Trihexyphenidyl 2mg/5ml oral solution sugar free

IntroductionAnterior sialorrhoea, or "drooling," is the involuntary loss of saliva due to an inability to manage oral secretions. In cerebral palsy (CP), drooling results from oral motor dysfunction, significantly impacting the quality of life of both patients and their caregivers. Despite its physical and psychological repercussions, the clinical approach to sialorrhoea remains poorly defined.ObjectivesThis document aims to provide a guideline for the evaluation and management of sialorrhoea in children with CP, based on the best available evidence and expert consensus. Additionally, it seeks to identify gaps in the literature and propose future research directions.MethodologyA working group was formed, composed of paediatric neurologists from the Spanish Society of Paediatric Neurology (SENEP). A systematic review of the literature was conducted in databases such as MEDLINE, PubMed, and Cochrane, prioritising randomised clinical trials and systematic reviews. Clinical evidence was included when higher-level evidence was unavailable, and recommendations were formulated based on expert consensus.Consensus and discussionThe management of sialorrhoea should be multidisciplinary, including thorough clinical evaluations and assessment scales for severity and impact. Treatment should follow a stepwise approach, starting with non-pharmacological strategies (oromotor therapy, postural correction) and, if necessary, pharmacological interventions with anticholinergics (glycopyrrolate, trihexyphenidyl) or botulinum toxin injection. Surgical options and radiotherapy are reserved for refractory cases.ConclusionSialorrhoea is a clinically relevant issue in children with CP, requiring an individualised approach based on the best available evidence. This consensus provides a useful guideline for clinical practice and highlights the need for further studies to optimise treatment.

Abstract licence: CC BY-NC-ND

BackgroundBilateral focal hand dystonia is an almost pathognomonic sign of Partington syndrome, frequently accompanied by intellectual disability and oromotor dyspraxia. However, a few studies have focused on the treatment of this focal dystonia, making patient management uncertain.CasesWe present 2 cases of Partington syndrome featuring Aristaless-related homeobox (ARX) gene mutations, hand dystonia, and other clinical signs. Various drug treatments were attempted, including levodopa (l-dopa), trihexyphenidyl, tetrabenazine, and benzodiazepines, as well as botulinum toxin. Additionally, a blinded dystonia protocol was used to assess l-dopa's efficacy in 1 patient, which confirmed only mild benefit.Literature reviewThrough a systematic review of the literature, we found that only l-dopa and baclofen might result in mild improvement, whereas propranolol, gabapentin, and haloperidol were reported as ineffective. The descriptions in those studies were, however, imprecise and the improvement rather mild, hindering definitive conclusions about their effectiveness.ConclusionsTreatment options in Partington syndrome-associated dystonia remain elusive. Further research and additional case studies are needed to fully characterize the clinical features of Partington syndrome and to identify effective treatments.

Abstract licence: CC BY

AimTo identify the outcomes reported in published studies of intervention approaches used with non-degenerative childhood hyperkinetic movement disorders, including dystonia, dyskinesia, hypertonia, athetosis, chorea, cerebral palsy, involuntary movement, and kernicterus, and map them to the International Classification of Functioning, Disability and Health (ICF) framework.MethodThis was a scoping review that used the Arksey and O'Malley's framework. Medline, CINAHL plus, and EMBASE were searched from 2001 (when the ICF was approved for use by the World Health Assembly) to February 2025. Data were extracted and mapped to the ICF framework.ResultsA total of 294 studies included 159 surgical (e.g. deep brain stimulation, intrathecal baclofen pump), 81 pharmacological (e.g. levodopa, trihexyphenidyl, toxin injections), 51 non-pharmacological and non-surgical studies, and three studies reporting outcomes longitudinally. Neuromodulation, particularly deep brain stimulation, was reported in 122 studies. Over half of the non-pharmacological/non-surgical studies described the management of the underlying impairments. Outcomes were reported as measured objectively 650 times with 209 unique tools. The most evaluated ICF domain was body functions and structures (375 of 635, 59%), followed by activity (165 of 635, 26%), and participation (37 of 635, 5.8%). The least assessed domains were quality of life (28 of 635, 0.04%), goals (25 of 635, 0.04%), and environment (5 of 635, 0.007%).InterpretationThe major focus of assessment of interventions for children with non-degenerative hyperkinetic movement disorders is on body structure and function. The voices of children remain unheard across all studies, with a lack of individualized measurement. Partnering with children to understand what meaningful outcomes mean to them will go a long way to address this gap.

Abstract licence: CC BY