title: Interventions for drooling in children with cerebral palsy.
abstract: BACKGROUND
  Drooling is a common problem for children with cerebral palsy (CP). This can be distressing for these children as well as for their parents and caregivers. The consequences of drooling include risk of social rejection, damp and soiled clothing, unpleasant odour, irritated chapped skin, mouth infections, dehydration, interference with speech, damage to books, communication aids, computers, and the risk of social isolation (Blasco 1992; Van der Burg 2006). A range of interventions exist that aim to reduce or eliminate drooling. There is a lack of consensus regarding which interventions are most effective for children with CP.
  
  
  OBJECTIVE
  (1) To evaluate the effectiveness and safety of interventions aimed at reducing or eliminating drooling in children with cerebral palsy. (2) To provide the best available evidence to inform clinical practice. (3) To assist with future research planning.
  
  
  METHODS
  We searched the following databases from inception to December 2010 : Cochrane Central Register of Controlled Trials (CENTRAL); Medline via Ovid; EMBASE; CINAHL; ERIC; Psych INFO; Web of Science; Web of Knowledge; AMED; SCOPUS; Dissertation Abstracts.We searched for ongoing clinical trials in the Clinical Trials web site (http://clinicaltrials.gov.) and in the Current Controlled Trials web site (http://www.controlled-trials.com/). We hand searched a range of relevant journals and conference proceeding abstracts.
  
  
  METHODS
  Only randomised controlled trials (RCTs) and controlled clinical trials (CCTs) were included.
  
  
  METHODS
  Data were extracted independently by MW, MS and LP and differences resolved through discussion.
  
  
  RESULTS
  Six studies were eligible for inclusion in the review. Four of these studies were trials using botulinum toxin-A (BoNT-A) and two were trials on the pharmacological interventions, benztropine and glycopyrrolate. No RCTs or CCTs were retrieved on surgery, physical, oro-motor and oro-sensory therapies, behavioural interventions, intra-oral appliances or acupuncture. In the studies eligible for review, there was considerable heterogeneity within and across interventions and a meta-analysis was not possible. A descriptive summary of each study is provided. All studies showed some statistically significant change for treatment groups up to 1 month post intervention. However, there were methodological flaws associated with all six studies.
  
  
  CONCLUSIONS
  It was not possible to reach a conclusion on the effectiveness and safety of either BoNT-A or the pharmaceutical interventions, benztropine and glycopyrrolate. There is insufficient evidence to inform clinical practice on interventions for drooling in children with CP. Directions for future research are provided.
authors.affiliation: Clinical Speech and Language Studies,TrinityCollegeDublin,Dublin 2, Ireland. walshema@tcd.ie.
authors.forename: Margaret
authors.initials: M
authors.lastname: Walshe
authors.forename: Martine
authors.initials: M
authors.lastname: Smith
authors.forename: Lindsay
authors.initials: L
authors.lastname: Pennington
mesh_terms: D000293:Adolescent; D000328:Adult; D001590:Benztropine / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006024:Glycopyrrolate / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D009465:Neuromuscular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012472:Salivation / Q000187:drug effects; D012798:Sialorrhea / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D001590:Benztropine; D019274:Botulinum Toxins, Type A; D006024:Glycopyrrolate