Exploring treatments for drooling in children with neurological disorders

ABSTRACT

Introduction: Drooling represents a major problem in the every-day life of pediatric patients with neurological disorders. The significant burden, both physical and socio-psychological, of the disorder requires adequate clinical evaluation and proper management. However, treating drooling remains a challenge for clinicians. This is a review of the most up-to-date therapeutic options for the treatment of drooling in the pediatric population, hence both conservative, pharmacological, and surgical approaches are discussed.

Areas covered: Randomized clinical trials (RCTs), structured reviews, and case reports are included. Special focus is paid on the methods used to evaluate the efficacy and safety outcomes in the selected RCTs, trying to promote the use of more validated scales to assess drooling in the future.

Expert opinion: The lack of reliable metrics to assess efficacy and safety outcomes in drooling limits researchers from identifying the best patient-suitable treatment. The relatively small number of clinical trials carried out over the last two decades is also due to the difficulty in assessing drooling using subjective scales. A key enabler for new efficient therapies stands in the introduction of accurate and robust metrics to measure treatment effectiveness on drooling.

KEYWORDS:

• Cerebral palsy
• children
• drooling
• neurological disorders
• treatments

Article highlights

• Drooling severely impacts on the Health-Related Quality of Life (HRQoL) of patients with neurological disorders, and it is particularly frequent in children with cerebral palsy (CP).

• Objective methods to measure drooling are not validated and do not evaluate the impact on the every-day life of patients; hence, the subjective scales currently seem more accurate.

• Conservative measures are used as the first approach; then, in most children, anticholinergic drugs are required. Botulinum toxin injection and surgical methods represent an alternative when all the above-mentioned methods fail.

• Glycopyrrolate emerges as the best performing drug in terms of efficacy and side effects as compared to the other anticholinergic drugs.

Acknowledgments

This work was developed within the framework of the DINOGMI Department of Excellence of MIUR 2018-2022 (legge 232 del 2016).

Declaration of interest

P Striano has served on a scientific advisory board for the Italian Agency of the Drug (AIFA); has received honoraria from GW pharma, Kolfarma s.r.l, and Eisai Inc.; and has received research support from the Italian Ministry of Health and Fondazione San Paolo. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript is an advisor and speaker for Abbvie, Ipsen, and Merz. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.