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Objective: This retrospective review documents the experience of ipratropium bromide use among pediatric patients with sialorrhea at our multidisciplinary sialorrhea clinic at Children's Hospital at London Health Sciences Centre (LHSC). Methods: A retrospective chart review of patients diagnosed with sialorrhea at our multidisciplinary clinic between January 2015 and June 2021 was completed. Data on patient demographics, comorbidities, clinical presentation, previous interventions, quality of life, and medication adverse side effects was collected. Drooling Frequency and Severity Scale (DFSS) scores were reviewed to compare sialorrhea management pre- and post-treatment with topical 0.03% ipratropium bromide nasal solution. A descriptive analysis and Wilcoxon signed rank tests were conducted to compare pre- versus post-treatment DFSS scores. Results: A total of 12 patients presented for follow-up and were included in the final analysis. At the pre-treatment visit, the median DFSS score was 4 for frequency and 5 for severity. Post-treatment, median DFSS score was 3 for frequency and 4.5 for severity, (P =.020 and.129, respectively). Minimal adverse effects were encountered. Conclusions: Ipratropium bromide provided a statistically significant benefit for drooling frequency in the patients studied and may present an additional topical medical option for pediatric sialorrhea with limited adverse effects. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of COVID-19 preventive mouthwashes on the surface hardness, surface roughness (Ra), and color change (ΔE) of three different polymer-based composite CAD/CAM materials (Vita Enamic (ENA), Grandio Block (GB), Lava Ultimate (LU)). Methods: A total of 100 rectangular-shaped specimens with dimensions of 2 mm × 7 mm × 12 mm were obtained by sectioning three different CAD/CAM blocks and randomly divided into five subgroups according to the 30 days of mouthwash immersion protocol as follows: Control: artificial saliva, PVP-I: 1% povidone-iodine, HP: 1.5% hydrogen peroxide, CPC: mouthwash containing 0.075% cetylpyridinium chloride, EO: mouthwash containing essential oils. Microhardness, Ra, and ΔE values were measured at baseline and after 30 days of immersion protocols. Data were analyzed using the Wald Chi-square, two-way ANOVA, and post hoc Tukey tests. Results: The independent factors (materials and solutions) significantly influenced the microhardness and color (p < 0.001). Ra of the materials was not affected by any of the mouthwashes (p > 0.05). The microhardness and color of each material varied significantly after immersion in PvP-I and HP (p < 0.05). The highest percentage change in microhardness, Ra, and ΔE was found in LU immersed in PvP-I and HP mouthwashes, while the lowest change was found in ENA groups (p < 0.05). Conclusion: Within the limitations of this study, it was found that the surface hardness and color of tested polymer-based composite CAD/CAM materials are susceptible to degradation and change after 30 days of immersion in 1% PvP-I and 1.5% HP mouthwashes. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Individuals with cerebral palsy may be at risk of obesity, but outcomes and risk factors are understudied. The study objectives are to evaluate the frequency of body mass index (BMI) weight categories of individuals with cerebral palsy and the odds of cardiometabolic-specific diseases and medications. We hypothesize subjects with cerebral palsy and an increased body mass index will have higher odds of cardiometabolic specific diseases and medications. Methods: This is a retrospective observational cohort study utilizing TriNetX, an electronic health record database, in subjects with cerebral palsy aged 2-18 years with an available body mass index. The study population was divided into 4 body mass index percentile categories, underweight (<5th body mass index percentile), healthy weight (≥5th to <85th percentile), overweight (≥85th to <95th percentile), and obese (≥95th percentile), and the odds of the following variables were evaluated: diagnostic codes and medication codes. We computed the odds ratio to test for associations between the body mass index categories and the variables of interest. Results: A total of 5993 subjects were included: underweight (251, 4.2%), healthy weight (2390, 39.9%), overweight (943, 15.7%), and obese (2409, 40.2%). Obese subjects had a higher odds of asthma, diabetes mellitus, hypertension, and sleep apnea when compared to the health weight group. Conclusions: This study found patients with cerebral palsy classified as obese had higher odds of cardiometabolic comorbidity and medication codes that influence weight. Body mass index measurements are limited in this population but may be used cautiously to evaluate the body type of children with cerebral palsy and monitor cardiometabolic-associated comorbidity occurrence. [ABSTRACT FROM AUTHOR]

Objective: Botulinum toxin A is known to be effective and safe in managing sialorrhea in pediatric patients; however, there is no consensus on a protocol for optimal injection sites and appropriate dosing for injection. Methods: This review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. PubMed, EMBASE, and other databases were queried to identify articles that evaluated botulinum toxin type A for the treatment of sialorrhea in the pediatric population. A total of 405 studies were identified. After applying inclusion and exclusion criteria, 31 articles were included for review. Results: A total of 14 studies evaluated 2-gland injections, and 17 studies evaluated 4-gland injections. Of the 31 studies included, one study assessed incobotulinumtoxinA (Xeomin®) the remaining all used onabotulinumtoxinA (Botox®). For 2-gland injection studies, a combined total of 899 participants were reviewed, where 602 participants received 50 units into their submandibular glands, while 262 participants received 30 to 50 units. Among 4-gland injection studies, there was a combined total of 388 participants, with the most prevalent dosage utilized being 60 to 100 units in 230 participants, followed by 100 units total in 77 participants. The most common adverse event was dysphagia which resolved in nearly all cases. Three studies aimed to examine 2-gland versus 4-gland injections, with 2 of the studies concluding 4-gland injection was superior. Conclusions: The strength of evidence suggests that the dosing of 50 units total of onabotulinumtoxinA to the submandibular glands is safe and effective in the pediatric population. For 4-gland injections, bilateral submandibular and parotid gland injections of 60 to 100 units total is the safe and effective dosage. There is no substantial evidence comparing 4-gland injections to 2-gland injections, but research thus far suggests 4-gland injections to be superior. Future study is needed to evaluate incobotulinumtoxinA and abobotulinumtoxinA dosages in the pediatric population. [ABSTRACT FROM AUTHOR]

