Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.
Dev Med Child Neurol. 2020 Mar;62(3):346-353. doi: 10.1111/dmcn.14350. Epub 2019 Sep 8.
To determine: the effectiveness of three anticholinergic medications in reducing drooling in children with developmental disabilities (such as cerebral palsy, intellectual disability, and autism spectrum disorder), the frequency and nature of side effects, and their impact on treatment discontinuation.
After prescription of benzhexol hydrochloride, glycopyrrolate, or scopolamine patches at a tertiary saliva control clinic, all carers of 110 consecutive, eligible patients were recruited over a 5-year period. They provided data for 52 weeks, or until drug discontinuation, on compliance, drooling, adverse effects, and reasons for cessation. We evaluated and compared best drooling response, side effects, and drug cessation rates using survival analysis, and the effect of baseline variables on the discontinuation rate using proportional hazards regression.
Among 110 participants (71 males, 39 females; mean age 8y 5mo [SD 4y 3mo], range 1y 11mo-18y 11mo), benzhexol, glycopyrrolate, and scopolamine were prescribed 81, 62, and 17 times respectively, with respective response rates of 85%, 75%, and 65%. Poor head control and poor oromotor function were predictive of poor response. Side effects frequently prompted drug cessation in males more than females (hazard ratio 1.8 [95% confidence interval 1.0-3.2], p=0.048). Glycopyrrolate had the fewest side effects.
Benzhexol, glycopyrrolate, and scopolamine reduce drooling, but improvement is offset by adverse side effects. Overall, glycopyrrolate performs best.
In drooling, glycopyrrolate produced the greatest improvement with fewer side effects compared with benzhexol and scopolamine. Poor head control and poor oromotor function were associated with poor response. Medication side effects were common and often led to treatment discontinuation. Behavioural issues instigated cessation of benzhexol more often in males than females.
确定三种抗胆碱能药物在减少发育障碍儿童（如脑瘫、智力障碍和自闭症谱系障碍）流涎方面的有效性，包括副作用的频率和性质，以及它们对停药的影响。
在一个三级唾液控制诊所，为 110 名连续、符合条件的患者中的每一位开具盐酸苯海索、格隆溴铵或东莨菪碱贴片处方后，在 5 年内招募了所有 110 名患者的照顾者。他们在 52 周内或直至停药，提供了关于依从性、流涎、不良反应和停药原因的数据。我们使用生存分析评估和比较了最佳流涎反应、副作用和停药率，并使用比例风险回归分析了基线变量对停药率的影响。
在 110 名参与者（71 名男性，39 名女性；平均年龄 8y 5mo[SD 4y 3mo]，范围 1y 11mo-18y 11mo）中，分别为 81、62 和 17 次处方了盐酸苯海索、格隆溴铵和东莨菪碱，相应的反应率分别为 85%、75%和 65%。头部控制不良和口腔运动功能不良是反应不良的预测因素。男性比女性更容易因副作用而停药（危险比 1.8[95%置信区间 1.0-3.2]，p=0.048）。格隆溴铵的副作用最少。
苯海索、格隆溴铵和东莨菪碱均可减少流涎，但不良反应会抵消改善效果。总的来说，格隆溴铵效果最好。
在流涎方面，与苯海索和东莨菪碱相比，格隆溴铵的效果最好，副作用最少。头部控制不良和口腔运动功能不良与反应不良有关。药物副作用很常见，常常导致治疗中断。行为问题导致男性比女性更频繁地停止使用苯海索。
