Management of drooling in disabled patients with scopolamine patches.
OBJECTIVE
To evaluate the efficacy of scopolamine administered transdermally for the treatment of drooling in severely disabled patients.


METHODS
A prospective, randomized, double-blind, crossover, placebo-controlled clinical trial was designed. The study group consisted of 30 handicapped patients with persistent drooling. The exclusion criteria were the specific contra-indications of scopolamine. Severity of drooling was quantified using a modified Thomas-Stonell and Greenberg visual scale simplified into three grades: 1 = dry; 2 = mild/moderate; 3 = severe/fulsome. The frequency of drooling was estimated using the number of bibs used each day. The baseline observational phase was followed by the application of a 1.5 mg scopolamine (Scopoderm TTS; Novartis Consumer Healthcare, UK) or placebo patch every 72 h for a fortnight. This was followed by a 1 week washout period and then crossover of assignments for 2 weeks.


RESULTS
At baseline, 77% of patients showed grade 3 of drooling. The placebo administration showed no significant reduction in drooling. We found a significant drooling reduction (P < 0.005) in the scopolamine group in the 1 and 2 week controls (69% and 80% respectively <or= grade 3). The mean number of bibs/day decreased during the scopolamine phase from 6/day at baseline to 3/day at the 2 week control. Four patients (13.3%) dropped out because of scopolamine side effects and minor adverse reactions were observed in three other patients. No blood alterations were found during the study period.


CONCLUSIONS
Scopolamine can be useful to control drooling in severely disabled patients although it requires appropriate patient selection and is not free from adverse effects.
Mato
Abigail
A
Special Needs Department, School of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, Spain.
Limeres
Jacobo
J
Tomás
Inmaculada
I
Muñoz
Maria
M
Abuín
Concepción
C
Feijoo
Javier F
JF
Diz
Pedro
P
D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D002648:Child; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012601:Scopolamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012798:Sialorrhea / Q000188:drug therapy*; D055815:Young Adult
D018680:Cholinergic Antagonists; D012601:Scopolamine