75 Submandibular Duct Ligation After Botulinum Neurotoxin A Treatment of Drooling in Children With Cerebral Palsy 3 Despite a −7.1 drooling quotient before surgery, this difference was non-significant (z-score=−1.9, p=0.06). The 6.0 VAS baseline before bilateral submandibular duct ligation compared to the VAS before BoNT-A was also non-significant (z-score=−1.7, p=0.094). With treatment success defined as a ≥50% reduction in VAS and/or drooling quotient from baseline, 20 children showed successful treatment with BoNT-A after 8 weeks and 10 after 32 weeks. Submandibular duct ligation resulted in 24 children treated successfully after 8 weeks; 15 children showed continued treatment success after 32 weeks. Treatment success 32 weeks after bilateral submandibular duct ligation could not be predicted by BoNT-A treatment success after 8 weeks. Only half of the children successfully treated 8 weeks after BoNT-A (positive predictive value 50%, 95% CI=0.17–3.89) were treated successfully 32 weeks after bilateral submandibular duct ligation. Additionally, an unsuccessful response 8 weeks after BoNT-A treatment was not a predictor for bilateral submandibular duct ligation treatment failure since only 4 out of the 9 (negative predictive value 44%) children treated unsuccessfully 8 weeks after BoNT-A also failed to reach treatment success 32 weeks after bilateral submandibular duct ligation (95% CI=0.17–3.89). Likewise, there was no predictive value of treatment success 32 weeks after BoNT-A and treatment success 32 weeks after bilateral submandibular duct ligation (positive predictive value 40%, 95% CI=0.10–2.31). Potential selection bias was examined by comparing patient characteristics and response to BoNT-A in these 29 children with the response to 407 BoNT-A treatments for drooling in 232 children treated at our centre between January 2002 and May 2013. Baseline VAS values between the two groups did not differ significantly (73 vs 72.9; U=5637, p=0.718; CI=0.71–0.73). Likewise, the VAS scores 8 weeks after BoNT-A treatment were closely related (51.3 vs 50.9; U=5800, p=0.894; CI=0.89–0.90). However, the VAS scores 32 weeks after BoNT-A treatment were 13 points higher in the children included in this study than the other group of children
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