Botulinum toxin injection of the cricopharyngeus muscle for the treatment of dysphagia

2000 ◽  
Vol 122 (5) ◽  
pp. 691-695 ◽  
Author(s):  
Syed F. Ahsan ◽  
Robert J. Meleca ◽  
Paul Dworkin James
Keyword(s):  
Botulinum Toxin ◽  
Rating Scale ◽  
Botulinum Toxin Injection ◽  
Retrospective Chart Review ◽  
Muscle Spasm ◽  
Barium Swallow ◽  
Patient Questionnaire ◽  
Therapeutic Effects ◽  
Swallowing Function ◽  
Botox Injection

OBJECTIVE: This study was conducted to evaluate, subjectively and objectively, the diagnostic and therapeutic effects of botulinum toxin (Botox) in patients with dysphagia caused by cricopharyngeus (CP) muscle spasm and/or hypertonicity. METHODS: A retrospective chart review was done of 5 patients with normally functioning larynges treated with CP Botox injection for dysphagia caused by perceived spasm. Subjective measures of swallowing function after injection were obtained with a patient questionnaire. Objective data were obtained both before and after surgery by one or more of the following tests: modified barium swallow study, manometry, videostroboscopy, and fiberoptic endoscopic evaluation of swallowing. Quality-of-life measures were obtained with a swallowing rating scale. RESULTS: Overall, all patients had initial improvement in swallowing after Botox injection. The duration of benefit was from 2 to 14 months. There were no complications. Four of 5 patients had long-term benefits, as evidenced by decreased or eliminated aspiration symptoms, removal of tracheotomy, ability to eat solid foods, and weight gain. One patient continues to have poor swallowing function. CONCLUSION: Botox injection of the CP muscle to treat dysphagia is effective in patients with underlying muscle spasm or hypertonicity. A positive response to Botox can also help confirm the diagnosis of CP muscle spasm.

Botulinum Toxin Injection of the Cricopharyngeus Muscle for the Treatment of Dysphagia

2000 ◽  
Vol 122 (5) ◽  
pp. 691-695 ◽  
Author(s):  
Syed F. Ahsan ◽  
Robert J. Meleca ◽  
James Paul Dworkin
Keyword(s):  
Botulinum Toxin ◽  
Rating Scale ◽  
Botulinum Toxin Injection ◽  
Retrospective Chart Review ◽  
Muscle Spasm ◽  
Barium Swallow ◽  
Patient Questionnaire ◽  
Therapeutic Effects ◽  
Swallowing Function ◽  
Botox Injection

OBJECTIVE: This study was conducted to evaluate, subjectively and objectively, the diagnostic and therapeutic effects of botulinum toxin (Botox) in patients with dysphagia caused by cricopharyngeus (CP) muscle spasm and/or hypertonicity. METHODS: A retrospective chart review was done of 5 patients with normally functioning larynges treated with CP Botox injection for dysphagia caused by perceived spasm. Subjective measures of swallowing function after injection were obtained with a patient questionnaire. Objective data were obtained both before and after surgery by one or more of the following tests: modified barium swallow study, manometry, videostroboscopy, and fiberoptic endoscopic evaluation of swallowing. Quality-of-life measures were obtained with a swallowing rating scale. RESULTS: Overall, all patients had initial improvement in swallowing after Botox injection. The duration of benefit was from 2 to 14 months. There were no complications. Four of 5 patients had long-term benefits, as evidenced by decreased or eliminated aspiration symptoms, removal of tracheotomy, ability to eat solid foods, and weight gain. One patient continues to have poor swallowing function. CONCLUSION: Botox injection of the CP muscle to treat dysphagia is effective in patients with underlying muscle spasm or hypertonicity. A positive response to Botox can also help confirm the diagnosis of CP muscle spasm.

scholarly journals Botulinum toxin treatment of spasticity targeted to muscle endplates: an international, randomised, evaluator-blinded study comparing two different botulinum toxin injection strategies for the treatment of upper limb spasticity

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e024340 ◽  
Author(s):  
Tiina Rekand ◽  
Bo Biering-Sörensen ◽  
Jun He ◽  
Ole Jakob Vilholm ◽  
Peter Brøgger Christensen ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Neuromuscular Junctions ◽  
Botulinum Toxin Injection ◽  
Primary Outcome Measure ◽  
Comparable Efficacy ◽  
Therapeutic Effects ◽  
Open Label ◽  
Blinded Study ◽  
Limb Spasticity

