Botulinum toxin treatment for oropharyngeal dysphagia in patients with stroke.

Abstract

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).

• Authors: R Terré, A Panadés, F Mearin
• Journal: Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society (Neurogastroenterol Motil) Vol. 25 Issue 11 Pg. 896-e702 (Nov 2013) ISSN: 1365-2982 [Electronic] England
• PMID: 23991889 (Publication Type: Clinical Trial, Journal Article)
• Copyright: © 2013 John Wiley & Sons Ltd.

Chemical References

• Botulinum Toxins, Type A

Topics

• Adult
• Aged
• Botulinum Toxins, Type A (therapeutic use)
• Deglutition Disorders (drug therapy, etiology)
• Female
• Follow-Up Studies
• Humans
• Male
• Manometry
• Middle Aged
• Prospective Studies
• Stroke (complications, drug therapy)
• Treatment Outcome
• Young Adult