1/12. Treatment of relative sialorrhoea with botulinum toxin type A: description and rationale for an injection procedure with case report.This paper describes a technique for treatment of relative sialorrhoea by injection of botulinum toxin type A. It includes the rationale for treatment, a description of the regional anatomy, the physiological basis for treatment and the applied pharmacology of the drug. Included also is a case report which is intended to provide an illustration of the benefits of using this method for treating this condition.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/12. Botulinum toxin as an effective treatment of clozapine-induced hypersalivation.Hypersalivation is a common and frequently disabling side effect of atypical neuroleptics such as clozapine. Current treatment options of this adverse advent are limited by lack of efficacy or additional side effects. Botulinum toxin (BTX) injections into the parotid glands have been shown to be very effective in treating sialorrhea in the context of various neurological disorders, such as Parkinson's and motor neuron disease. Surprisingly, BTX treatment of drug-induced sialorrhea has not yet been described. We here report a patient with clozapine-induced hypersalivation and a good response to BTX injections lasting for more than 12 weeks, resulting in a marked reduction of the hypersalivation and consequently of his social withdrawal. Our patient serves to alert clinicians to the frequent problem of drug-induced sialorrhea and suggests that BTX injections should be considered as an effective and safe treatment for hypersalivation in psychiatric patients treated with clozapine.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
3/12. Pediatric caustic ingestion and parental cocaine abuse.OBJECTIVE: To report two cases in which toddlers drank a caustic liquid which their parents had been using to prepare free-base and crack cocaine. DESIGN: Case series. RESULTS: Two toddlers presented with first- and second-degree burns of the oral cavity, pharynx and esophagus from caustic ingestion. The first had drunk ammonia from an unmarked clear plastic container the morning after "a party at a friend's house". The second had drunk potassium hydroxide from a clear plastic container which was labelled "pH UP" and had a small "Danger" sign. Both children were treated with intravenous hydration, steroids, antibiotics and analgesics. Fortunately, neither child suffered long-term physical sequelae. When questioned, the parents of both children admitted to using these alkalis to prepare free-base and crack cocaine. Appropriate steps were taken by social services to protect these children from further neglect. DISCUSSION: Despite federal legislation and public education, pediatric caustic ingestion remains a significant problem. These cases suggest that, in certain cases of pediatric caustic ingestion, caregivers should be questioned regarding possible drug abuse. Larger warning labels and further public education might help prevent many cases of pediatric caustic ingestion.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
4/12. Treating sialorrhea with transdermal scopolamine. Exploiting a side effect to treat an uncommon symptom in cancer patients.INTRODUCTION: sialorrhea is a distressing symptom accompanying oral cancer and many heterogeneous cancer-related conditions (chemotherapy-induced nausea, bowel subocclusion, pharmacologic side effects), but its incidence is low in cancer patients. Conversely, it is frequent in patients with neurological damage, and some therapeutic options have been attempted such as botulinum toxins, anticholinergic agents, and surgical procedures. CASE REPORT: We report the case of an 80-year-old woman with peritoneal carcinomatosis and bowel subocclusion, suffering from distressing nausea and sialorrhea that rapidly improved using transdermal scopolamine. No relevant side effects occurred during the treatment, and the reduction of the abnormal salivation allowed the recovery of oral feeding. CONCLUSIONS: Anticholinergic drugs are classified as secondary options in the treatment of sialorrhea of patients with Parkinson's disease or cerebral palsy, owing to the relevant side effects occurring during prolonged treatments. However, they could be useful in cancer patients with bowel subocclusion, as the reduction of gastrointestinal secretions and intestinal motility (frequent side effects of anticholinergic drugs) could be effective in controlling nausea, vomiting, and abdominal pain. Moreover, the transdermal or sublingual route of administration can be of some interest, avoiding other more invasive parenteral approaches.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
5/12. Visual side-effects from transdermal scopolamine (hyoscine).Transdermal scopolamine may be used to reduce drooling in children with disabilities. Side-effects include dilated pupils and a reduction in the near point of accommodation (the closest point at which clear vision is possible). Two male children with epilepsy, one with spinal dysraphism (aged 7y 6mo) and one with cerebral palsy (aged 5y 8mo), who have undergone treatment for drooling with transdermal scopolamine are described. Near visual acuity was reduced, and both children showed dilated pupils with reduced or no response to light. These responses became normal on cessation of the scopolamine patch. As the effect of this drug may be cumulative, and many patients are unable to communicate difficulties, clinicians need to be aware of these possible side-effects.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