Objective: Describes dental, occlusal, and craniofacial characteristics of 3 children aged 3 to 4 years with microcephaly due to congenital Zika infection in Cali Valle del Cauca, 2020. Design: Three children case report with congenital Zika virus microcephaly. Setting: Institutional Patients: Three children with maternal viral infection confirmed by polymerase chain reaction during first trimester of pregnancy were included and were born from 2016 to 2017. Interventions: Oral and mouth functional examination was performed including soft tissue examination; lingual and labial frenulum; evaluation of swallowing and chewing; craniofacial analysis; dimension of dental arch; intercanine and intermolar distance, palate form; relationship and growth of maxilla, mandible, and facial dental midline using plaster models; and complementary image analysis. Main Outcome Measures: Child and mother sociodemographic features, craniofacial measurements; dental and oral features; maxillary and mandibular measures; and speech, swallowing, and chewing disorders. Results: Small head circumference at birth and at the time of clinical evaluation was compared to normal children of approximately their age. Upper third of the face was short, and presence of hypertonic masticatory muscles with hypotonic swallowing muscles, dysphagia, dyslalia, bruxism, lip incompetence, tongue interposition, and hypersalivation and epilepsy were the main medical problem. They have complete primary dentition with normal dental morphology, tooth eruption altered, dental caries, and dental malocclusion was identified. Conclusion: There are no changes in the dental formula and dental morphology in the deciduous dentition. They present severe chewing and speaking limitation, facial disproportion, and occlusal problems that warrant dental and medical attention. [ABSTRACT FROM AUTHOR]

Foot-and-mouth disease (FMD) is a highly contagious aphthoviral infection of cloven-hoofed animals, inducing vesiculopustular stomatitis, pododermatitis, and thelitis. Vesicular fluid represents a major pathway of virus excretion, but bovine milk is another important source of virus shedding. We describe here the time course of FMD virus (FMDV) excretion in the milk and characterize associated lesions in the mammary gland. Three dairy cows were infected by nasopharyngeal instillation of FMDV and monitored over 12 d. Autopsy was performed at the end of the study, and specimens were collected for histopathology, IHC, and RT-qPCR. All 3 cows developed fever, drooling, vesiculopustular stomatitis, interdigital dermatitis, and thelitis. FMDV RNA was detectable in whole milk until the end of the trial, but only transiently in saliva, nasal secretions, and blood serum. Although histology confirmed vesiculopustular lesions in the oral and epidermal specimens, the mammary glands did not have unequivocal evidence of FMDV-induced inflammation. FMDV antigen was detectable in skin and oral mucosa, but not in the mammary gland, and FMDV RNA was detectable in 9 of 29 samples of squamous epithelia but only in 1 of 12 samples of mammary gland. [ABSTRACT FROM AUTHOR]

Purpose Equinus is the most common deformity in cerebral palsy (CP) and gastrocsoleus lengthening (GSL) is the most commonly performed surgery to improve gait and function in ambulatory children with CP. Substantial variation exists in the indications for GSL and surgical technique. The purpose of this study was to review surgical anatomy and biomechanics of the gastrocsoleus and to utilize expert orthopaedic opinion through a Delphi technique to establish consensus for surgical indications for GSL in ambulatory children with CP. Methods A 17-member panel, of Fellowship-trained paediatric orthopaedic surgeons, each with at least 9 years of clinical post-training experience in the surgical management of children with CP, was established. Consensus for the surgical indications for GSL was achieved through a standardized, iterative Delphi process. Results Consensus was reached to support conservative Zone 1 surgery in diplegia and Zone 3 surgery (lengthening of the Achilles tendon) was contraindicated. Zone 2 or Zone 3 surgery reached general agreement as a choice in hemiplegia and under-correction was preferred to any degree of overcorrection. Agreement was reached that the optimum age for GSL surgery was 6 years to 10 years and should be avoided in children aged under 4 years. Physical examination measures with the child awake and under anaesthesia were important in decision making. Gait analysis was supported both for decision making and for assessing outcomes, in combination with patient reported outcomes (PROMS). Conclusions The results from this study may encourage informed practice evaluation, reduce practice variability, improve clinical outcomes and point to questions for further research. [ABSTRACT FROM AUTHOR]

