18 GENERAL INTRODUCTION efficacy when reducing drooling and improving quality of life has not been studied in a prospective, controlled setting. Similarly, patient selection for the procedure, cost-effectiveness, and the medium to long-term effect has not yet been explored. Outline of the thesis Chapter 1 Botulinum neurotoxin type A (BoNT-A) is currently used as a first-line interventional treatment for drooling. Almost all children exposed to surgery were previously treated with BoNT-A. The effect throughout multiple Botulinum neurotoxin type A (BoNT-A) injections has not been assessed yet. The first chapter aims to evaluate repeated BoNT-A injections to reveal the feasibility of repeated injections in neurodisabilities. Chapter 2 The second chapter primarily compares the effectiveness and adverse events of 2-DL to BoNT-A. BoNT-A served as a control intervention in this randomized clinical trial (RCT) because it is our institute’s first-line interventional treatment for drooling. Chapter 3 Although surgery is effective in the majority of patients, drooling remains refractory to treatment in some patients. The third chapter evaluates the predictive value of submandibular BoNT-A to 2-DL treatment success and compares the effect of 2-DL to BoNT-A within participants. Chapter 4 It has been well-established that surgery for drooling does not always result in favourable outcomes. Drooling is multifactorial, but clinical predictors for treatment success are yet unavailable. Predictors would be useful to guide families and health professionals and would ideally help avoid 2-DL when there is likely to be no positive outcome. The fourth chapter aims to identify predictors for 2-DL treatment success.
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