57 Randomized controlled trial comparing botulinum versus surgery for drooling in neurodisabilities 2 we find that some degree of patients are overtreated when initially combining injections, and to limit morbidity.18 We compared the effectiveness, morbidity, patient’s satisfaction, and procedural time, of BoNT-A and 2-DL in a prospectively controlled setting. In contrast with prior literature there were no complications of 2-DL requiring surgical re-intervention.14 Complaints after 2-DL were all temporary and patients were free of complaints after a mean of 10 days. Even though there were three SAE after 2-DL, there seemed to be no direct relation between the intervention and two SAE. Procedural time and thereby time under general anesthesia for BoNT-A injections was significantly shorter, and BoNT-A was associated with fewer postoperative complaints than 2-DL, and there were fewer complications (19.2% vs 40.7%) after BoNT-A. Prior studies reported 0 to 33% adverse events after BoNT-A injections which is analogous to the proportion of adverse events in this study.5, 23, 24 In conclusion, the morbidity of BoNT-A is less than for 2-DL. However, it could be argued that this is to some extent offset by the fact that BoNT-A injections will usually have to be repeated to maintain treatment effect. There is a contrast in reported response to treatment at 8 and 32 weeks after BoNT-A between our study and previous literature into the effects of submandibular BoNT-A, even those conducted in our own center. The difference is presumably due to varying definitions for response to treatment. We found 63.0% and 26.9% response after 8 and 32 weeks, respectively, defining response to treatment as a >50% reduction in VAS or DQ. A previous study reported 47% and 15% after 8 and 32 weeks, respectively. “Succes” in this study had a more limited definition, however: only a 50% reduction in DQ was considered therapeutic succes.3 Another recent study reported 65% response to treatment 8 weeks after submandibular BoNT-A; response to treatment in this particular study was defined as a 50% reduction in DQ or >2SD in VAS.23 The changing definitions reflect increasing clinical insight, and we feel the present definition most closely reflects actual clinical ‘succes’. If we would have applied similar ‘success criteria’ as previous studies, the response rate in this study would be 58%
RkJQdWJsaXNoZXIy MjY0ODMw