Management of drooling in children with cerebral palsy: A French survey

Abstract

After the age of 4 years, drooling becomes pathological and impacts the quality of life of children with cerebral palsy. The aim of the communication is to characterise children with cerebral palsy and pathological drooling in France, and to describe care pathways, assessment and treatment. A transversal, observational, descriptive survey of the practices and opinions of 400 health professionals potentially involved in the care of children with cerebral palsy, was carried out nationally across France in 2013. The response rate was 36%. Seventy-five questionnaires were returned and analysed (52%). A small proportion of children were specifically treated for drooling (< 25%). Assessments were carried out in 75% of cases and 91% of professionals prescribed treatments. Use of assessment tools varied widely. The most common treatment was oro-facial rehabilitation (95% of professionals), followed by anticholinergic drugs (Scopolamine ® ) (94%) botulinum toxin injections (66%) and surgery (34%). Scopolamine was considered to be less effective than botulinum toxin and to have more side effects. Regarding the protocol, Botox ® is the most commonly used, with a median dose of 1 U/Kg/gland, injected both in parotid and sub-mandibulars glands. The period between two injections is from 3 to 6 months. Glands are located by ultrasound examination. The analgesic method differ from injection centers. The rate of pathological drooling in children with cerebral palsy is likely underestimated and under treated in France. There is a lack of knowledge regarding assessment tools. Aside from rehabilitation, current practice is to prescribe medication as the first-line treatment, however professionals consider that botulinum toxin is more effective and has less side effects. For now, there is no general agreement for the protocol of toxin injection. Further studies should be conducted to define a standardized protocol for injections.