scale [1 = never drools to 9 = clothing, hands, and objects frequently become wet]) for glycopyrrolate (mean highest tolerated dose, 0.11 mg/kg) compared with placebo of 1.85 versus 6.33 (P < 0.001). In a parallel study of 36 patients (age range, 3-16 years), 14 of 20 patients randomized to receive glycopyrrolate solution showed improvement in the mean modified Teacher's Drooling Scale score compared with only 3 patients receiving placebo (-3.5 vs -0.1, respectively). Glycopyrrolate was initiated at 0.02 mg/kg per dose orally TID (Max dose: 3 mg) and titrated over a 4-week period. Adverse effects identified in studies include dry mouth (9%-41%), constipation (9%-39%), and behavioral changes (18%-36%).
CONCLUSIONS
Glycopyrrolate is effective in decreasing sialorrhea in children with cerebral palsy or other neurodevelopmental disabilities. Adverse effects did occur, more frequently at higher doses, and should be monitored.
Topics: Biological Availability; Child; Chronic Disease; Clinical Trials as Topic; Glycopyrrolate; Humans; Muscarinic Antagonists; Sialorrhea
PubMed: 22445330
DOI: 10.1016/j.clinthera.2012.02.026 -
Neurological Sciences : Official... Mar 2021Drooling is characterized by an excessive pooling of saliva in the oral cavity. The exact pathophysiological mechanism of drooling in Parkinson's disease (PD) is not yet... (Review)
Review
INTRODUCTION
Drooling is characterized by an excessive pooling of saliva in the oral cavity. The exact pathophysiological mechanism of drooling in Parkinson's disease (PD) is not yet fully understood.
OBJECTIVE
To identify the relationship between drooling and other clinical features in people diagnosed with PD.
METHOD
Research on the topic was carried out on the PubMed and ScienceDirect electronic databases. Articles published between March 2015 and March 2020 were selected. Search terms and inclusion and exclusion criteria were previously defined. The articles included met those requirements.
RESULTS
Sixteen articles were included for analysis. The prevalence of drooling varies between 9.26 and 70% and can occur at any stage of the disease. Higher prevalence of drooling is related to disease duration, disease severity, older age, male, levodopa equivalent dose, hypomimia, dysphagia, dysarthria, cognition, sleep, non-dominant tremor, motor fluctuations, bradykinesia, more symmetric pattern, gastrointestinal and urinary problems, sexual dysfunction, obstipation, and orthostatic hypotension. However, it is not related to hallucinations, rapid eye movement sleep behavior disorder, akinetic-rigid PD, mixed, nor dyskinesias.
CONCLUSION
Drooling is not caused by a single factor; it is influenced and related to several clinical features. Some clinical factors participate in the onset of drooling while others are concomitant.
Topics: Aged; Humans; Hypokinesia; Levodopa; Male; Parkinson Disease; REM Sleep Behavior Disorder; Sialorrhea
PubMed: 33443673
DOI: 10.1007/s10072-020-05005-0 -
Psychopharmacology Apr 2006Clozapine is an atypical antipsychotic agent with proven efficacy in refractory schizophrenia, but its widespread use is limited by adverse effects such as... (Review)
Review
RATIONALE
Clozapine is an atypical antipsychotic agent with proven efficacy in refractory schizophrenia, but its widespread use is limited by adverse effects such as agranulocytosis, seizures, sedation, weight gain, and sialorrhea. Clozapine-induced sialorrhea (CIS) is bothersome and has socially stigmatizing adverse effects, which result in poor treatment compliance. The pathophysiology of this condition is poorly understood and the treatment options available are based mostly on case reports and open-label studies.
OBJECTIVE
To review the available studies on CIS.
METHOD
All relevant studies available through PUBMED search supplemented with manual search were undertaken.
RESULT
The clinical features, complications, assessment, pathophysiology, and management of CIS are discussed.
CONCLUSION
Although the studies evaluating the therapeutic options has limitations and no drug has been found to be superior, judicious use of pharmacological agents along with behavioral methods will reduce this troublesome side effect and enhance compliance.
Topics: Adrenergic alpha-Agonists; Antipsychotic Agents; Cholinergic Antagonists; Clozapine; Humans; Sialorrhea
PubMed: 16514524
DOI: 10.1007/s00213-005-0248-4 -
Medicina Oral, Patologia Oral Y Cirugia... Sep 2011Drooling is the uncontrolled leakage of saliva outside the mouth, generally as a result of difficulty in swallowing the saliva produced. Many factors contribute to... (Review)
Review
Drooling is the uncontrolled leakage of saliva outside the mouth, generally as a result of difficulty in swallowing the saliva produced. Many factors contribute to drooling, though it is more commonly seen in children with brain paralysis - particularly those receiving anticonvulsivant medication. Drooling is also often seen in patients with lip sealing problems or malocclusions such as anterior open bite. Clinically, the affected patients can develop skin irritation or abrasions, problems of hygiene, unpleasant smell and - in the more severe presentations - the need to wear protectors or frequently change clothing. Treatment of this disorder is complex, and should be addressed from a multidisciplinary perspective, with planning on an individualized basis. Among the different existing managements, myofunctional therapy, behavioral change programs and drug treatments are the most widely used options, though there are also more invasive surgical techniques designed to reduce or cause submandibular saliva secretion to be rerouted towards posterior zones of the oral cavity. In any case, no scientific evidence-based management protocol has yet been established capable of affording favorable results in the majority of cases. The present study offers a review and update on the clinical and dental management aspects of drooling.