Objective: To describe the 2-year neurodevelopmental outcome in children with cerebral palsy associated with congenital Zika (CZ) and explore variables associated with a more severe presentation. Methods: Data on 69 children with cerebral palsy associated with CZ, followed in a neurorehabilitation hospital, who consecutively attended the neurodevelopmental assessment at 2 years of age, were collected. Bayley III Scales of Infant and Toddler Development, Hammersmith Infant Neurological Examination, and Gross Motor Function Classification System were used for the outcome evaluation. Descriptive and inferential statistical analysis were performed. Results: The median age at follow-up was of 24.0 (23-32) months. Only 3 (4.3%) children were not microcephalic. The majority presented with bilateral (94.2%), spastic (100.0%), Gross Motor Function Classification System grade IV or V (92.8%) cerebral palsy, epilepsy (73.1%), extremely low performances on cognitive (94.2%), language (95.7%), and motor (95.7%) Bayley-III Scales of Infant and Toddler Development Test scores. The median Hammersmith Infant Neurological Examination score was of 21.0 (range 9-75). There was a correlation between birth head circumference with the cognitive (r = 0.3, P <.01), language (r = 0.3, P <.01), and motor (r = 0.3, P <.01) Bayley-III Scales of Infant and Toddler Development Test scores, as well as with the Hammersmith Infant Neurological Examination score (r = 0.2, P <.03). An association was observed between an inferior median Hammersmith Infant Neurological Examination score with congenital microcephaly (P =.04), arthrogryposis (P =.02), and epilepsy in the first year (P <.01). Conclusion: Cerebral palsy related to CZ presents with a severe global impairment at a 2-year follow-up. Birth head circumference, arthrogryposis, and early epilepsy are associated with a worse outcome and may be considered as prognostic markers. These findings are important for the neurorehabilitation planning, parents' guiding, and future prognostic studies. [ABSTRACT FROM AUTHOR]

Botulinum toxins (BoNTs) are a product of the bacteria Clostridium botulinum. By entering nerve endings, they cleave and inactivate SNARE proteins, which are essential for neurotransmitter release. Prevention of acetylcholine release at the neuromuscular junction causes long-lasting and potentially fatal flaccid paralysis-a major feature of botulism. However, an intramuscular injection of minute amounts of BoNTs, primarily type A (BoNT-A), has useful long-lasting muscle relaxation effects on spastic motor disorders. This characteristic of BoNT-A is widely used in neurology and cosmetics. Over the last few decades, it has been demonstrated that the functions of BoNT-A are not limited to muscle-relaxing or autonomic cholinergic effects but that it can act as an analgesic agent as well. More recently, it was revealed that this antinociceptive effect starts after entering the sensory nerve endings, where these agents are axonally transported to the central nervous system, suggesting that at least part of their analgesic effect might be of central origin. Because of its antinociceptive effect, BoNT-A is currently approved for treatment of chronic migraine; nonetheless, case reports and preclinical and clinical experiments indicating its benefit in numerous potential painful conditions have increased. In the field of dentistry, the US Food and Drug Administration approved BoNT-A for the treatment of sialorrhea only. Legal status of the use of BoNT-A in other countries is less known. However, there are controlled clinical trials suggesting its efficacy in other conditions, such as bruxism, temporomandibular disorders, and trigeminal neuropathic pain. Thereby, using criteria of the American Academy of Neurology, we critically reviewed the uses of BoNTs in oral medicine and found it effective for trigeminal neuralgia (category A) and probably effective in temporomandibular disorders and bruxism. [ABSTRACT FROM AUTHOR]

Cerebral palsy is a common cause of pediatric motor disability. Although there are increasing amounts of data on the clinical profile of children with cerebral palsy in high-income countries, corresponding information about low-income countries and developing countries is lacking. Therefore, we aimed to describe the clinical spectrum of cerebral palsy in children in Benin, a representative West African low-income country. Our cross-sectional observational study included 114 children with cerebral palsy recruited from community-based rehabilitation centers and teaching hospitals (median age: 7 years, range 2-17; sex: 66% male). Data were collected through review of medical records and interviews with children's mothers. Assessment included risk factors, clinical subtypes according to the Surveillance of CP in Europe criteria, severity of motor outcome scored by the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System, comorbidities, and school attendance. We recorded a high prevalence of intrapartum adverse events. Seventeen percent of children had postneonatal cerebral palsy, with cerebral malaria being the most common cause. Most children were severely affected (67.5% as bilateral spastic; 54.4% as GMFCS IV or V), but severity declined substantially with age. Only 23% of the children with cerebral palsy had attended school. Poor motor outcomes and comorbidities were associated with school nonattendance. These results suggest that intrapartum risk factors and postnatal cerebral malaria in infants are opportune targets for prevention of cerebral palsy in Sub-Saharan low-income countries. [ABSTRACT FROM AUTHOR]

