Proveca Symposium Summary
European Paediatric Neurology Congress – Athens 2019
Proveca sponsored Symposium:
Chronic Drooling in Children – Consequences and Management – A New Era
- Speaker – Professor Rajat Gupta – Birmingham Children’s Hospital, UK
- Co-Chair – Professor Roser Pons- Agia Sofia Children’s Hospital, Athens
Sialanar® for Chronic drooling in children – Consequences and management – A new era
Dr Rajat Gupta, Head of the Neurorehabilitation Department at the Birmingham Children’s Hospital, UK, began his presentation with the most important take-home message, that ‘chronic drooling is a problem that should be taken seriously.’
Dr Gupta described the key functions of saliva, salivary glands and swallowing, and then described the consequences of salivary control dysfunction. He described how secondary sialorrhea occurs in about 40% of children and young people with cerebral palsy and discussed the main consequences, including social rejection and isolation, loss of self-esteem, repeated clothes changes, skin rashes, malodour, disrupted speech and recurrent chest signs and symptoms.
Dr Gupta explained the different rating scales that can be used to assess children and young people who present with drooling, but also suggested that parents or carers are asked simple questions about the frequency of clothes and bib changes to ensure that the problem is not overlooked.
The key team members that should be involved in the assessment and management of children with chronic drooling were listed – the ‘dream team’ should include a paediatrician, a speech and language therapist, an occupational therapist, an oral health specialist, an ENT surgeon, a pharmacist and a clinical nurse specialist. Dr Gupta then discussed the range of management approaches that can be employed, such as posture management, oral awareness programmes, behavioural management techniques, medications including anti-cholinergics and anti-dystonic agents, and more invasive techniques including botulinum toxin injections and surgical procedures that may be used in severe cases.
Dr Gupta then discussed the benefits of glycopyrronium bromide solution (Sialanar®), which is available for paediatric use in Europe and the rest of the world via a managed access programme. He described a head-to-head trial of glycopyrronium bromide solution compared with hyoscine patches and explained that both medications improved drooling considerably but that hyoscine patches were associated with more problematic adverse events and treatment cessations. Specifically designed for children, Dr Gupta pointed out that Sialanar® is provided in a concentrated solution and that the dose can be easily titrated and adjusted by small increments if needed. Children and young people receiving Sialanar® should be regularly monitored to assess response and also the development of any adverse events.
Dr Gupta finished his presentation with a real-life case study, explaining how 14-year-old ‘Rosie’ had chronic drooling but was unable to tolerate hyoscine patches and found crushed glycopyrronium tablets ineffective. When Rosie began to take Sialanar®, her drooling was substantially reduced – she was able to eat more orally with less dependency on a gastrostomy tube and had improved quality of life due to fewer clothes changes, less malodour and fewer urinary tract infections due to less dehydration.
Dr Gupta concluded by saying that drooling must not be ignored and that effective treatment is available. The approach taken must be chosen to suit the individual’s needs and to provide the best balance between factors that might adversely affect the patient, such as side effects, and improved quality of life.
Created March 2020