Topics: Humans; Sialorrhea
PubMed: 21743406
DOI: 10.4317/medoral.17260 -
European Journal of Pediatrics Jul 2022Drooling, or sialorrhea, is a common condition in patients with cerebral palsy, rare diseases, and neurodevelopmental disorders. The goal of this review was to identify... (Review)
Review
Drooling, or sialorrhea, is a common condition in patients with cerebral palsy, rare diseases, and neurodevelopmental disorders. The goal of this review was to identify the different properties of sialorrhea outcome measures in children. Four databases were analysed in search of sialorrhea measurement tools, and the review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist was used for quality appraisal of the outcome measures. The initial search yielded 891 articles, 430 of which were duplicates. Thus, 461 full-text articles were evaluated. Among these, 21 met the inclusion criteria, reporting 19 different outcome measures that encompassed both quantitative measures and parent/proxy questionnaires. Conclusions: Among the outcome measures found through this review, the 5-min Drooling Quotient can objectively discriminate sialorrhea frequency in patients with developmental disabilities. The Drooling Impact Scale can be used to evaluate changes after treatment. The modified drooling questionnaire can measure sialorrhea severity and its social acceptability. To date, the tests proposed in this review are the only tools displaying adequate measurement properties. The acquisition of new data about reliability, validity, and responsiveness of these tests will confirm our findings. What is Known: • Although sialorrhea is a recognized problem in children with disabilities, especially those with cerebral palsy (CP), there is a lack of confidence among physicians in measuring sialorrhea. What is New: • Few sialorrhea measures are available for clinicians that may guide decision-making and at the same time have strong evidence to provide confidence in the results. • A combination of both quantitative measures and parent/proxy questionnaires might provide an adequate measurement of sialorrhea in children.
Topics: Cerebral Palsy; Child; Humans; Outcome Assessment, Health Care; Reproducibility of Results; Sialorrhea; Surveys and Questionnaires
PubMed: 35441248
DOI: 10.1007/s00431-022-04460-5 -
Archives of Otolaryngology--head & Neck... Sep 2009To review and assess the current published literature regarding the efficacy of surgical management of sialorrhea in pediatric patients. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To review and assess the current published literature regarding the efficacy of surgical management of sialorrhea in pediatric patients.
DATA SOURCES
The MEDLINE database was systematically reviewed for articles reporting on the use of surgical procedures to treat sialorrhea published from January 1, 1963, to November 30, 2008.
STUDY SELECTION
Inclusion criteria included presence of data on the success of surgical treatment of sialorrhea, English language, sample size greater than 5, and presentation of extractable data regarding the subjective success of surgical management of sialorrhea.
DATA EXTRACTION
Data regarding demographic characteristics of study participants, follow-up duration, subjective success rates, and number and type of complications were extracted by blinded reviewers.
DATA SYNTHESIS
A total of 325 studies were identified on initial search. Abstract review reduced the sample to 46. Cross-referencing yielded an additional 4 articles, resulting in the final sample of 50 articles. Forty-seven studies were case series (Centre for Evidence-Based Medicine level 4 evidence), 2 were cohort studies (level 2), and 1 was a prospective cohort study (level 1b). Median sample size was 18 (range, 5-181), and median follow-up duration was 8.1 months (range, 0.1-50 months). Subjective success was reported in more than 50% of patients in 49 of 50 studies. Random-effects modeling estimated the overall subjective success rate for all procedures to be 81.6% (95% confidence interval, 77.5%-85.7%; P < .001). Bilateral submandibular gland excision and parotid duct rerouting appeared to have the highest subjective success rates at 87.8% (k = 8 studies; 95% confidence interval, 80.5%-95.1%; P <.001), and 4-duct ligation was the lowest at 64.1% (4 studies; 27.6%-100%; P = .001).
CONCLUSIONS
Most evidence regarding surgical outcomes of sialorrhea management is low quality and heterogeneous. Despite this, most patients experience a subjective improvement following surgical treatment.
Topics: Adult; Child; Female; Humans; Incidence; Male; Middle Aged; Prognosis; Risk Assessment; Salivary Glands; Severity of Illness Index; Sialography; Sialorrhea; Submandibular Gland; Treatment Outcome
PubMed: 19770427
DOI: 10.1001/archoto.2009.110