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Transdermal Scopolamine Withdrawal Syndrome Case Report in the Pediatric Cerebral Palsy Population
Nasim A Chowdhury1, Mary Laura Sewatsky, Heakyung Kim
1From the New York-Presbyterian Hospital/Weill Cornell Medical Center, Weill Cornell Medicine (NAC); and NewYork-Presbyterian Hospital/Columbia University Medical Center, Columbia University College of Physicians & Surgeons (MLS, HK), New York, New York.
Insights
Botulinum toxin injections for sialorrhea in children with cerebral palsy may cause scopolamine withdrawal. Prompt diagnosis and treatment with meclizine can improve outcomes.
Area of Science:
- Pediatric Neurology
- Gastroenterology
- Pharmacology
Background:
- Sialorrhea in children with cerebral palsy (CP) negatively impacts quality of life and increases aspiration risk.
- Transdermal scopolamine patches are a common management option, but have potential side effects.
- Botulinum toxin (BTX) injections offer an alternative with a potentially safer side effect profile.
Observation:
- A 15-year-old boy with CP experienced nausea, emesis, and lethargy post-BTX-A salivary gland injection.
- These symptoms were attributed to withdrawal from prior transdermal scopolamine use.
- This case highlights a potential, under-recognized withdrawal syndrome in pediatric patients.
Findings:
- Transdermal scopolamine withdrawal syndrome is not well-documented in pediatric literature, leading to diagnostic delays.
- Meclizine showed success in treating the withdrawal symptoms in this case.
- The safety and efficacy of meclizine in children under 12 for this indication are not established.
Implications:
- Increased awareness of transdermal scopolamine withdrawal is crucial for timely diagnosis and management in children with CP.
- Early recognition can prevent prolonged illness and reduce hospitalization costs.
- Further research is needed to establish treatment guidelines for this syndrome in pediatric populations.
Abstract:
Sialorrhea in children with cerebral palsy (CP) results in aspiration, decreased social integration, and poor quality of life. Management options include transdermal anticholinergics such as the scopolamine patch. A controlled clinical trial has proven botulinum toxin (BTX) injections into the salivary glands are an effective alternative to transdermal anticholinergics with a safer side effect profile. Multiple studies of the injections in diverse populations demonstrate reduction in saliva production with improvement in quality of life and decrease in hospitalization-associated costs. The authors describe a 15-year-old boy with spastic quadriplegic CP who developed emesis, nausea, and lethargy 1 day after the first injection of botulinum toxin A (BTX-A) to his salivary glands for sialorrhea management. The authors ascribed his symptoms to scopolamine withdrawal. Given the lack of exposure in the medical literature, there is minimal awareness of the withdrawal syndrome from transdermal scopolamine in children with or without CP, resulting in delayed diagnosis and potential complications. Treatment of the withdrawal syndrome has been successful with meclizine though safety and efficacy has not been established in children younger than 12 despite frequent clinical and over-the-counter use. Prompt diagnosis of the transdermal scopolamine withdrawal syndrome can result in quicker treatment and a shorter hospital stay.