Congenital anomalies are a strong risk factor for cerebral palsy, particularly for children born at term. This systematic review aimed to address gaps in our understanding of the association between congenital anomalies and cerebral palsy. Eight population-based studies (n = 10 081) were identified. Congenital anomalies were reported in 12% to 32% of children with pre/perinatal brain injury and 20% of children with postneonatal brain injury. Variation between studies included study cohort inclusion criteria and the definitions and classification of included anomalies. The most common cerebral anomalies were microcephaly and hydrocephaly, whereas circulatory system anomalies were the most common noncerebral anomalies. The proportion of congenital anomalies was higher in children born at term than preterm. Synthesizing the highest quality data published, this review identified that congenital anomalies are common in cerebral palsy. New collaborative research, addressing sources of variation, is vital to identify pathways to cerebral palsy that include specific congenital anomalies, and explore opportunities for prevention. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to assess the effectiveness of bilateral submandibular duct relocation and bilateral sublingual gland excision in combination with botulinum toxin A injection into the parotid glands in children with sialorrhea. Previously in the literature, either surgery or botulinum toxin injection but not their combination has been reported. Methods: Preoperative and at least 6-month postoperative assessments using the Drooling Severity Scale and Drooling Frequency Scale (Thomas-Stonell and Greenberg classification) and the Teacher Drooling Scale and by interviewing parents and caregivers face to face or via telephone were performed. Also, decreases in the daily number of bib changes and hourly frequency of saliva wiping were recorded as success. Complications were recorded. Results: The Drooling Frequency and Severity Scale, the Teacher Drooling Scale, daily number of bib changes, and hourly frequency of saliva wiping decreased significantly in 21 patients (95.5%) and remained unchanged in 1 patient (4.5%). Postoperative bleeding was observed in 1 patient (4.5%). Conclusions: Drooling is a complex problem that benefits from a multidisciplinary approach. Many treatment methods exist, each with advantages and disadvantages. In this study botulinum toxin A injection was applied in conjunction with bilateral submandibular duct relocation and bilateral sublingual gland excision surgery, achieving a success rate of 95.5%. Moreover, minimal complications and no recurrence after at least 6-month follow-up were observed. The authors therefore recommend further use of this combination treatment. Larger and longer term studies may also help clarify its effectiveness. [ABSTRACT FROM AUTHOR]

Objectives: Dysphagia and impaired saliva control are common in children and adolescents with congenital and developmental disabilities. The aim of the present review was to investigate the evidence base for oral sensory-motor interventions in children and adolescents with dysphagia or impaired saliva control secondary to congenital or early-acquired disabilities and to make recommendations regarding methods for intervention. Methods: A review of the literature from 2000 to 2016, including oral sensory-motor intervention studies for children and adolescents (3-18 years of age) with dysphagia or impaired saliva control secondary to congenital or early-acquired disabilities, was performed. The literature search included the PubMed, CINAHL, Medline, SpeechBITE, OVID, ERIC, Cochrane, and Google Scholar databases. Primary studies were evaluated on a 4-grade scale using the Grading of Recommendations Assessment, Development and Evaluation. Results: Twenty primary studies of oral sensory-motor interventions for dysphagia and 6 studies for the treatment of impaired saliva control fulfilled the inclusion criteria. Of these, 3 were randomized, controlled trials. Five systematic reviews and 16 narrative reviews were also included. Limited and moderately strong recommendations were made on the basis of the grading results from the primary studies. The studies reported good results, but study design was often insufficient, and the study groups were small. The systematic reviews confirmed the lack of high scientific support for oral sensory-motor interventions in children and adolescents with congenital and developmental disabilities. Conclusions: There is an urgent need for high-quality studies that could serve as the basis for strong recommendations relating to oral sensory-motor interventions for children with dysphagia and impaired saliva control. [ABSTRACT FROM AUTHOR]

Drooling is a common problem in children with progressive dystonia. The authors noted a 58% incidence of drooling in 22/38 children with MEGDEL, a rare neurodegenerative cause of dystonia and report on the clinical course of four patients. Drooling of varying severity and subsequent respiratory problems were treated at the authors’ multidisciplinary saliva-control outpatient clinic. One patient improved on antireflux medication, the second after medication with drooling as side effect was changed. Two other patients underwent salivary gland surgery, one of whom significantly improved; the other died shortly after surgery. The heterogeneity of the cases presented shows the need for stepwise and personalized treatment. The authors recommend the following: (1) optimize the treatment of the underlying neurological condition and replace medication that stimulates saliva secretion; (2) treat constipation, scoliosis, and gastroesophageal reflux if there is still a risk of chronic aspiration of saliva; (3) perform more intense/invasive treatment (botulinum toxin, salivary gland surgery). [ABSTRACT FROM AUTHOR]

