Scopolia extract is effective for the management of sialorrhea and respiratory problems due to excess oral secretion in patients with severe motor and intellectual disabilities

<p>  Objective: Sialorrhea and excess oral secretion are major problems in patients with severe motor and intellectual disabilities (SMID). These cause respiratory problems as well as sanitary problems, and lead to a severe burden on caregivers. However, there is no appropriate treatment to these conditions. Scopolia extract (SE) is usually used as a patent medicine to treat gastrointestinal disorders. It contains belladonna alkaloids which suppress the parasympathetic nerves and is expected to reduce saliva secretion. Methods: The caregivers (guardians, nurses and/or health care assistants) of the residents with SMID at our institution who suffered from above problems asked us to manage them. Following informed consent from the caregivers and later approval from the ethical committee for off-label use of SE for sialorrhea and excess oral secretion were obtained, up to 1.1-3.5 mg/kg (mean : 2.2 mg/kg) of SE was administered to the patients. SE was considered to be effective when sialorrhea nearly disappeared or when oral secretion decreased to less than half of that at the baseline level, and the efficacy was retrospectively surveyed. The impact of SE on nursing was surveyed on 27 nurses and healthcare assistants. Results: SE was administered to 47 patients and effective in 45 patients : 23/24 cases of sialorrhea and 22/23 cases of excess oral secretion. Adverse events occurred in six cases, including four cases of increased gastric residue and each one case of decreased bowel movement and sticky sputa, which was resolved by reducing or discontinuing SE. Constipation worsened in 10 cases but improved in four cases. SE was discontinued in six patients, including two patients with adverse events. Decreased sialorrhea and oral secretion led to a reduction in caregivers’ time and mental stress. In addition, it also improved the quality of life of both patients and caregivers. Conclusions: With regard to off-label use, SE is effective and applicable to the management of sialorrhea and respiratory problems due to excess oral secretion in patients with SMID.</p>