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Background <p>Neurogenic sialorrhea is a common and distressing symptom in neurological disorders affecting pediatric and adult populations. It most often reflects impaired oropharyngeal control, reduced swallowing, or autonomic dysfunction rather than true salivary overproduction, and it may contribute to aspiration risk, caregiver burden, and reduced quality of life. Sublingual atropine is increasingly used off-label for rapid control of drooling.</p> Methods <p>PubMed, Scopus, and Web of Science were searched from database inception to April 10, 2026. Randomized controlled trials comparing sublingual atropine with placebo, usual care, rehabilitation, or another control intervention in patients with neurogenic sialorrhea were eligible. Findings were synthesized narratively and, when possible, using random-effects meta-analysis with standardized mean differences (SMDs).</p> Results <p>Two randomized controlled trials involving 214 participants were included, comprising pediatric cerebral palsy and adult post-stroke populations. At study-defined endpoints, sublingual atropine significantly reduced drooling compared with control (SMD = -0.67, 95% CI: -0.95 to -0.40; <i>p</i> &lt; 0.00001; I² = 0%). In the 1-week time-matched sensitivity analysis, the pooled effect was not statistically significant (SMD = -0.24, 95% CI: -0.99 to 0.51; <i>p</i> = 0.52), with substantial heterogeneity (I² = 87%). Adverse events were consistent with anticholinergic effects, although a higher frequency of angioedema was reported in the post-stroke trial.</p> Conclusion <p>Sublingual atropine may reduce neurogenic sialorrhea, but the available randomized evidence is limited to two small and clinically heterogeneous trials. The observed effect appears dependent on population, comparator, outcome measure, and follow-up timing. Larger, blinded, dose-finding trials with standardized outcome measures and systematic safety monitoring are needed.</p>

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Sialorrhea Outcomes After Sublingual Atropine in Neurogenic Disorders: Evidence From Randomized Controlled Trials

  • 期刊论文

  • 发表日期：

    2026年7月25日

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  • Youssef Heikal,
  • Mohamed Wagdy,
  • Mostafa M. Abouzahra,
  • Abdulah Mohammad Abdalhamed Aboukaff,
  • Afnan Ismail Ibrahim

摘要

Background

Neurogenic sialorrhea is a common and distressing symptom in neurological disorders affecting pediatric and adult populations. It most often reflects impaired oropharyngeal control, reduced swallowing, or autonomic dysfunction rather than true salivary overproduction, and it may contribute to aspiration risk, caregiver burden, and reduced quality of life. Sublingual atropine is increasingly used off-label for rapid control of drooling.

Methods

PubMed, Scopus, and Web of Science were searched from database inception to April 10, 2026. Randomized controlled trials comparing sublingual atropine with placebo, usual care, rehabilitation, or another control intervention in patients with neurogenic sialorrhea were eligible. Findings were synthesized narratively and, when possible, using random-effects meta-analysis with standardized mean differences (SMDs).

Results

Two randomized controlled trials involving 214 participants were included, comprising pediatric cerebral palsy and adult post-stroke populations. At study-defined endpoints, sublingual atropine significantly reduced drooling compared with control (SMD = -0.67, 95% CI: -0.95 to -0.40; p < 0.00001; I² = 0%). In the 1-week time-matched sensitivity analysis, the pooled effect was not statistically significant (SMD = -0.24, 95% CI: -0.99 to 0.51; p = 0.52), with substantial heterogeneity (I² = 87%). Adverse events were consistent with anticholinergic effects, although a higher frequency of angioedema was reported in the post-stroke trial.

Conclusion

Sublingual atropine may reduce neurogenic sialorrhea, but the available randomized evidence is limited to two small and clinically heterogeneous trials. The observed effect appears dependent on population, comparator, outcome measure, and follow-up timing. Larger, blinded, dose-finding trials with standardized outcome measures and systematic safety monitoring are needed.