TITLE:
Botulinum toxin treatment of severe dysphagia following brainstem stroke
AUTHORS:
Domenico De Grandis, Sofia Faletti, Francesco Pirali, Gianna Santus
KEYWORDS:
Deglutition Disorders; Brainstem Stroke; Upper Esophageal Sphincter; Rehabilitation; Botulinum Toxins; Electromyography; Gastrostomy
JOURNAL NAME:
World Journal of Neuroscience,
Vol.3 No.4,
October
8,
2013
ABSTRACT: Objective:
To evaluate botulinum toxin treatment of hyperactive upper esophageal sphincter
after first-time brainstem stroke. Design: A retrospective study. Subjects:
Twelve patients with long standing dysphagia after brainstem vascular injury
admitted to the rehabilitation department of a medical centre. Methods: All patients underwent clinical
examination, videofluoroscopic study of swallowing and electromyography.
Botulinum toxin was injected percutaneously under electromyographic guide. Outcomes
were measured after two weeks and through a long follow up programme, which
ranged from two to ten years. Results: A total of 75% of patients (9 of 12) had
favourable outcomes. Two patients showed long lasting functional benefits after
only one botulinum toxin injection, while seven patients required further
treatments to maintain an adequate oral intake. In seven cases it was possible
to remove percutaneous endoscopic gastrostomy. No relevant complications were
observed. Conclusion: Botulinum toxin can improve severe dysphagia with
elective hyperactivity of the upper esophageal sphincter in patients with or
without unilateral paresis of the inferior constrictor muscle and in absence of
a nuclear involvement of the IXth and Xth cranial nerves. The outcome could be
unsatisfactory in the cases of oral phase involvement, bilateral lesion of the
inferior constrictor muscle and when there is velopharyngeal insufficiency.