Comparison of Oropharyngeal Dysphagia before and after Botulinum Toxin Injection in Cervical Dystonia

Document Type

Conference Proceeding

Publication Date

8-6-2024

Publication Title

Dysphagia

Keywords

barium, botulinum toxin, adult, aged, airway obstruction, cervical dystonia, cohort analysis, conference abstract, coughing, diffusion, dysphagia, esophagography, female, human, male, patient-reported outcome, self concept, speech language pathologist, surgery, swallowing

Abstract

Purpose: To determine if Botulinum toxin (BoNT) injection affects physiological swallowing in individuals with CD based upon results of the videofluoroscopic swallowing study (VFSS) using the Modified Barium Swallow Impairment Profile (MBSImP); (2) To determine if BoNT affects patient reported outcomes of the physical, emotional and functional handicapping effects of dysphagia in individuals with CD based on results of the Dysphagia Handicap Index (DHI); (3) To determine the association between changes in VFSS and DHI pre and post BoNT; (4) To determine the association between BoNT dose and changes in MBSImP and DHI scores. Methods: Eighteen subjects with CD completed the VFSS and DHI prior to their BoNT injection and 14-19 days post injection. A speech-language pathologist certified in MBSImP rated all VFSS studies blinded to subject information. Paired t-tests were done to assess changes between pre and post BoNT injections and DHI measurements. Signed rank tests were done to assess changes between pre and post BoNT injections and MBSImP scores for each consistency, as well as changes in DHI perceived severity. Spearman's correlations coefficients were computed to assess associations between changes in MBSImP scores and changes in DHI scores and the association between BoNT dose and the changes in MBSImP and changes in DHI measurements. Results: The MBSImP score worsened between pre and post BoNT injections for pudding consistency barium (p = 0.015). Differences between the pre and post DHI measurements were not significant. There were several positive and negative associations between changes in MBSImP and changes in DHI scores. There were several changes in MBSImP scores that worsened with increasing BoNT dosage. The changes in physical subscale, total DHI score and selfperceived severity scores of dysphagia handicap also significantly worsened with increasing BoNT dosage. Conclusions: Remote effects of BoNT may result in diffusion of the toxin to adjacent musculature affecting pharyngeal contractions for thicker consistencies such as pudding. There is a complex association of changes in objective swallowing characteristics with changes in self-perception of the handicapping effects of dysphagia. Patients with CD appear to perceive worsening changes in physical aspects of dysphagia, such as coughing or choking when eating, with higher doses of BoNT.

Volume

39

Issue

1

First Page

S64

Last Page

S65

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