Intraglandular injection of botulinum toxin type A (BoNT/A) is an effective treatment for sialorrhea. Despite numerous experimental and clinical studies on inhibition of saliva section by BoNT/A, the proteolysis of synaptosomal-associated protein 25 (SNAP-25) following BoNT/A treatment has not yet been confirmed in the salivary gland after injection of BoNT/A. More important, it is not known whether BoNT/A exerts a direct effect in acinar cells. Here, we show that injection of BoNT/A into the rat submandibular gland (SMG) decreased salivary flow in a dose-dependent manner; the inhibitory effect lasted at least 4 wk, and salivary flow recovered to normal levels by 12 wk. During the inhibitory period, SMG neurons and synapses expressed lower levels of full-length SNAP-25, and cleavage of SNAP-25 was observed, as indicated by detection of reduced molecular weight SNAP-25 using Western blotting. In addition, the water channel aquaporin 5 (AQP5) was downregulated and abnormally distributed in rat SMG after injection of BoNT/A. The direct effects of BoNT/A on AQP5 expression and distribution were assessed in vitro to exclude the influence of BoNT/A-induced inhibitory neurotransmission. In stable GFP-AQP5-transfected SMG-C6 cells, treatment with BoNT/A reduced the cell surface protein level of AQP5 in a dose- and time-dependent manner without affecting total AQP5 protein expression. Cell surface biotinylation and immunofluorescence demonstrated translocation of AQP5 from the membrane to the cytoplasm, which was confirmed by decreased levels of AQP5 protein in the membrane fraction and increased levels in the cytoplasmic fraction, suggestive of AQP5 redistribution. Taken together, these results indicated that BoNT/A reversibly decreased saliva secretion in rat SMGs through not only the presynaptic SNAP-25 cleavage but also the postsynaptic AQP5 redistribution. These data provide the first evidence for a direct effect of BoNT/A on the salivary gland. [ABSTRACT FROM AUTHOR]

The article presents a study on the feasibility of transoral submandibular neurectomy (TOSN) for the treatment of sialorrhea. Topics discussed include the psychosocial stressor drooling, the submandibular gland (SMG) excision techniques, and the use of botulinum injection for treating sialorrhea. Also mentioned is the results of the transoral submandibular ganglion neurectomy on the main trunk of lingual nerve.

A 1-year-old female Boer goat was presented for necropsy following spontaneous death and history of acute recumbency, nystagmus, and sialorrhea. A swollen area was grossly observed in the brainstem at the level of the pons. On cut surface, the right cerebellar peduncles were expanded by a focal, pale, poorly demarcated, slightly depressed, and soft area of malacia. Microscopically, this area contained diffuse edema and necrosis, with microabscesses, neuronal necrosis, neuronophagia, axonal spheroids, vasculitis, and perivascular accumulations of lymphocytes, plasma cells, macrophages, and neutrophils. The diagnosis was based on the morphologic findings, fluorescent antibody test results, and special staining. [ABSTRACT FROM PUBLISHER]

Collecting saliva is the most noninvasive way to detect changing levels of cortisol, a stress hormone of interest to behavioral and health scientists, where there are benefits from multiple samples taken over a period of days. Various self-collection strategies have been employed, ranging from treated cards to cotton swabs and passive drool methods. The current study investigates the effectiveness of a variety of reminder techniques in encouraging adherence to procedures requiring four samples per day on 3 separate days of passive drool collection among African American and European American young adults. The findings suggest that direct texts were associated with the greatest level of adherence, while phone reminders were most effective when controlling for total number of contacts. Results indicate that both traditional and novel reminder methods can positively influence adherence, even with challenging populations. [ABSTRACT FROM AUTHOR]

There are several treatment options available for drooling; botulinum toxin injections into the major salivary glands are one. There is no consensus as to how many and which glands should be injected. A research project on this topic was terminated because of adverse effects. Individual results and the adverse effects are described and discussed in this article. Six individuals with cerebral palsy were randomly allocated to 2 treatment groups, with five individuals receiving ultrasound-guided injections to parotid and submandibular glands and one receiving injections to the submandibular glands only. Reduction of observed drooling was registered in 3, while 4 patients reported subjective improvement (Visual Analog Scale). Two participants reported adverse effects, including dysphagia, dysarthria, and increased salivary viscosity. Injections with botulinum toxin can be a useful treatment option but there is a risk of adverse effects. Multidisciplinary evaluation and informed discussions with patients/caregivers are important factors in the decision-making process. [ABSTRACT FROM AUTHOR]

Intrasalivary gland injection of botulinum toxin type A is known to treat sialorrhea effectively in children with cerebral palsy. However, oral health may be compromised with escalating dose. In this randomized, double-blind, and placebo-controlled pilot trial, the authors aim to determine the therapeutic effect of low-dose, ultrasonography-controlled botulinum toxin type A injection to bilateral parotid and submandibular glands on oral health in the management of sialorrhea. Twenty children diagnosed with cerebral palsy were randomly assigned to 2 groups. The treatment group received botulinum toxin type A injections, whereas the control received normal saline in the same locations. The authors evaluated subjective drooling scales, salivary flow rate, and oral health (salivary compositions and cariogenic bacterial counts). A significant decrease was found in salivary flow rate at the 1- and 3-month follow-up in the botulinum toxin—treated group. The authors suggest that current protocol can effectively manage sialorrhea while maintaining oral health. [ABSTRACT FROM AUTHOR]

The article offers information on the clinical use of Glycopyrrolate oral solution. It states that the drug is used to reduce the severity of sialorrhea in children with indications of neurological disorders like cerebral palsy. It adds that Glycopyrrolate functions by blocking acetylcholine receptors which are active in the functions of the salivary glands. It also highlights contraindications on its use and asserts that patients with glaucoma and myasthenia gravis should not take it.

