114 CHAPTER 5 Drooling severity Caregivers marked the severity of drooling during 13 positions and daily activities as not applicable (99), none (1), mild (2), moderate (3), severe (4), or very severe (5). For some participants, positions and daily activities were not applicable in supported sit (BoNT-A1; 2-DL1), unsupportedsit (1;3), proneposition (5;5), walking (9;12), intensive movements (7;7), tired (0;0), eating (4;3), drinking (4;5), talking (9;8), concentrated activity (3;2), relaxed watching tv (2;1), strenuous activity (1;1) and enthusiastic (0;0) respectively. Excessive drooling (i.e. severe or very severe drooling) at baseline was most common in a prone position (89%) or during intensive movement (sport) (83%) and least reported during talking (49%) or drinking (53%). Eight weeks after BoNT-A and 2-DL, caregivers reported reduced drooling in all positions and daily activities (figure 1). Thirty-two weeks after treatment, the degree of drooling remained decreased in all positions and daily activities for the 2-DL group (p = <0·001) except for walking, in contrast to children who underwent BoNT-A, in whom the drooling severity had not significantly decreased during walking, intensive movements or eating and even significantly increased during drinking, talking and strenuous activity compared to baseline as illustrated by figure 1. The mean percentage of excessive drooling from all 13 positions and daily activities together, dropped from 74% to 46% 8 weeks after BoNT-A (mean difference 28·2, p = <0·001, 95% CI 19·4 to 37·1), but increased again to 66% 32 weeks after BoNT-A (mean difference from baseline 7·6, p = 0·009, 95% CI 2·3 to 13·0). For 2-DL, the mean percentage of excessive drooling from all 13 positions and daily activities together declined from 71% at baseline to 15% after 8 weeks (mean difference 55·6, p = <0·001, 95% CI 46·0 to 65·3), which increased to 34% 32 weeks post treatment (mean difference from baseline 37·4, p = <0·001, 95% CI 31·1 to 43·7). At both 8 and 32 weeks 2-DL had a larger effect on the mean excessive drooling reduction than BoNT-A with a mean difference of -27·4 (p = <0·001, 95% CI -39·8 to -15·0) and -29·8 (p = <0·001, 95% CI -37·7 to -21·9) respectively.
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