title: Successful treatment of long-standing post-stroke dysphagia with botulinum toxin and rehabilitation.
abstract: Cricopharyngeal myotomy is the most common treatment used to restore normal swallowing in patients with persistent (>6 months) cricopharyngeal muscle dysfunction post-stroke. We describe 2 patients whose dysphagia was due to cricopharyngeal muscle over-activity and who significantly improved after a percutaneous botulinum toxin injection in the cricopharyngeal muscle in combination with a rehabilitation treatment (dietary modifications, postural techniques, airflow protection manoeuvres). Swallowing was assessed clinically and by fibreoptic endoscopic evaluation of swallowing and videofluoroscopy; the degree of dysphagia was scored using the penetration-aspiration scale. Two months after the botulinum toxin injection the patients, who were previously fed via percutaneous endoscopic gastrostomy, returned to independent oral feeding and at 6, 12 and 24 months follow-up, both were still able to maintain an adequate oral intake with no signs of aspiration (by videofluoroscopy) or clinical complications. No further botulinum toxin injections or rehabilitation treatments were required. Our findings strongly suggest that even long-standing dysphagia can improve dramatically in selected patients. To the best of our knowledge, there are no other reports with such a long follow-up.
authors.affiliation: Department of Rehabilitation Medicine, University of Padova, School of Medicine, Italy. stef.masiero@unipd.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Masiero
authors.forename: Chiara
authors.initials: C
authors.lastname: Briani
authors.forename: Rosario
authors.initials: R
authors.lastname: Marchese-Ragona
authors.forename: Paola
authors.initials: P
authors.lastname: Giacometti
authors.forename: Mario
authors.initials: M
authors.lastname: Costantini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zaninotto
mesh_terms: D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003680:Deglutition Disorders / Q000188:drug therapy* / Q000209:etiology / Q000534:rehabilitation; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D010609:Pharyngeal Muscles; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A