Individuals receiving clozapine treatment for schizophrenia complain of drooling. Reports on salivary flow measurements are contradictory in humans and lacking in animals. Clozapine has affinity for several different receptor types and may, hypothetically, both stimulate and inhibit salivary secretion. In rats, intravenous clozapine evoked a long-lasting secretion, being more prominent from submandibular than from parotid glands. Chronic denervation enhanced the responses. Clozapine acted on muscarinic (M1-) receptors of acinar cells, independent of central nervous mechanisms, pre-synaptic intraglandular events, or circulating catecholamines. A fraction of the methacholine- and parasympathetic-nerve-evoked secretion was abolished by clozapine at doses below those evoking secretion. Sympathetic-nerve-evoked secretion was partially reduced by clozapine, due to antagonistic action on α-adrenoceptors; the β-adrenoceptor-mediated response persisted. Subsecretory doses of clozapine enhanced secretion induced by the β-adrenoceptor agonist isoprenaline. The overall actions of clozapine suggest that, in clozapine-treated humans, salivation is increased during sleep and at rest, but is decreased during meals. [ABSTRACT FROM AUTHOR]

Clozapine-induced sialorrhea (CIS) affects about one-third of patients treated with clozapine, at times can be stigmatizing, socially embarrassing, disabling, affect quality-of-life, cause poor compliance and can be potentially life-threatening adverse effect. Prompt and effective treatment of CIS may assist treatment tolerability, adherence, and better outcomes in patients with treatment nonresponsive schizophrenia. The beneficial effect of amisulpride augmentation of clozapine therapy for such patients may be enhanced by its anti-salivatory effect on CIS. Current series of five subjects who developed CIS that responded poorly to anticholinergic drugs found drastic improvement in daytime and nocturnal CIS with very lowdose (50-100 mg/day) of amisulpride. Low-dose amisulpride augmentation may also provide strong ameliorating effect on CIS. Nevertheless, a long-term, large-scale study with a broader dose range is warranted to evaluate the stability of this effect across time. [ABSTRACT FROM AUTHOR]

The article presents a case report of a 42-year-old female with severe pain and swelling of tongue. Examinations showed low-grade temperature elevation, significant tongue swelling, drooling with painful lingual protraction, an oval fluid density collection within the root of the tongue, and irregular lesion formation. The patient had lingual abscess caused by the Staphylococcus microorganism. She was given Ceftriaxone and Tachipirina and abscess changes resolved one month later.

Two men with profound developmental disabilities used a mouth-wiping response instrumental to reduce drooling via a micro-switch-based program (i.e., a program in which the response was automatically monitored and followed by positive stimulation). The wiping response was performed via a napkin or a handkerchief placed inside a belt pocket. The micro-switch technology consisted of two mini-tilt sensors and a radio transmitter hidden inside the napkin, or an optic sensor and a radio transmitter fixed inside the belt pocket. The study was carried out according to a multiple baseline across participants and included a 3-month postintervention check. During the baseline, the participants' mean frequencies of mouth wiping were near zero, and mean percentages of wet chin intervals were about 45 and 50. During the intervention, the mean wiping frequencies increased to 1.6 and 1.9 per min, whereas the mean percentages of wet-chin intervals were mostly below 10. These values were maintained at the postintervention check. Implications of the findings and limitations of the study are discussed. [ABSTRACT FROM AUTHOR]

Nemaline myopathy is defined by the presence of nemaline bodies, or rods, on muscle biopsy. Facial and bulbar weakness in nemaline myopathy cause chewing and swallowing difficulties, recurrent aspiration, and poor control of oral secretions. This article discusses 5 patients (4 infants and 1 adolescent) with nemaline myopathy who received dietary supplementation with L-tyrosine (250 to 3000 mg/day). All 4 infants were reported to have an initial decrease in sialorrhoea and an increase in energy levels. The adolescent showed improved strength and exercise tolerance. No adverse effects of treatment were observed. Dietary tyrosine supplementation may improve bulbar function, activity levels, and exercise tolerance in nemaline myopathy. [ABSTRACT FROM AUTHOR]

Objectives: Chronic aspiration of salivary secretions can cause major pulmonary morbidity in neurologically impaired patients. Many treatments are proposed to address these problems, some with significant side effects. Botulinum toxin type A injection into the salivary glands is known to reduce salivary flow without major complications. Few reports exist regarding the use of this treatment in the prevention of recurrent aspiration pneumonia. We studied the effects of this treatment for patients with recurrent aspiration pneumonia. Methods: We performed a chart review of 12 patients, ranging in age from 7 months to 37 years, treated with botulinum toxin injections at a single tertiary care institution. A caregiver telephone questionnaire was also administered. The numbers of pulmonary infections and hospitalizations before and after the initiation of treatment were compared. Results: Nine of 12 patients reported improvement in the numbers of hospitalizations and pulmonary infections following botulinum toxin injections. Reduction in the use of anticholinergic medication and reduced pulmonary toilet requirements were also noted. There were no complications of treatment. Conclusions: Botulinum toxin injection into the salivary glands can be effective in reducing pulmonary morbidity in many neurologically impaired patients. This relatively simple technique offers an alternative to the use of anticholinergic medication and may obviate the need for more invasive surgical treatment in certain patients. [ABSTRACT FROM AUTHOR]

