Severe sialorrhoea (drooling) in children and young people with chronic neurological disorders: oral glycopyrronium bromide Severe sialorrhoea (drooling) in children and young people with chronic neurological disorders: oral glycopyrronium bromide Evidence summary Published: 14 February 2017 www.nice.org.uk/guidance/es5 pathwaysKey points Key points The content of this evidence summary was up (chronic pathological drooling) in children and adolescents aged 3 years and older with chronic neurological disorders. Sialanar is licensed for short-term intermittent use and is only licensed in children. There is limited clinical trial evidence on the use of glycopyrronium in adults with sialorrhoea. Sialanar 320 micrograms/ml oral solution is the first formulation of glycopyrronium bromide licensed
A protocol for the evaluation of a wearable device for monitoring of symptoms, and cueing for the management of drooling, in people with Parkinson's disease. Drooling is a common symptom of Parkinson's Disease (PD) experienced in up to 70% of people with PD (PwP). Drooling can be a major problem in PwP leading to adverse physical and psychosocial issues. Current medical treatments decrease -worn device designed to work with a smartphone application to support the real-world evaluation of haptic cueing for the management of drooling. We will recruit 3,000 PwP to wear the device day and night for the intervention period to gain a greater understanding of the effectiveness and acceptability of the technology within real-world use. Additionally, 300 PwP who self-identity as having an issue
Negative effects on oral motor function after submandibular and parotid botulinum neurotoxin A injections for drooling in children with developmental disabilities. To evaluate negative effects on oral motor function after concurrent submandibular and parotid (four-gland) botulinum neurotoxin A (BoNT-A) injections as a treatment for paediatric drooling. This was a retrospective cohort study
Drooling in developmentally normal children: a review. Drooling or saliva spillage has been explored widely among children with neurodevelopmental conditions. Yet, the approach to drooling in an otherwise developmentally normal child remains unexplored, as it is regarded as self-limiting. Nonetheless, drooling beyond age 4 in the awake stage should raise concern. This narrative review aims to shed light on drooling in developmentally normal children, also known as 'healthy droolers', and the available evidence on its management. Most notable factors causing saliva spillage include poor oral-motor control and impaired oral sensation. Delayed saliva acquisition may be an early indicator of developmental or intellectual delay. Drooling impairs both the children's and parents' overall quality
Predicting non-response to intraglandular botulinum neurotoxin A injections for drooling in children with neurodevelopmental disabilities. To develop robust multivariable prediction models for non-response to (1) submandibular botulinum neurotoxin A (BoNT-A) injections and (2) concurrent submandibular and parotid (four-gland) injections, to guide treatment decisions for drooling in children
Comprehensive management of anterior drooling: An International Pediatric Otolaryngology Group (IPOG) consensus statement. To provide guidance for the comprehensive management of children referred for anterior drooling. The mission of the International Pediatric Otolaryngology Group (IPOG) is to develop expertise-based recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. Survey of expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The recommendations are derived from current expert consensus and critical review of the literature. Consensus recommendations include initial care and approach recommendations for health care providers who commonly evaluate children with drooling. This includes
Long-term effects of submandibular gland excision on drooling in children with neurodevelopmental disorders: A cross-sectional study. Submandibular gland excision (SMGE) is suitable for the management of drooling in patients with non-progressive neurodisabilities. We aimed to investigate the long-term effects of SMGE. Patients who had SMGE between 2007 and 2018 were included. Main outcomes were a Visual Analogue Scale (VAS), Drooling Severity (DS), and Drooling Frequency (DF) collected at baseline, 8 weeks, 32 weeks and with a median of 313 weeks after SMGE (long-term). Secondary outcomes were satisfaction with the procedure, Drooling Quotient (DQ) and adverse events (AEs). We included thirty-five patients in the long-term analysis with a mean age of 14.5 years. A baseline VAS score of 80.4
Sialanar (glycopyrronium) - for treating severe drooling of saliva in children and adolescents (aged 3 years and above) with conditions affecting the nervous system, such as cerebral palsy, epilepsy and neurodegenerative diseases 30 Churchill Place ● Canary Wharf ● London E14 5EU ● United Kingdom An agency of the European Union Telephone +44 (0)20 3660 6000 Facsimile +44 (0)20 3660 5520 mechanism of action MS Mass Spectrometry μg microgram mTDS Modified Teacher's Drooling Scale NICE National Institute for Health and Care Excellence TEAE treatment-emergent adverse event ND not detected NDA New Drug Application NHS National Health Service NLT not less than NMR Nuclear Magnetic Resonance NMT not more than NOEL no effect level NS not significant NSAID Non-Steroidal Anti
Radiation of parotid or submandibular glands is effective for drooling in patients with parkinsonism; a randomised double-blind placebo-controlled trial. Drooling is a common symptom in patients with parkinsonism, causing physical and emotional distress. It is unknown which major salivary glands are the best candidates for irradiation to reduce drooling with minimal adverse events. Therefore , this study assessed the efficacy and safety of submandibular and parotid salivary gland irradiation to reduce drooling. A prospective, randomised, double-blind, placebo-controlled trial was conducted at the University Medical Center Groningen, the Netherlands. After informed consent, 31 patients with parkinsonism and severe drooling according to the Unified Parkinson Disease Rating Scale (UPDRS) were
Effects of Kinesio Taping Compared with Manipulation Therapy on Drooling and Speech Intelligibility in Children with Oral Dysphagia: A Pilot Study. To determine the effectiveness of Kinesio Taping (KT) and Manipulation Therapy (MT) on drooling and speech intelligibility in children with oral dysphagia. A randomized clinical trial was conducted at Helping Hand Institute of Rehabilitation Sciences in Mansehra, Pakistan. A total of 20 patients were recruited via the random sampling technique and later assigned to one of two groups: KT (n = 10) or MT (n = 10). Every patient in both groups received their intervention 5 days a week for 1 month (20 sessions total), and each session lasted 45 minutes. Data was collected and analyzed at baseline and 1 month. Drooling was assessed via the Modified Teachers
The effect of Kinesio Taping on drooling in children with intellectual disability: A double-blind randomized controlled study. Drooling is an unintentional spillage of saliva, which can be caused by any condition that affects the neuromuscular control of mouth muscles. There are different treatments for drooling, some of which are novel therapies with unknown efficacy like Kinesio Taping (KT ). This study aimed to investigate the effects of adding KT to oral-motor training (OMT) on drooling in children with intellectual disability. This is a double-blind randomized controlled trial in which 18 children with intellectual disabilities participated through convenience sampling. Participants were randomly assigned into 2 groups by block randomization method. Kinesio taping of orbicularis oris, supra
Surgery versus botulinum neurotoxin A to reduce drooling and improve daily life for children with neurodevelopmental disabilities: A randomized controlled trial.
