From the Guidelines
Management of cerebral palsy secretions should prioritize a multi-faceted approach, including airway clearance techniques such as manually assisted cough, mechanical insufflation-exsufflation devices, and lung volume recruitment, as recommended by the most recent guidelines 1. When managing secretions in cerebral palsy patients, it is essential to consider the individual's respiratory muscle strength, cough effectiveness, and potential for aspiration.
- Airway clearance techniques, such as manually assisted cough and mechanical insufflation-exsufflation devices, can be beneficial in patients with impaired cough strength or frequent chest infections 1.
- Lung volume recruitment and breath stacking can also be used to improve inspiration and secretion clearance 1.
- Proper positioning, regular suctioning, and adequate hydration are also crucial in preventing complications like aspiration pneumonia and respiratory distress.
- The use of mucolytic agents like N-acetylcysteine may be considered in patients with thick secretions, although the evidence for its effectiveness in cerebral palsy is limited.
- Referral to a specialist respiratory service with a physiotherapist is recommended for patients with concerns about cough strength, ability to manage chest secretions, or frequent chest infections 1.
- A low threshold for antibiotic treatment should be considered in patients with recurrent lower respiratory chest infections, and individual care plans should be developed to advise on antibiotic treatment and other interventions 1.
From the FDA Drug Label
GLYCOPYRROLATE ORAL SOLUTION 1MG/5ML is an anticholinergic indicated to reduce chronic severe drooling in patients aged 3-16 years with neurologic conditions associated with problem drooling (e.g., cerebral palsy). The answer is: Glycopyrrolate oral solution is indicated to reduce chronic severe drooling in patients with cerebral palsy.
- The recommended dose is 0.02 mg/kg three times daily, titrated in increments of 0.02 mg/kg every 5-7 days, based on therapeutic response and adverse reactions.
- The maximum recommended dose is 0.1 mg/kg three times daily, not to exceed 1.5-3 mg per dose based upon weight 2.
From the Research
Cerebral Palsy and Secretions
- Cerebral palsy (CP) is a neurodevelopmental disorder characterized by abnormalities of muscle tone, movement, and motor skills, which can lead to various secondary medical conditions, including issues with secretions such as drooling 3.
- Drooling, or sialorrhea, is a common problem in children with cerebral palsy, and its management is crucial to prevent respiratory complications and improve the quality of life for these patients 4, 5.
Management of Drooling in Cerebral Palsy
- Botulinum toxin type A (BoNT-A) injections have been shown to be a safe and effective treatment for drooling in children with cerebral palsy, with studies demonstrating significant reductions in drooling quotient and frequency 4.
- Anticholinergic medications, such as glycopyrrolate, have also been used to manage drooling in children with cerebral palsy, with significant improvement in drooling noted in the majority of cases, although side effects can occur 5, 6.
- Nebulized glycopyrrolate has been reported as a noninvasive and relatively safe treatment option for posterior drooling in patients with brain injury, including cerebral palsy, with advantages including minimal central adverse effects 6.
Clinical Considerations
- The management of cerebral palsy requires a multidisciplinary team approach, including neurological rehabilitation, diagnosis, and management of co-morbidities, such as epilepsy, impairment of cognition, vision, hearing, and disturbances of growth and gastrointestinal function 3, 7.
- Early diagnosis and intervention are crucial in the management of cerebral palsy, with a combination of clinical history, standardized neuromotor assessment, and findings on magnetic resonance imaging (MRI) used to diagnose and monitor the condition 7.