| 저자 |
Hyunseok Moon1*, Sungwon Park1, Ju Young Cho1, Kwang Jae Yu1, Jong Min Kim1, Donghwi Park1, Byung Joo Lee1, Zeeihn Lee1† |
Introduction
Drooling of saliva is common in children with physical, intellectual and learning disability, and with poor neuromuscular coordination and oral control. It can cause skin breakdown, psychosocial problems for the child and family. For many years, glycopyrronium has been prescribed off-label using the injection solution given orally or tablets crushed and suspended in water. From January 2017, a glycopyrronium oral solution (Sialanar®) became available in the UK as the first licensed product for the trearment of severe drooling in children and adolescents aged 3 years and older with chronic neurological disorders. In south korea, since December 2017, a glycopyrronium oral solution (Sialanar®) became purchasable only through Korea Orphan & Essential Drug Center. At the patient age of 9, With the consent of the patient’s guardian, patient’s guardian was able to purchase a glycopyrronium oral solution (Sialanar®) through the Korea Orphan & Essential Drug Center. So, we need to consider this new product in the management of severe drooling.
Case
This patient is 9-year-old male who diagnosed as cerebral palsy at the age of 2. He had not only physical, intellectual and learning disability, but also swallowing difficulty. His Gross Motor Function Classification System was corresponded level 4 and His Manual Ability Classification System level was corresponded level 4. He was usually fed by his guardian with total oral intake of multiple consistencies requiring special preparation.
Since the age of eight, his guardian has complained about his odor of saliva. So we planned a pharmacological intervention to control his salivation.
Prior to medication, we assessed the status of drooling of him by Drooling Impact Scale, Drooling Rating scale, Drooling Severity and Frequency scale. He obtained a score of 76.5/100 on Drooling Impact Scale. In each item, he obtained a score of 4 on Drooling Severity and Frequency scale. And also he obtained a score of 14/15 on Drooling Rating scale.
Under Nottinghamshire area prescribing committee guideline, we prescribed 1.5ml per day as loading dose. After a month, We found no side effects on him, and then we prescribed 2.4ml per day as maintaining dose. Since 2 month later, we assessed the status of drooling of him by Drooling Impact Scale, Drooling Rating scale, Drooling Severity and Frequency scale as follow up. He obtained a score of 62.5/100 on Drooling Impact Scale. In each item, he obtained a score of 3 on Drooling Severity and Frequency scale. And also he obtained a score of 12/15 on Drooling Rating scale.
Until now, no specific side effects have been found in him.
Conclusion
Glycopyrronium oral solution (Sialanar ® ) is the possible choice of therapeutic option for the pediatric patient who suffered from severe drooling.
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