Medical Management of Sialorrhea in the Child with Cerebral Palsy

Abstract

Drooling is defined as the inability to control and swallow oral secretions resulting in unintentional loss of saliva from the mouth. This distressing condition chronically afflicts many patients with cerebral palsy and has numerous deleterious effects such as skin irritation, perioral infection, aspiration pneumonia, soiled clothing, assistive equipment damage, increased caregiver burden, lowered self-esteem, social isolation, and an overall lower quality of life. Clinical assessment and quantification of drooling are important for planning and monitoring the effectiveness of interventions. Common assessment scales include the Drooling Quotient, the Drooling Severity and Frequency Scale, and the Drooling Impact Scale. Treatment may initially involve non-pharmacologic, noninvasive methods such as behavioral modifications and oral-motor exercises. Medical therapy typically includes anticholinergic medications, such as glycopyrrolate and scopolamine patches. When conservative therapies are insufficient, direct injection of botulinum toxin into the salivary glands is frequently performed. In patients with more severe drooling that is inadequately managed with other therapies or in patients who desire more permanent solutions, a variety of surgical options are available.