Botulinum toxin treatment for oropharyngeal dysphagia in patients with stroke

BackgroundIn 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 (>25mmHg). The aim of this study was to confirm the long-lasting efficacy of this procedure after stroke. MethodsWe prospectively studied 23 patients with stroke for at least 6months 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 3weeks and 3, 6, and 12months postinjection. Key ResultsEighteen 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 66.8mmHg (range: 25-120mmHg). We observed a significant improvement in feeding mode during follow-up: after 3months, 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 & InferencesA single injection of BTX-A is efficacious for a period of at least 12months in improving oropharyngeal dysphagia in stroke patients with UES opening dysfunction and some pharyngeal contraction (>25mmHg).