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Botulinum toxin treatment for oropharyngeal dysphagia in patients with stroke
Author(s) -
Terré R.,
Panadés A.,
Mearin F.
Publication year - 2013
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.12213
Subject(s) - dysphagia , oropharyngeal dysphagia , botulinum toxin , medicine , stroke (engine) , physical medicine and rehabilitation , surgery , mechanical engineering , engineering
Background In a previous pilot study, we demonstrated that a single injection of botulinum toxin A ( BTX ‐A) in the cricopharyngeus muscle is effective in patients with neurologic dysphagia with upper esophageal sphincter ( UES ) opening dysfunction and presence of some pharyngeal contraction (>25 mmHg). The aim of this study was to confirm the long‐lasting efficacy of this procedure after stroke. Methods We prospectively studied 23 patients with stroke for at least 6 months before administration of a BTX ‐A injection. Baseline diagnosis of UES opening dysfunction and presence of some pharyngeal contraction were assessed by videofluoroscopy ( VFS ) and esophageal manometry ( EM ). Clinical and VFS follow‐up was made at 3 weeks and 3, 6, and 12 months postinjection. Key Results Eighteen patients (78%) were fed by gastrostomy tube prior to treatment. Videofluoroscopy showed UES relaxation impairment, residue in pyriform sinuses, and aspiration in all cases. After BTX ‐A, the number of patients with aspiration and pharyngeal residue decreased to 52% and 70%, respectively (p < 0.05 for both); residue was severe in only 4%. Esophageal manometry showed a mean pharyngeal amplitude 66.8 mmHg (range: 25–120 mmHg). We observed a significant improvement in feeding mode during follow‐up: after 3 months, 70% of patients were eating exclusively by mouth. Lower residual pressure and minor pharyngeal delay time at baseline were all predictive factors for treatment effectiveness. Conclusions & Inferences A single injection of BTX ‐A is efficacious for a period of at least 12 months in improving oropharyngeal dysphagia in stroke patients with UES opening dysfunction and some pharyngeal contraction (>25 mmHg).