PWT Tse, BSK Chiu, AKH Chan

Purpose: To evaluate the efficacy & safety of transdermal scopolamine (TTS) in the reduction of oral secretions in severely developmentally disabled (DD) children. Drooling is a common problem which can give rise to serious clinical complications such as aspiration pneumonia in this group of children. TTS patch is a synthetic anticholinergic which provides a convenient method of constant release of the drug over a 3 day period.

Methods: A prospective, doubled-blind, placebo-controlled, cross-over study of the effect of TTS in 30 severe DD children. These children were all residents of Mental Handicap Unit, Paediatric Department of Caritas Medical Centre and they all had moderate to severe drooling. They are randomised into two groups: 1. Treatment Group; 2. Placebo Group. For the first 2 weeks, the Treatment Group received TTS patches which were changed twice weekly, while placebo was applied to the other group. This was followed by one week of Wash-Out Period, after which the 2 Groups crossed over for another 2 weeks.

The observers (blinded) were constant caregivers of the children; either the nurses or the class-teacher at school. An observational scale (0-5) for assessment of drooling was used and a score was given daily. Mean Treatment & Placebo Scores were compared.

Results: 25 out of 30 children showed reduction in drooling. Data analysis with Wilcoxon matched-pairs signed ranks test - 2 tailed p = 0.0004 (significant). No clinically significant side-effect was observed.

Conclusions: Transdermal scopolamine is effective and safe in reduction of drooling in children with severe developmental disabilities.