ObjectivesThe therapeutic effects of botulinum neurotoxin (BoNT) are well documented in upper limb spasticity. However, several factors may influence treatment efficacy, including targeting of neuromuscular junctions (NMJs). We examined whether NMJ-targeted BoNT injections were non-inferior, in terms of efficacy, to current injection practices.DesignOpen-label prospective evaluator-blinded study.SettingConducted across 20 medical centres in Denmark, Finland, Norway and Sweden (24 September 2012 to 11 March 2015).ParticipantsAged ˃18 years with upper limb spasticity (Modified Ashworth Scale [MAS] score of 2 or 3) following stroke or traumatic brain injury, had received ≥2 consecutive BoNT-A treatment cycles (the latest of which was abobotulinumtoxinA [aboBoNT-A]) and needed BoNT-A retreatment (same modality as previous cycle). Patients requiring aboBoNT-A doses >800units were excluded. In total, 88 patients were randomised (intention-to-treat [ITT] population), most were male (n=58/88, 65.9%) and 54/88 (61.4%) completed the study (per protocol [PP] population).InterventionsRandomisation (1:1) to receive a single dose of aboBoNT-A (≤800 U) according to either current clinical practice (300 U/mL) or as an NMJ-targeted injection (100 U/mL).Primary outcome measureProportion of patients with a ≥1 level reduction from baseline in MAS score at week 4 post-injection (responders).ResultsIn the ITT population, the proportion of responders at elbow flexors was 72.7% in the current practice group and 56.8% in the NMJ-targeted group (adjusted difference −0.1673 [95% CIs: −0.3630 to 0.0284]; p=0.0986). Similar results were observed in the PP population (69.0% vs 68.0%, respectively, adjusted difference 0.0707 [−0.1948 to 0.3362]; p=0.6052).ConclusionsOwing to the limited number of participants, non-inferiority of NMJ-targeted injections could not be determined. However, there was no statistical difference between groups. Larger studies are needed confirm whether the two techniques offer comparable efficacy.Trial registration numberNCT01682148.

scholarly journals Spatiotemporal Gait Analysis and Lower Limb Functioning in Foot Dystonia Treated with Botulinum Toxin

Toxins ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 532 ◽  
Author(s):  
Anupam Datta Gupta ◽  
Graeme Tucker ◽  
Simon Koblar ◽  
Renuka Visvanathan ◽  
Ian Cameron
Keyword(s):  
Botulinum Toxin ◽  
Gait Analysis ◽  
Lower Limb ◽  
Functional Outcomes ◽  
Stride Length ◽  
Rating Scale ◽  
Botulinum Toxin Injection ◽  
Step Length ◽  
Small Sample ◽  
Gait Velocity

Foot dystonia (FD) is a disabling condition causing pain, spasm and difficulty in walking. We treated fourteen (14) adult patients experiencing FD with onabotulinum toxin A injection into the dystonic foot muscles. We analyzed the spatiotemporal gait utilizing the GaitRite system pre- and 3 weeks post-botulinum toxin injection along with measuring dystonia by the Fahn–Marsden Dystonia Scale (FMDS), pain by the Visual Analog Scale (VAS) and other lower limb functional outcomes such as gait velocity, the Berg Balance Scale (BBS), the Unified Parkinson’s Disease Rating Scale–Lower Limb Score (UPDRS–LL), the Timed Up and Go (TUG) test and the Goal Attainment Scale (GAS). We found that stride length increased significantly in both the affected (p = 0.02) and unaffected leg (p = 0.01) after treatment, and the improvement in stride length was roughly the same in each leg. Similar results were found for step length (p = 0.02) with improvement in the step length differential (p = 0.01). The improvements in the lower limb functional outcomes were also significant—FMDS, VAS, TUG, and UPDRS–LL decreased significantly after treatment (all p < 0.001), and BBS (p = 0.001), GAS (p < 0.001) except cadence (p = 0.37). BT injection improved walking in foot dystonia as evidenced through gait analysis, pain and lower limb functional outcomes. Main study limitations were small sample size and lack of control.

Airway Closure Delay: The Predominant Pathophysiology in Reflux-Associated Dysphagia

2019 ◽  
Vol 160 (5) ◽  
pp. 885-890 ◽  
Author(s):  
Katherine A. Kendall
Keyword(s):  
Tertiary Care ◽  
Oropharyngeal Dysphagia ◽  
Retrospective Chart Review ◽  
Upper Esophageal Sphincter ◽  
Barium Swallow ◽  
Airway Closure ◽  
Swallowing Function ◽  
Pharyngeal Transit ◽  
Pharyngeal Swallowing ◽  
The Impact

