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Anticholinergic treatment for sialorrhea in children: A systematic review
Peng You1, Julie Strychowsky1, Karan Gandhi2
1Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Insights
Anticholinergic medications like glycopyrrolate and scopolamine effectively treat childhood sialorrhea. However, common side effects and varied study designs limit definitive conclusions, necessitating further research for evidence-based treatment guidelines.
Area of Science:
- Pediatric Neurology
- Pharmacology
- Systematic Reviews
Background:
- Sialorrhea in children presents significant physical and social challenges.
- Anticholinergic medications offer symptomatic relief but lack consensus on optimal efficacy.
Purpose of the Study:
- To systematically review the effectiveness of anticholinergic medications for treating sialorrhea in pediatric patients.
Main Methods:
- A comprehensive systematic review of five databases (Medline, EMBASE, Cochrane, Scopus, Web of Science) was conducted.
- Included studies reported original data on anticholinergic efficacy in children (0-17 years) with sialorrhea.
- PRISMA standards were followed for data extraction and synthesis.
Main Results:
- Twenty-seven articles, including five randomized controlled trials, were synthesized.
- Glycopyrrolate, scopolamine/hyoscine, trihexyphenidyl/benzhexol, benztropine, and atropine demonstrated efficacy.
- Adverse effects were frequent, and heterogeneity in study design precluded meta-analysis.
Conclusions:
- Multiple anticholinergics are effective for pediatric sialorrhea, but evidence is limited by study variability.
- Further research with standardized outcome measures is crucial for evidence-based treatment decisions.
- A guidance table is provided to aid clinical decision-making.
Background:
Sialorrhea in children can be associated with adverse physical and social effects. Treatment using anticholinergic medications has been shown to offer symptomatic relief, but there is no consensus regarding which treatment is the most efficacious.
Objective:
To examine the effectiveness of anticholinergic medications for sialorrhea in children.
Methods:
A systematic review was carried out in Medline, EMBASE, Cochrane, Scopus, and the Web of Science from inception until April 29, 2020. Studies reporting original data on the efficacy of anticholinergic medications in the management of sialorrhea in children aged 0 to 17 years of age were included. This review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards. Data on study design, setting, population, pharmacologic intervention(s), comparator(s), outcomes, and results were extracted and summarized.
Results:
The search strategy identified 2,800 studies of which 27 articles were included in the synthesis, including five randomized controlled trials. Each anticholinergic undergoing experimental study (glycopyrrolate, scopolamine/hyoscine, trihexyphenidyl/benzhexol, benztropine, and atropine) showed evidence of efficacy. Adverse side effects were common. Significant heterogeneity exists in the studies' methodology and the variability of outcome measures used between studies precluded a meta-analysis.
Conclusions:
Glycopyrrolate, scopolamine/hyoscine, trihexyphenidyl/benzhexol, benztropine, and atropine have all shown efficacy in the treatment of sialorrhea in children. The small number of reports and the variability in study design precluded a meta-analysis. More studies are needed with uniformity in outcome measures to help guide evidence-based decision making. A guidance table is presented.
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