Surgery versus botulinum neurotoxin A to reduce drooling and improve daily life for children with neurodevelopmental disabilities: a randomized controlled trial. To compare the effect of bilateral submandibular duct ligation and botulinum neurotoxin A (BoNT-A) on drooling severity and its impact on daily life and care in children and adolescents with moderate-to-severe drooling . This was a randomized, interventional, controlled trial in which 53 children and adolescents (31 males, 22 females, mean age 11y, range 8-22y, SD 2y 10mo) with cerebral palsy (58.5%) or other non-progressive developmental disorders (41.5%) were randomized to BoNT-A (n=26) or bilateral submandibular duct ligation (n=27). A parent questionnaire on the severity of drooling in specific positions and daily activities
Subtotal functional sialoadenectomy vs four-duct ligation for the treatment of drooling in neurologically impaired children: long-term follow-up. The best surgical option to treat drooling in neurodisabilities is still under debate. The aim of this study was to describe the technique of subtotal functional sialoadenectomy (SFS) (ie four-duct ligation (4-DL) together with bilateral sublingual gland excision) and its long-term outcomes, in comparison with 4-DL. Retrospective observational cohort study. Unit of Pediatric Surgery of Bambino Gesù Children's Hospital (Rome). Seventy-five patients surgically treated for drooling between 2002 and 2012, with at least five years of follow-up, divided into two groups: 4-DL group (19 patients) underwent four-duct ligation, and SFS group (56 patients
Cost-effectiveness of botulinum neurotoxin A versus surgery for drooling: a randomized clinical trial. This study compared the cost-effectiveness of botulinum neurotoxin A (BoNT-A) injections with two-duct ligation of the submandibular glands as treatment for severe drooling after one treatment cycle. The study was part of a larger, partly single-blinded, randomized clinical trial (trialregister.nl identifier NTR3537). Data were collected between 2012 and 2017. Evaluation was at 32 weeks after one treatment cycle. Fifty-seven patients with cerebral palsy or other neurological, non-progressive disorders and severe drooling classified as having a drooling frequency ≥3 or a drooling severity ≥2, in whom conservative treatment was deemed ineffective, were randomized to treatment by BoNT
Randomized controlled trial comparing botulinum vs surgery for drooling in neurodisabilities To compare the effect of submandibular duct ligation (2-DL) and submandibular botulinum neurotoxin type A (BoNT-A) for drooling in children and adolescents with neurodevelopmental disabilities. A randomized, interventional, controlled, and partly single-blinded study was performed in which submandibular BoNT-A was compared with 2-DL to treat excessive drooling. Main outcomes included a Visual Analog Scale (VAS), drooling quotient (DQ), drooling severity (DS) scale and drooling frequency (DF) scale. Each was obtained at baseline, and 8 and 32 weeks post treatment. Fifty-seven patients (mean age: 11 years, mean baseline VAS score 7.9, mean baseline DQ 27.3%) were randomized to the 2-DL or BoNT-A group
Unsuccessful submandibular duct surgery for anterior drooling: Surgical failure or parotid gland salivation? To evaluate if drooling recurrence after surgery of the submandibular ducts is due to surgical failure or other variables. Historic cohort with prospective collected data of all patients with severe drooling who underwent unsuccessful submandibular duct surgery with subsequent re ) in the current cohort when compared to the reference cohort. Recurrence of drooling surgery is most likely not caused by surgical failure of the primary intervention, because re-intervention (submandibular gland excision) did not lead to more success. Dysarthria and dental malocclusion might negatively influence treatment outcome.
Effects of salivary gland botulinum Toxin-A on drooling and respiratory morbidity in children with neurological dysfunction. To describe the effects of salivary gland Botulinum Toxin-A (SG BoNT-A) on children with drooling due to neurological dysfunction. This was a 3½-year prospective observational case series design of children referred for SG BoNT-A injections at a pediatric hospital (2010 -2014). Outcomes were parent-reported severity, frequency, impact of drooling, and respiratory morbidity; and, from hospital records, number of respiratory hospital admissions. Out of 17 children treated, complete data were available for 15 (including 8 boys) aged 3-14 years (Mean = 9.9 years; SD = 3.4), with a combined total of 71 injections. Most had cerebral palsy (n = 11), classified as Level V
A 48-Year-Old Man With Excessive Drooling and Descending Paralysis Requiring Mechanical Ventilation. A 48-year-old man presented with a chief report of worsening dysphagia for 5 days. Initially, he had difficulty swallowing solids, but it has progressed to difficulty with liquids. There was associated sialorrhea, hypophonia, slurring of speech, hoarseness of voice, cough, and prominent upper