Excessive Salivation as a Hidden Comorbidity of Basal Ganglia Germ Cell TumorFunding None.
23 April 2018
13 June 2018
30 July 2018 (online)
The progression of basal ganglia germ cell tumor (BGGCT) is slow and insidious, and the diagnosis is often delayed. We report here an 11-year-old boy with BGGCT associated with psychomotor deterioration and excessive salivation. Serial salivary gland scintigraphy and single photon emission computed tomography suggested that the dysregulation of basal ganglia to cortical circuitry accounts for the neurological comorbidity associated with BGGCT. We also found that topical scopolamine patches are safe and effective to suppress excessive salivation.
Clinical Trial Registration: No.
Keywordsbasal ganglia germ cell tumor - excessive salivation - unstimulated salivary gland scintigraphy - basal ganglia to cortical circuitry
All authors have no financial relationships relevant to this article to disclose.
Written informed consent for the usage of topical scopolamine patches and publication of the clinical course was obtained from the guardians.
Dr. Kobayashi conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. Dr. Suehiro and Dr. Usami reviewed and analyzed the data. Dr. Maihara and Dr. Heike critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
- 1 Surmeier DJ, Mercer JN, Chan CS. Autonomous pacemakers in the basal ganglia: who needs excitatory synapses anyway?. Curr Opin Neurobiol 2005; 15 (03) 312-318
- 2 Leisman G, Moustafa AA, Shafir T. Thinking, walking, talking: integratory motor and cognitive brain function. Front Public Health 2016; 4: 94
- 3 Leisman G, Braun-Benjamin O, Melillo R. Cognitive-motor interactions of the basal ganglia in development. Front Syst Neurosci 2014; 8: 16
- 4 Sonoda Y, Kumabe T, Sugiyama S. , et al. Germ cell tumors in the basal ganglia: problems of early diagnosis and treatment. J Neurosurg Pediatr 2008; 2 (02) 118-124
- 5 Malbari F, Gershon TR, Garvin JH. , et al. Psychiatric manifestations as initial presentation for pediatric CNS germ cell tumors, a case series. Childs Nerv Syst 2016; 32 (08) 1359-1362
- 6 Rotteveel LJ, Jongerius PH, van Limbeek J, van den Hoogen FJ. Salivation in healthy schoolchildren. Int J Pediatr Otorhinolaryngol 2004; 68 (06) 767-774
- 7 Erasmus CE, Van Hulst K, Rotteveel LJ. , et al. Drooling in cerebral palsy: hypersalivation or dysfunctional oral motor control?. Dev Med Child Neurol 2009; 51 (06) 454-459
- 8 Lewis DW, Fontana C, Mehallick LK, Everett Y. Transdermal scopolamine for reduction of drooling in developmentally delayed children. Dev Med Child Neurol 1994; 36 (06) 484-486
- 9 Crawford JR, Santi MR, Vezina G. , et al. CNS germ cell tumor (CNSGCT) of childhood: presentation and delayed diagnosis. Neurology 2007; 68 (20) 1668-1673
- 10 Proctor GB, Carpenter GH. Salivary secretion: mechanism and neural regulation. Monogr Oral Sci 2014; 24: 14-29
- 11 Ozelame RV, Shroff M, Wood B. , et al. Basal ganglia germinoma in children with associated ipsilateral cerebral and brain stem hemiatrophy. Pediatr Radiol 2006; 36 (04) 325-330
- 12 Higano S, Takahashi S, Ishii K, Matsumoto K, Ikeda H, Sakamoto K. Germinoma originating in the basal ganglia and thalamus: MR and CT evaluation. Am J Neuroradiol 1994; 15 (08) 1435-1441
- 13 Nguyen DK, Botez MI. Diaschisis and neurobehavior. Can J Neurol Sci 1998; 25 (01) 5-12
- 14 Miwa H, Tsuruta K, Kondo T. Avoidance of swallowing saliva: a symptom related to aberrant basal ganglia functions?. Neurocase 2013; 19 (03) 232-235
- 15 Nass R, Coffey BJ. Compulsive spitting in a child with pervasive developmental disorder and Tourette's disorder: tic or compulsion?. J Child Adolesc Psychopharmacol 2010; 20 (01) 71-73
- 16 Renier WO. Compulsive spitting as manifestation of temporal lobe epilepsy. Eur J Paediatr Neurol 2004; 8 (01) 61-62
- 17 Hussein I, Kershaw AE, Tahmassebi JF, Fayle SA. The management of drooling in children and patients with mental and physical disabilities: a literature review. Int J Paediatr Dent 1998; 8 (01) 3-11