Objective Reflux disease is common in patients with oropharyngeal dysphagia, but the impact of reflux on oropharyngeal swallowing physiology is not known. This study uses objective measures of swallowing function from modified barium swallow studies to describe the pathophysiology of dysphagia in a group of patients whose only associated condition is reflux. Study Design Retrospective chart review. Setting Tertiary care voice and swallowing clinic. Subjects and Methods The Swallowing Database at the University of Utah was queried for patients with a diagnosis of reflux without additional conditions known to affect swallowing function. Pharyngeal transit time (TPT), distance of hyoid elevation (Hmax), maximum opening size of the upper esophageal sphincter (UESmax), area of pharynx at maximum constriction (PAmax), airway closure timing relative to the arrival of the bolus at the UES, and penetration/aspiration (Pen/Asp) score were assessed. Results Of the 122 patients who met inclusion criteria for the study, 42% had normal pharyngeal swallowing function, 57% had at least 1 abnormal swallowing measure, and 47.5% demonstrated a delay in airway closure relative to arrival of the bolus at the UES on at least 1 swallow. The incidence of prolonged TPT, diminished Hmax, poor UESmax, and enlarged PAmax were 2.5%, 8%, 4%, and 11.5%, respectively. Sixty percent with a delay in airway closure had a normal Pen/Asp score. Conclusion A delay in airway closure relative to the arrival of the bolus at the UES is the most common abnormality of swallowing function found in patients with reflux-associated dysphagia but may not be identified using the Pen/Asp score.

Botulinum toxin injection for failed tracheo-oesophageal voice in laryngectomees: the Sunderland experience

2003 ◽  
Vol 117 (7) ◽  
pp. 544-548 ◽  
Author(s):  
K. Ramachandran ◽  
P. S. Arunachalam ◽  
Anne Hurren ◽  
R. L. Marsh ◽  
P. R. Samuel
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Neurotoxin ◽  
Speech Therapy ◽  
Rating Scale ◽  
Botulinum Toxin Injection ◽  
Voice Restoration ◽  
Early Results ◽  
Pharyngeal Plexus

Spasm of the pharyngo-oesophageal segment is one of the important causes of tracheo-oesophageal voice failure. Traditionally it has been managed by either prolonged speech therapy, surgical pharyngeal myotomy or pharyngeal plexus neurectomy with varying degrees of success. Botulinum neurotoxin has been found to be effective in relieving pharyngo-oesophageal segment spasm. Since 1995, we have used botulinum toxin injection on 10 laryngectomees with either aphonia or hypertonicity due to pharyngo-oesophageal segment spasm. Early results were analysed by the Sunderland Surgical Voice Restoration Rating scale. Seven of the 10 patients, who were previously completely aphonic, developed voice following this therapy and are using their valve choice as their only method of communication. Out of the three patients who were treated for hypertonic voice, two did derive some benefit from the procedure. One patient developed a hypotonic voice, which lasted for a few months.

scholarly journals Botulinum toxin for chronic pelvic pain in women with endometriosis: a cohort study of a pain-focused treatment

2019 ◽  
Vol 44 (9) ◽  
pp. 886-892 ◽  
Author(s):  
Hannah K Tandon ◽  
Pamela Stratton ◽  
Ninet Sinaii ◽  
Jay Shah ◽  
Barbara I Karp
Keyword(s):  
Botulinum Toxin ◽  
Pelvic Floor ◽  
Pelvic Pain ◽  
Pelvic Floor Muscle ◽  
Botulinum Toxin Injection ◽  
Case Series ◽  
Pain Medication ◽  
Muscle Spasm ◽  
Open Label ◽  
Topical Anesthetic

Background and objectivesMany women with endometriosis continue to have pelvic pain despite optimal surgical and hormonal treatment; some also have palpable pelvic floor muscle spasm. We describe changes in pain, spasm, and disability after pelvic muscle onabotulinumtoxinA injection in women with endometriosis-associated pelvic pain, a specific population not addressed in prior pelvic pain studies on botulinum toxin.MethodsWe present an open-label proof-of-concept case series of women with surgically diagnosed endometriosis. Under conscious sedation and with topical anesthetic, 100 units of onabotulinumtoxinA was injected transvaginally into pelvic floor muscle spasm areas under electromyography guidance. Changes in pain intensity, muscle spasm, disability, and pain medication use were assessed at periodic visits for up to 1 year after injection.ResultsThirteen women underwent botulinum toxin injection and were followed for at least 4 months. Before injection, 11 of the 13 women had spasm in >4/6 assessed pelvic muscles and reported moderate pain (median visual analog scale (VAS): 5/10; range: 2–7). By 4–8 weeks after injection, spasm was absent/less widespread (≤3 muscles) in all (p=0.0005). Eleven rated their postinjection pain as absent/mild (median VAS: 2; range: 0–5; p<0.0001); 7/13 reduced pain medication. Disability decreased in 6/8 women with at least moderate preinjection disability (p=0.0033). Relief lasted 5–11 months in 7 of the 11 patients followed for up to 1 year. Adverse events were mild and transient.ConclusionsThese findings suggest pelvic floor spasm may be a major contributor to endometriosis-associated pelvic pain. Botulinum toxin injection may provide meaningful relief of pain and associated disability.Trial registration numberNCT01553201

scholarly journals Hitchhiker's Toe and Lumbar Disc Lesion: A Strange Coincidence in a Patient with Idiopathic Dystonia Treated with Botulinum Toxin Injection

