title: Botulinum toxin treatment for oropharyngeal dysphagia associated with diabetic neuropathy.
abstract: OBJECTIVE
  No specific treatment for oropharyngeal dysphagia related to diabetic neuropathy has been described to date. Chemical myotomy of the cricopharyngeus (CP) muscle by botulinum neurotoxin type A (BoNT/A) has been effective in reducing or abolishing dysphagia associated with upper esophageal sphincter (UES) hyperactivity of different etiologies. In the present study, we evaluated the efficacy of BoNT/A injections into the CP muscle in diabetic patients with severe oropharyngeal dysphagia associated with diabetic autonomic and/or somatic peripheral neuropathy.
  
  
  METHODS
  Twelve type 2 diabetic patients with severe dysphagia for both solid and liquid foods associated with autonomic and/or peripheral somatic neuropathy were investigated. Swallowing function was evaluated by clinical examination, videofluoroscopy, and simultaneous needle electromyography (EMG) of the CP and pharyngeal inferior constrictor (IC) muscles. Clinical evaluation using a four-level dysphagia severity score was performed every other day for the 1st week and thereafter every other week until week 24. Videofluoroscopy and EMG follow-up were carried out at week 1, 4, 12, 16, 18, and 24 after BoNT/A injection. BoNT/A was injected percutaneously into the CP muscle under EMG control.
  
  
  RESULTS
  BoNT/A induced the complete recovery of dysphagia in 10 patients and had a significant (P = 0.0001, ANOVA) improvement in 2 patients within 4 +/- 1.1 days (range 3-7). Clinical improvement was confirmed by videofluoroscopy and EMG.
  
  
  CONCLUSIONS
  Our findings suggest a potential benefit from BoNT/A treatment in dysphagia associated with diabetic neuropathy. Randomized controlled trials are needed to confirm this observation.
authors.affiliation: Division of Endocrinology, Garibaldi Hospital, via Palermo 636, Catania I-95121, Catania, Italy.
authors.forename: Domenico A
authors.initials: DA
authors.lastname: Restivo
authors.forename: Rosario
authors.initials: R
authors.lastname: Marchese-Ragona
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lauria
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Squatrito
authors.forename: Damiano
authors.initials: D
authors.lastname: Gullo
authors.forename: Riccardo
authors.initials: R
authors.lastname: Vigneri
mesh_terms: D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000627:therapeutic use*; D003680:Deglutition Disorders / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins