Stroke And Drooling: Understanding The Connection

A stroke can indeed cause drooling, or sialorrhea, in babies and adults. Drooling is a sign of a stroke in babies who should have developed the ability to hold their mouth closed and swallow. However, there are often more likely explanations for a child's drooling, such as teething. In adults, drooling after a stroke is often a result of dysphagia, or difficulty swallowing. This can lead to an overproduction of saliva, which can cause embarrassment and social isolation, as well as serious complications like aspiration pneumonia. Treatments for post-stroke drooling include speech and swallowing therapy, medication, and injections or surgery to reduce saliva production.

Excessive drooling in babies can be a sign of a stroke

While excessive drooling can be a sign of a stroke in infants and toddlers, it is not one of the most common signs. Some of the more common signs of a pediatric stroke include seizures, extreme sleepiness and lethargy, only using one side of the body, marked weakness on one side, and difficulty with motor-related developmental milestones.

It is important to seek medical attention if you suspect your child is exhibiting any signs of a stroke, as early intervention is crucial for improving outcomes. In addition to medical treatment, speech and swallowing therapy can also be beneficial for children with drooling caused by a stroke. This type of therapy can help improve the safety of swallowing and minimize the risks of aspiration.

In some cases, medication or surgery may be recommended to control drooling. Anticholinergic medications, such as glycopyrrolate, are often used to reduce drooling by drying up saliva. Botulinum toxin injections into the salivary glands are another option, as they can paralyze the muscles that produce saliva.

Stroke is one of the leading causes of disability and death worldwide

Stroke is the second leading cause of death worldwide, and a major cause of disability. Over half of people who have a stroke will die as a result, and survivors can be left with devastating physical and mental impairments. These can include reduced physical mobility, difficulties eating and speaking, and impaired emotions and thought processes.

The risk of having a stroke increases with age, but they can occur at any time. Globally, one in four adults over the age of 25 will have a stroke in their lifetime, and more than 100 million people have experienced a stroke. Stroke incidence is increasing as the global population ages, and more young people are affected by strokes in low- and middle-income countries.

Stroke-related disorders include limb paresis, headaches, epileptic seizures, deep vein thrombosis, and urinary tract infections. The mortality rate among people with post-stroke dysphagia and tube feeding ranges from 20 to 24%. Stroke is also a fundamental cause of depression and dementia.

High blood pressure, high cholesterol, smoking, obesity, and diabetes are leading causes of stroke. Preventative measures such as quitting smoking, improving diet, and increasing exercise can help to reduce the risk of stroke.

Botulinum toxin injections are an effective treatment for drooling

Several studies have shown that botulinum toxin injections are a safe, reversible, and effective treatment for drooling, with few adverse effects and no life-threatening events. The injections can be repeated if drooling recurs, and their effects typically last for at least 8–12 weeks, with some studies showing efficacy for up to 6 months. The optimal protocol for injection involves administering 20 units of botulinum toxin into each submaxillary gland and 30 units into each parotid gland. The total dose typically ranges from 10–120 units or 2–4 units/kg, and it is recommended that the dosage does not exceed 4 units/kg to avoid major complications.

The benefits of botulinum toxin injections for treating drooling include their ability to reduce the impact of drooling on patients' quality of life, ease of administration, and lack of permanent adverse effects, as the treatment is not irreversible like some surgical procedures. The injections can be guided by ultrasound to ensure accurate targeting of the salivary glands, which improves the efficacy of the treatment.

Overall, botulinum toxin injections are a well-established and effective treatment for drooling, particularly in children with cerebral palsy, offering a safe and reversible option with minimal side effects.

Speech and swallowing therapy can help control drooling

A speech therapist can conduct an evaluation to determine the baseline of muscle function in the lips, cheeks, jaw, tongue, and soft palate. During this process, numerous muscle functions will be evaluated, such as the response to pressure and movement, and the strength of movement. Once the cause of the drooling is determined, a speech therapist may use one of the following therapeutic strategies:

Oral Facial Facilitation

Oral facial facilitation is a speech therapy method used to improve oral motor control, sensory awareness, and the frequency of swallowing. Oral facial facilitation includes a variety of techniques aimed at improving muscle tone and saliva control. Examples include applying ice to improve tone and the swallow reflex, brushing teeth before meals, using vibrations to improve muscle tone, and manipulation of muscles, such as tapping, stroking, or patting with fingertips to improve oral awareness.

Developing Eating and Drinking Skills

Drooling can be exacerbated by poor eating and drinking skills. A speech therapist can help develop better techniques surrounding lip closure, tongue movement, and swallowing. They may also advise against eating and drinking certain foods that increase saliva production, such as alcohol and acidic fruits.

Positioning Improvements

Changing body positioning can significantly improve drooling in adults. A speech therapist will work with the patient to practice good posture and proper trunk and head control, as these skills provide the basis for improving oral control and drooling. They may also recommend specific sleeping positions to improve nighttime drooling, such as switching to sleeping on the back, which can be facilitated by using a wedge pillow.

Behavioral Modification

Behavioral modification uses cueing, overcorrection, and positive and negative reinforcement to address drooling in adults. During behavioral modification therapy, behaviors such as swallowing and mouth wiping are encouraged, while behaviors such as keeping the mouth open and thumb-sucking are discouraged. This can help improve drooling by increasing awareness of the mouth and its functions, increasing the frequency of swallowing, and improving swallowing skills. Behavioral modification is also particularly useful as it can be practiced at home with family and friends and carries no negative side effects.

Anticholinergic medications can be used to treat drooling

Three commonly used anticholinergic medications for drooling are benzhexol, glycopyrrolate, and scopolamine. Benzhexol, glycopyrrolate, and scopolamine were prescribed 81, 62, and 17 times, respectively, with respective response rates of 85%, 75%, and 65%. Poor head control and poor oromotor function were predictive of a poor response. Side effects were common and often led to treatment discontinuation, with males more likely to experience side effects than females. Of the three medications, glycopyrrolate had the best results and fewest side effects.

Anticholinergic medications can also be used to treat drooling caused by the use of antipsychotics or neuroleptics. Drooling is a common side effect of these drugs and can be challenging to treat. However, no studies were found to support the use of anticholinergics for this purpose, and more research is needed to guide clinical practice.

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