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Dysphagia
Published in: Dysphagia 1/2004

01-01-2004 | Case Report

Prolonged Effect of Botulinum Toxin Injection in the Treatment of Cricopharyngeal Dysphagia: Case Report and Literature Review

Authors: Ming-Jang Chiu, MD, PhD, Yeun-Chung Chang, MD, Tzu-Yu Hsiao, MD, PhD

Published in: Dysphagia | Issue 1/2004

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Abstract

Cricopharyngeus (CP) muscle spasm can lead to severe dysphagia. Myotomy of the CP muscle was the treatment of choice. Recently, botulinum toxin type A (BtxA) has been used for CP spasm. It usually brings improvement in deglutition but most patients require reinjection in 3–5 months. We report a 35-year-old man who had an arteriovenous malformation hemorrhage in the brain stem resulting in CP spasm and consequently severe dysphagia. He received BtxA injection and deglutition and nutrition remained good one year after treatment. A literature review analyzing 28 patients and our patient showed negative correlations between age and BtxA dose and between age and duration. Efficacy was positively correlated with duration and BtxA dose was positively correlated with pretreatment severity. In conclusion, physicians would use higher doses on patients with more severe cases but use lower doses on older patients. Those who obtained better post-treatment results would enjoy longer effective duration. Thus, the effective duration of the BtxA is multifactorial.
Literature
1.
Jankovic, J, Brin, MF 1991Therapeutic use of botulinum toxin.N Engl J Med32411861192PubMed
2.
Pasricha, PJ, Ravich, WJ, Hendrix, TR, Sostre, S, Jones, B, Kalloo, AN 1995Intrasphincteric botulinum toxin for the treatment of achalasia.N Engl J Med332774778CrossRefPubMed
3.
Jones, MP 1996Botulinum toxin in hypertensive lower esophageal sphincter.Am J Gastroenterol9112831284PubMed
4.
Schneider, J, Thumfart, W, Potoschnig, C, Eckel, HE 1994Treatment of dysfunction of the cricopharyngeal muscle with botulinum A toxin: introduction of a new, noninvasive method.Ann Otol Rhinol Laryngol1033135PubMed
5.
Blitzer, A, Brin, MF 1997Use of botulinum toxin for diagnosis and management of cricopharyngeal achalasia.Otolaryngol Head Neck Surg116328329PubMed
6.
Blitzer, A 1997Cricopharyngeal muscle spasm and dysphagia.Op Tech Otolaryngol Head Neck Surg8191192
7.
Born, LJ, Harned, RH, Rillers, LF, Peiffer, RF, Quigley, EM 1996Cricopharyngeal dysfunction in Parkinson’s disease: role in dysphagia and response to myotomy.Mov Disord115358PubMed
8.
Mackenna, JA, Dedo, HH 1992Cricopharyngeal myotomy: indications and technique.Ann Otol Rhinol Laryngol101216221PubMed
9.
St. Guily, J, Perie, S, Willig, T 1994Swallowing disorders in muscular disease: functional assessment and indication of cricopharyngeal myotomy.Ear Nose Throat J733440PubMed
10.
Atkinson, SI, Rees, J 1997Botulinum toxin for circopharyngeal dysphagia: Case reports of CT guided injection.J Otolaryngol26273276PubMed
11.
Ahsan, SF, Meleca, RJ, Dworkin, JP 2000Botulinum toxin injection of the cricopharyngeus muscle for the treatment of dysphagia.Otolaryngol Head Neck Surg122691695PubMed
12.
Parameswaran, MS, Soliman, AM 2002Endoscopic botulinum toxin injection for cricopharyngeal dysphagia.Ann Otol Rhinol Laryngol111871874PubMed
13.
Restivo, DA, Plameri, A, Marchese–Ragona, R 2002Botulinum toxin for cricopharyngeal dysfunction in Parkinson’s disease.N Engl J Med34611741175CrossRefPubMed
14.
Restivo, DA, Marchese–Ragona, R, Staffieri, A, de Grandis, D 2000Successful botulinum toxin treatment of dysphagia in oculopharyngeal muscular dystrophy.Gastroenterology1191416
15.
Marion, ME, Sheehy, M, Sangla, S, Soulayrol, S 1995Dose standardization of botulinum toxin.Lancet59102103
16.
Odergren, T, Hjaltasaon, H, Kaakkola, S, Solders, G, Hanko, J, Fehling, C,  et al. 1998A double blind, randomized parallel group study to investigate the dose equivalence of Dysport and Botox in the treatment of cervical dystonia.J Neurol Neurosurg Psychiatry64612PubMed
17.
Brandypadhyay, S, Clark, AW, Desgupta, BR, Sathyamoorthy, V 1987Role of the heavy and light chain of botulinum neurotoxin in neuromuscular paralysis.J Biol Chem26226602663PubMed
18.
Black, JD, Dolly, JO 1986Interaction of 125I-labeled botulinum neurotoxins with nerve terminals. II. Autoradiographic evidence for its uptake into motor nerves by acceptor-mediated endocytosis.J Cell Biol103535544PubMed
19.
Coffield, JA, Considine, RV, Simpson, LL 1994The site and mechanism of action of botulinum neurotoxin.Jankovic, JHallet, M eds. Therapy with Botulinum Toxin. Marcel DekkerNew York313
20.
Blasi, J, Chapman, ER, Link, E,  et al. 1993Botulinum neurotoxin A selectively cleaves the synaptic protein SNAP-25.Nature365160163PubMed
21.
Alderson, K, Holds, JB, Anderson, RL 1991Botulinum-induced alteration of nerve–muscle interactions in the human orbicularis oculi following treatment for blepharospasm.Neurology4118001805PubMed
22.
de Paiva, A, Meunier, FA, Molgo, J, Aoki, KR, Dolly, JO 1999Functional repair of motor endplates after botulinum neurotoxin type A poisoning: biphasic switch of synaptic activity between nerve sprouts and their parent terminals.Proc Natl Acad Sci USA9632003205CrossRefPubMed
23.
Brown, P 1994Pathophysiology of spasticity.J Neurol Neurosurg Psychiatry57773777PubMed
24.
On, AY, Kirazli, Y, Kismali, B, Aksit, R 1999Mechanisms of action of phenol block and botulinus toxin type A in relieving spasticity: electrophysiologic investigation and follow-up.Am J Phys Med Rehabil78344349CrossRefPubMed
25.
Duchen, LW 1971Changes in the electron microscope structure of slow and fast skeletal muscle fibres of the mouse after local injection of botulinum toxin.J Neurol Sci146171CrossRefPubMed
26.
Lund, WS 1964The function of the cricopharyngeal sphincter during swallowing.Acta Otolaryngol59497510
27.
Mu, L, Sanders, I 2002Muscle fiber-type distribution pattern in the human cricopharyngeus muscle.Dysphagia178796CrossRefPubMed
28.
D’Onofrio, V, Miletto, P, Leandro, G, Iaguinto, G 2002Long-term follow-up of achalasia patients treated with botulinum toxin.Dig Liver Dis34105110CrossRefPubMed
Metadata
Title
Prolonged Effect of Botulinum Toxin Injection in the Treatment of Cricopharyngeal Dysphagia: Case Report and Literature Review
Authors
Ming-Jang Chiu, MD, PhD
Yeun-Chung Chang, MD
Tzu-Yu Hsiao, MD, PhD
Publication date
01-01-2004
Publisher
Springer-Verlag
Published in
Dysphagia / Issue 1/2004
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI
https://doi.org/10.1007/s00455-003-0029-3

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