Abstract
To explore the correlations of botulinum toxin (BT) therapy with dysphagia, we wanted to study a group of cervical dystonia (CD) patients with optimised BT therapy during a prolonged period of time to record their dysphagia frequency, severity and duration, to study potential risk factors and try to avoid it by BT application with ultrasound guidance. BT therapy of 75 CD patients (23 males, 52 females, age 60 ± 12 years, BT total dose 303.5 ± 101.5 uMU) was retrospectively analysed for 1 year. BT therapy was optimised prior to the observation period. Dysphagia was noticed by one fifth of the patients. In those patients, it only occurred in about one third of the injection series. It was never associated with a functional deficit and lasted several days to 2 weeks. It was not related to patient age or gender, BT total dose, BT dose in the sternocleidomastoid muscle, BT dose in the sternocleidomastoid and scalenii muscles, by BT therapy with bilateral sternocleidomastoid muscle injections or BT therapy with abobotulinumtoxinA. Ultrasound guidance was not able to prevent it. Further prospective studies will be necessary to study underlying dystonia associated swallowing abnormalities as a potentially predisposing factor.
Highlights
Cervical dystonia (CD) is the most common focal primary dystonia and is associated with decreased quality of life (Drexel et al 2020)
In the group of patients with dysphagia (63 botulinum toxin (BT) injections), it occurred after 32 ± 19% of BT applications (20 BT injec‐ tions)
Whenever dysphagia occurred in our patient series its dura‐ tion was limited from several days to 2 weeks maximum
Summary
Cervical dystonia (CD) is the most common focal primary dystonia and is associated with decreased quality of life (Drexel et al 2020). First line treatment of CD are intramus‐ cular injections of botulinum toxin (BT). Their most com‐ mon adverse effect is dysphagia. Many aspects of this dysphagia still remain unclear including its frequency, severity, duration, reproducibility, its potential risk factors, and strategies to avoid it (Blackie and Lees 1990; Anderson et al 1992; Comella et al 1992, 2011; Poewe et al 1998; Truong et al 2010). We wanted to retrospectively study a group of CD patients with optimised BT therapy during a prolonged period of time, record the frequency, severity, duration, and reproducibility of their dysphagia, study poten‐ tial risk factors, and evaluate BT application with ultrasound guidance.
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