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Lovardi E, De Ioris MA, Lettori D, Geremia C, Staccioli S, Bella GD, Scrocca R, Scarselli A, Aversa M, De Peppo F, Campana A, Castelli E. Glycopyrrolate for drooling in children with medical complexity under three years of age. Ital J Pediatr 2022; 48:2. [PMID: 34998418 PMCID: PMC8742944 DOI: 10.1186/s13052-021-01195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background The aim of the study is to determine that Glycopirrolate is safe and effective in decreasing drooling in children with medical complexity under 3 years of age. Medical treatment is based on anticholinergic drugs as transdermal scopolamine, benzotropine and GLY. GLY (Glycopyrronium bromide) is a synthetic quaternary ammonium anticholinergic agent with poor blood–brain barrier penetration and consequently has limited central effects. Actually, the oral GLY formulation was approved by the United States Food and Drug Administration (FDA) to treat drooling in children aged 3–16 years. Five studies reported on GLY use for the treatment of drooling in children with cerebral palsy and other conditions with neurological impairment; four are prospective studies while one a retrospective review. Methods this is a case report of eighteen children (sex ratio 11/8, median age 17 months, range 2–36 months) under three years of age, followed by a multidisciplinary team at the Bambino Gesù Children Hospital. The median follow-up was of 31.5 months (range 1–69 months). Response to treatment was assessed according to the Drooling Impact Scale administered at time 0 and after 1 month. All patients have an important neurological impairment: nine patients have a cerebral palsy (Gross Motor Function Classification System class V) and nine a genetic/malformative syndrome. Twelve patients have a tracheostomy and two need mechanical ventilation. Gastrostomy is present in 16 out of 18 patients. All patients received Glycopirrolate. The median starting daily dose was 0.065 mg/kg/die (range 0.02–0.21 mg/kg/die) three times a day. The drooling impact scale was administered at time O and after 1 month. Results Four out 18 patients stopped treatment for adverse event, lack of efficacy or parental decision. The mean Drooling Impact Scale at time 0 was 89 (range 81–100) and after 1 month 61(range 43–78); the difference was statistically significant (P < 0.001). The overall response to treatment was 94%. Conclusions This is the first study to determine the safety and effectiveness of Glycopyrrolate in decreasing drooling in a specific subset of patients. No major side effects were observed. Further comparative studies are needed to confirm our results.
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Affiliation(s)
- Eleonora Lovardi
- Neurorehabilitation Unit, Department of Neurosciences, Bambino Gesù Children Hospital, IRCCS, Rome, Italy. .,Child Neuropsychiatric Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.
| | | | - Donatella Lettori
- Neurorehabilitation Unit, Department of Neurosciences, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | - Susanna Staccioli
- Neurorehabilitation Unit, Department of Neurosciences, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Gessica Della Bella
- Neurorehabilitation Unit, Department of Neurosciences, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | | | - Marcella Aversa
- Intensive Care Unit, Department of Anesthesia and Intensive Care, Rome, Italy
| | - Francesco De Peppo
- Department of Pediatric Surgery and Transplantation Center, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Andrea Campana
- Pediatrics, University Department of Pediatrics, Rome, Italy
| | - Enrico Castelli
- Neurorehabilitation Unit, Department of Neurosciences, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
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Ursitti F, Ulgiati F, Papetti L, Nicita F, Lovardi E, Vecchi C, Di Marino V, Bertola F, Spalice A. Novel mutations in the glycine receptor alpha subunit gene in two sisters with hyperekplexia. Pediatr Neurol 2014; 51:e3-4. [PMID: 25079583 DOI: 10.1016/j.pediatrneurol.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Fabiana Ursitti
- Division of Child Neurology, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Fiorenza Ulgiati
- Division of Child Neurology, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Laura Papetti
- Division of Child Neurology, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Francesco Nicita
- Division of Child Neurology, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Eleonora Lovardi
- Division of Child Neurology, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Claudia Vecchi
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
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