220 SUMMARY Chapter 1 Repeated botulinum neurotoxin type A (BoNT-A) is currently the first-line interventional treatment for drooling because it is minimally invasive, and there is limited risk for severe adverse events. BoNT-A is effective in the majority of patients. Yet, the effect is temporary, and, injections are required at least once yearly to maintain the effect. Moreover, BoNT-A is injected under general anaesthesia, so one injection necessitates multiple hospital visits. These drawbacks often lead to the discontinuation of treatment. Another possible reason for discontinuation is the lack or diminished effect after repeated injections. Neutralizing antibodies may play a role in decreasing effect after repeated injections, while alternative literature suggests gland atrophy and therewith permanent reduction in drooling after repeated injections. This study aims to evaluate the effect of repeated BoNT-A injections. Main outcomes included Drooling Quotient (DQ) and Visual Analog Scale (VAS) at baseline and 8 weeks follow-up. The objective (drooling quotient) and subjective (VAS) effect after the second injection was lower compared to the first injection. The third injection showed less objective and significantly less subjective effect compared to the first injection. An overall success rate of 74.0%, 41.6%, and 45.8% was found for the first, second, and third injection, respectively. The first chapter reveals that although there might be some loss of effect after repeated injections, A continued improvement is seen in most patients. Chapter 2 The second chapter aims to study the effect of submandibular duct ligation (2-DL) and submandibular botulinum neurotoxin type A (BoNT-A) for drooling in patients with neurodevelopmental disabilities in a randomized, controlled trial. This partly single-blinded study was performed to compare the effect of BoNT-A to 2-DL in the treatment of excessive drooling. The main outcomes included treatment effect, which is defined as a ≥50% reduction in DQ or VAS after 32 weeks. Visual Analog Scale (VAS, range 0 - 100), Drooling Quotient (DQ, range 0 – 100%) were among the secondary outcomes of this study. Measurements were obtained at baseline and 8 and 32 weeks post-intervention. Fifty-three patients with a mean age of 11 years were left for intention-to-treat analyses. Treatment success at 32 weeks was
RkJQdWJsaXNoZXIy MjY0ODMw