Many children with mental retardation and developmental disabilities suffer from the consequences of chronic drooling. Behavioral treatment for drooling should be considered before other, more intrusive treatments such as medication and surgery are implemented. However, empirical studies on behavioral procedures are scarce. This article reviews 19 behavioral studies published since 1970. Treatment procedures are (a) instruction, prompting, and positive reinforcement; (b) negative social reinforcement and declarative procedures; (c) cueing techniques; and (d) self-management procedures. Although these procedures yield positive results, critical examination of experimental methodology of the studies reveals several methodological shortcomings. Guidelines for clinical use of behavioral treatment for drooling are presented, and recommendations are given for future research in this area. [ABSTRACT FROM AUTHOR]

Introduction: Drooling occasionally occurs in cancer patients, impairing their quality of life. Recommended treatment includes the use of anticholinergic drugs, but there is a lack of scientific evidence supporting it; some recent reports tested the use of sublingual atropine, and further controlled studies have been recommended. Objective: To evaluate the effectiveness of sublingual atropine for the relief of drooling when compared with a placebo, in a population of patients with upper digestive cancer at the Gastroenterology 'Bonorino Udaondo' Hospital. Population and methodology: From March 2002 to March 2003, 22 consecutive patients were enrolled in a prospective, randomized, placebo-controlled, double-blind, cross-over trial (gender: M/F = 14/8; median age = 66, range: 48–87 years). Patients were randomly allocated to receive atropine or placebo for 48 hours (phase 1), followed by a wash-out period of 48 hours, and final cross-over during the next 48 hours (phase 2). We evaluated the impact on sialorrhoea, choking, interference with daily and social activities, and global impact from drooling by visual analogue scales (VAS) at the beginning and end of each phase, as well as patients' choice at the end of the study. Results: Mean score for sialorrhoea was 59.6 (SD = 28.5) at baseline and 34.9 (SD = 27.7) after 48 hours of receiving atropine; 62.1 (SD = 27.6) at baseline and 40.7 (SD = 30.5) after 48 hours of placebo. Analysis of variance (ANOVA) for repeated measures and two factors was not significant for either the variable sialorrhoea (P = 0.58) or any of the secondary outcomes measured. No severe toxicity was reported. Conclusions: This study failed to demonstrate the effectiveness of atropine over placebo in this population; we provide further discussion of results. [ABSTRACT FROM AUTHOR]

We evaluated a multicomponent intervention that successfully eliminated drooling by a 17-year-old student with autism who attended a public high school. The student was taught to perform compensatory responses (wiping his mouth and swallowing saliva), received positive reinforcement for having a "dry mouth," and was given opportunities to monitor his appearance. Implemented in a multiple-baseline design across three school locations, intervention was applied with high integrity and judged positively by staff. [ABSTRACT FROM AUTHOR]

The etiology of salivary gland hypofunction in HIV(+) patients is unclear. This study was designed to determine the effect of early-stage HIV(+) infection (CD4+ > 200 cells/μL; n = 139) on salivary gland function and the relationship of this dysfunction to the taking of xerostomic medications. Salivary flow rates and the content of electrolytes and antimicrobial proteins in stimulated parotid and submandibular/sublingual saliva were determined. Compared with healthy controls (n = 50), the HIV(+) group showed significant reductions in flow rates of unstimulated whole (35%), stimulated parotid (47%), unstimulated submandibular/sublingual (23%), and stimulated submandibular/sublingual (39%) saliva. The flow rates for the HIV(+) patients taking xerostomic medications did not differ from those of patients who did not. Concentrations of some salivary gland components were altered in the HIV(+) group. Analysis of these data suggests that salivary gland function is adversely affected early in HIV infection and that these changes do not appear to be compounded by the taking of xerostomic medications. [ABSTRACT FROM AUTHOR]

The article presents a case report on 55-year-old male with treatment resistant schizophrenia, admitted and treated in an extended care unit due to significant risks associated with wandering and disorganization. It mentions that increased levels of synaptic dopamine may stimulate central dopaminergic projections to the nucleus accumbens, resulting in an increase in disinhibited and impulsive behaviors.

Presents the results of a survey of parents and caretakers of children with cerebral palsy on their use of antisialorrheic medication for excessive drooling. Number of respondents using glycopyrrolate; Side effects; Use of benzhexol hydrochloride.

Troublesome and persistent drooling is not an uncommon problem in neurologically impaired children. For the past 15 years, a team approach has been utilized to assess and manage affected individuals. Programs intended to improve oral motor skills should be utilized initially. Surgery has proven necessary in over half of these patients; bilateral submandibular duct relocation and sublingual gland excisions are the current procedures of choice at our institution. [ABSTRACT FROM AUTHOR]

