Chowdhury Nasim A, Sewatsky Mary Laura, Kim Heakyung
From 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.
Am J Phys Med Rehabil. 2017 Aug;96(8):e151-e154. doi: 10.1097/PHM.0000000000000665.
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.
脑瘫（CP）患儿的流涎会导致误吸、社会融合度降低及生活质量下降。治疗选择包括使用透皮抗胆碱能药物，如东莨菪碱贴片。一项对照临床试验已证实，向唾液腺注射肉毒杆菌毒素（BTX）是透皮抗胆碱能药物的一种有效替代方法，且副作用更安全。针对不同人群进行的多项注射研究表明，唾液分泌减少，生活质量得到改善，与住院相关的费用降低。作者描述了一名15岁的痉挛性四肢瘫脑瘫男孩，在首次向其唾液腺注射A型肉毒杆菌毒素（BTX-A）以治疗流涎1天后，出现呕吐、恶心和嗜睡症状。作者将他的症状归因于东莨菪碱戒断。鉴于医学文献中缺乏相关报道，无论是患有或未患有CP的儿童，对透皮东莨菪碱戒断综合征的认识都很少，导致诊断延迟和潜在并发症。尽管在12岁以下儿童中，尽管临床和非处方使用频繁，但美克洛嗪治疗戒断综合征已取得成功，但其安全性和有效性尚未确立。及时诊断透皮东莨菪碱戒断综合征可导致更快的治疗和更短的住院时间。