6/12. Fixation-sensitive myoclonus in lafora disease.The authors report a patient with lafora disease, whose myoclonus was suppressed by passive eye closure. Neurophysiologic studies disclosed that fixation was the most important enhancer of myoclonus. Magnetoencephalographic studies of visual evoked fields revealed abnormal activation of the visual corticocortical pathway via the insular cortex not seen in controls. The authors hypothesize that abnormal activation of the insular cortex may be involved in triggering the mechanism of fixation-sensitive myoclonus.- - - - - - - - - - ranking = 0.65180700050224keywords = closure (Clic here for more details about this article) |
7/12. The effect of mouth closure on drooling and speech.The efficacy of a feeding program to decrease drooling and increase vocalizations by promoting mouth closure was explored in two boys with cerebral palsy through the use of oral facilitation techniques. A single-subject ABA design was repeated across subjects. Baseline 1 consisted of 5 (Subject 1) and 10 (Subject 2) half-hour sessions during which the subjects were fed applesauce and apple juice without treatment. A 1-hr play session followed, during which saliva was collected on an absorbent bib and weighted. Bilabial vocalizations produced by the subjects were recorded and counted. A 12-session intervention phase followed, which was identical to the baseline phase except that treatment was implemented. Treatment consisted of techniques to reduce tactile hypersensitivity before feeding and the application of jaw control during feeding. Baseline 2 consisted of 7 sessions identical to baseline 1. The results suggest that this intervention decreases drooling but does not increase bilabial vocalizations. Longer treatment and follow-up may be needed in future efficacy studies.- - - - - - - - - - ranking = 3.2590350025112keywords = closure (Clic here for more details about this article) |
8/12. The use of transdermal scopolamine to control drooling. A case report.Drooling is a serious social handicap experienced by some neurologically impaired patients. No one method has been identified to control drooling for all patients, however, anticholinergic drugs recently have been utilized. In the case study described, transdermal scopolamine patches were found to be effective for controlling drooling in a traumatic brain-injured patient for whom more conservative methods failed. From a baseline saliva flow rate, saliva flow decreased an average of 30% with one-patch and 59% with two-patch dosing. No significant side effects were observed with treatment, and the decrease in drooling was maintained for a 4-month period. Although transdermal scopolamine may represent one acceptable facet of long-term treatment, it must be stressed that efficacy is variable across patient populations and that treatment approaches must be individualized.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
9/12. Nonsurgical treatment of drooling in a patient with closed head injury and severe dysarthria.The purpose of this investigation was to measure the effectiveness of the antimuscarinic drug atropine sulfate in the treatment of chronic drooling in a patient with a history of severe closed head injury and resultant widespread oral neuromuscular and higher cortical disturbances. Results of the A-B-A-B-A-B withdrawal paradigm, chosen to demonstrate the functional relationship between drug therapy and the degree of drooling, revealed that administration of atropine sulfate reduced by more than 50% of baseline levels the amount of resting secretion, intraoral accumulation, and pharyngeal-laryngeal pooling of saliva, with negligible side effects. These results are discussed and compared to the alternative drug and surgical approaches to treatment that have been the primary focus of recent research on drooling.- - - - - - - - - - ranking = 3keywords = drug (Clic here for more details about this article) |
10/12. Decreasing drooling through techniques to facilitate mouth closure.A single case ABA experimental design is presented in which techniques to facilitate mouth closure were hypothesized to decrease drooling. The subject was an 11-year-old male with mental retardation and cerebral palsy. Baseline 1 consisted of 10 half-hour sessions of play, followed by 1-hour periods during which the amount of saliva collected on an absorbent bib was measured and recorded. The subsequent treatment phase of 4 weeks was identical to the baseline except that a half-hour period of intervention was substituted for the half-hour of play. Intervention involved providing jaw control with intermittent tapping and jiggling, stroking the upper gum, and giving juice with jaw control. Baseline 2 consisted of 10 sessions identical to baseline 1. Results indicate that the amount of saliva leaving the mouth was a function of the presence or absence of intervention.- - - - - - - - - - ranking = 3.2590350025112keywords = closure (Clic here for more details about this article) |
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