The assessment of submandibular/sublingual (sm/sl) saliva is a procedure of increasing significance. However, the collection of these fluids by traditional techniques is difficult and therefore often neglected. To collect sm/sl saliva, we have assembled a novel, universal system consisting of four parts--collecting tubing, a buffering chamber, a storing tube, and a suction device. Submandibular/sublingual saliva samples were collected from ten healthy and ten xerostomic individuals. The system showed intra-examiner reproducibility of 0.92 for healthy and 0.89 for xerostomic subjects, and inter-examiner reproducibility of 0.93 for normal subjects and 0.80 for xerostomic individuals. The flow rates obtained by the present collecting set-up were similar to those measured by all known previous methods that were published during the last 40 years. The system was also efficient, in that more than 90% of the fluid that entered the system was eventually collected in the storing tube for analysis. The system appears to collect relatively pure sm/sl fluids, since contamination of the collected sample by a stimulant solution swabbed repeatedly over the tongue during saliva collection was minimal. The system is reliable, safe, practical, and comfortable for the patient. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine salivary flow rate and its association with the use of medication in a representative sample of 76-, 81-, and 86-year-old subjects, totaling 368. In this study, 23% (n = 80) of the subjects were unmedicated. From one to three daily medications were used by 47% (n = 168) and more than four medications by 30% (n = 104). The most commonly used medications were nitrates, digitalis or anti-arrhythmic drugs (47.7%), analgesics and antipyretics (32.6%), and diuretics (29.5%). The mean number used daily was significantly higher in 86-year-olds than in the two younger age groups (p < 0.01). No significant differences in this respect were found between genders. Among the unmedicated subjects, 76-year-olds had significantly higher stimulated salivary flow rates than did the 81-year-olds (p < 0.05). Unmedicated women showed significantly lower unstimulated (p < 0.01) and stimulated flow rates than did men (p < 0.05). Stimulated salivary flow rate was also significantly higher in the 76-year-old medicated subjects than in the medicated 86-year-old subjects (p < 0.05). No statistically significant differences were found in unstimulated salivary flow rates among the three age groups. Medicated women showed significantly lower unstimulated salivary flow rates than men (p < 0.001), although the difference in stimulated saliva flow was not significant. A statistically significant difference in unstimulated and stimulated salivary flow rates was found between unmedicated persons and those who took from four to six, or more than seven, prescribed medications daily. [ABSTRACT FROM AUTHOR]

The article discusses the roles that neurotransmitters play in the control of salivary secretion, and it mentions how neural signals are transmitted to salivary gland acinar cells. Plasma membrane polyphosphoinositides and cyclic adenosine monophosphate (cAMP) formation are examined, along with the activation of N or G proteins. The physiological aspects of salivary glands are assessed, as well as neurotransmitters such as norepinephrine and acetylcholine.

Submandibular saliva samples were obtained with a new collection device, under resting and post-stimulation conditions, from 28 healthy individuals between 70 and 91 years of age, and from 30 healthy individuals between 18 and 39 years of age. The salivary flow rates were significantly decreased in the aged group compared with the control group. The mean resting and post-stimulation flow rates for the aged group averaged 22% and 39%, respectively, of control values. [ABSTRACT FROM AUTHOR]

Two patients with spastic cerebral palsy recently treated with modafinil at the Walter Reed Army Medical Center child neurology clinic have stopped drooling. This occurred after starting modafinil for spasticity and without other changes in the patients' treatment programs. The decrease in drooling is to a remarkable degree. Both patients had a chronic problem with drooling. One patient has gone from wearing a bib or bandanna, which was constantly wet from drooling to being essentially dry. After starting modafinil, both patients stopped drooling. The parents initially observed decreased drooling at home. Clinic appointment examinations and evaluations at physical therapy confirmed these observations. Better coordination and speech have been noted in each patient. Modafinil improves drooling in at least some patients with spastic cerebral palsy. The decreased drooling is due to improvements noted in swallowing. [ABSTRACT FROM AUTHOR]

Clozapine has shown superior efficacy in treatment of refractory schizophrenia, but its use is limited by emergent side-effects. Among other adverse effects, sialorrhea is a troublesome side-effect, its stigmatizing nature results in poor treatment compliance. Several hypotheses have been put forward in the etiology of clozapine-induced sialorrhea. α2 adrenergic antagonism is hypothesized to be involved in its pathophysiology, based on the response to clonidine and lofexidine. Oral clonidine (50 to 100 µg/day) was tried on 12 stable outpatients of schizophrenia maintained on clozapine. Wet area over the pillow as reported by the patients was recorded at baseline and at 4 weeks of treatment along with the subjective response after the treatment. Most of the patients reported a decrease in sialorrhea without any adverse events. We describe encouraging results in an open case series of oral clonidine for clozapine-induced sialorrhea. [ABSTRACT FROM AUTHOR]

This is a case report of an otherwise healthy 2-year-old boy with a history of pica, associated with iron deficiency anemia. This boy was referred to our department for a neurologic evaluation because of an acute episode of sialorrhea, difficulty in speaking, dysphagia, and repeated swallowing movements. An uncertain episode of a brief-duration still gaze was also reported. In addition, the history revealed that the child had earlier ingested a leaf from a poisonous houseplant called Colocasia esculenta, also known as “elephant's ear.” The habit of pica subsided after treatment with iron supplements. A 9-month follow-up period was uneventful. Neurologic manifestations can accompany accidental intoxications of some non-nutrient substances. Thus, pica must be suspected in children with acute behavior alterations. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the effect of radiotherapy on the rate of unstimulated whole saliva flow. The individuals examined for the study are described, noting that the subjects are 10 white males between the ages of 47 and 67 with head and heck cancer. The method by which the saliva is collected is described, which involves directing the patients to drool into calibrated tubes prior to weekly irradiation treatments. The mean weekly salivary flow rate is also determined for each patient.