2015 ◽  
Vol 26 (4) ◽  
pp. 111-113
Author(s):  
Ayyoub Baqer ◽  
S Jai Shanthini ◽  
Wael Abdul Gawad
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Botulinum Toxin ◽  
Chronic Low Back Pain ◽  
Lumbar Disc ◽  
Botulinum Toxin Injection ◽  
Low Back ◽  
Extensor Hallucis Longus ◽  
Botox Injection ◽  
Idiopathic Dystonia

Abstract A 40 years old female with generalised dystonia and chronic low back pain was injected with botulinum toxin injection to extensor hallucis longus(EHL) for management of Hitchhiker's toe. The patient benefited functionally but later developed EHL and extensor digitorum (ED) weakness. Further workup revealed degenerative L4/5 disc lesion causing L5 root affection as the cause for the weakness. This coincidental occurrence of EHL and ED weakness due to L4/5 disc lesion in a patient with generalised dystonia, following botox injection to EHL for management of Hitch hiker's toe, has not been reported before.

Point-Touch Technique of Botulinum Toxin Injection for the Treatment of Spasmodic Dysphonia

1992 ◽  
Vol 101 (11) ◽  
pp. 883-887 ◽  
Author(s):  
David C. Green ◽  
Paul H. Ward ◽  
Gerald S. Berke ◽  
Bruce R. Gerratt
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Injection ◽  
Current Method ◽  
Spasmodic Dysphonia ◽  
Needle Placement ◽  
Careful Evaluation ◽  
Anatomic Landmarks ◽  
Adductor Spasmodic Dysphonia ◽  
Botox Injection ◽  
Thyroarytenoid Muscle

Intralaryngeal injections of botulinum toxin (Botox), under electromyographic guidance, have emerged as an effective treatment for adductor spasmodic dysphonia. To remain effective, these injections must be repeated every 3 to 9 months as the symptoms recur. One drawback to the current method is the need for electromyographic confirmation of needle placement into the thyroarytenoid muscle. This report describes an anatomic approach to Botox injection that requires only flexible nasopharyngeal endoscopy and careful evaluation of the anatomic landmarks. This technique has been used successfully on 13 patients, and objective pretreatment and posttreatment measures are reported.

The Effect of Botulinum Toxin Injection into the Common Extensor Tendon in Patients with Chronic Lateral Epicondylitis: A Randomized Trial

Pain Medicine ◽  
2019 ◽  
Vol 21 (9) ◽  
pp. 1971-1976 ◽  
Author(s):  
Sang Hoon Lee ◽  
Hyun Hee Choi ◽  
Min Cheol Chang
Keyword(s):  
Botulinum Toxin ◽  
Pain Relief ◽  
Grip Strength ◽  
Dose Group ◽  
Rating Scale ◽  
Botulinum Toxin Injection ◽  
Botulinum Toxin Type A ◽  
Lateral Epicondylitis ◽  
Extensor Tendon ◽  
The Common

Abstract Background Botulinum toxin (BTX) is widely used for pain control in various musculoskeletal disorders. Objectives We evaluated the analgesic effect of botulinum toxin type A (BTX-A) in chronic lateral epicondylitis and compared the effect between 10 and 50 IU of BTX-A. Methods Sixty subjects with chronic lateral epicondylitis were included and underwent a BTX-A injection in the common extensor tendon. The subjects were randomly allocated into two groups: the small-dose group (SD group; 30 subjects, 10 IU) and large-dose group (LD group; 30 subjects, 50 IU). Treatment outcomes were evaluated by measuring the pain level using the numeric rating scale (NRS) and measuring grip strength before and one, two, three, four, five, and six months after treatment. Results Subjects in both groups showed a significant decrease in NRS scores at all evaluation time points after treatment. The reduction in NRS scores was significantly greater in the LD group at one, two, three, and four months after treatment. Six months after treatment, 19 subjects (63.3%) in the SD group and 21 (70%) in the LD group reported successful pain relief (pain relief ≥50%). The rate of successful pain relief was not significantly different between the two groups. Grip strength was more increased in the LD group at one, two, three, four, and six months after treatment. Conclusions BTX-A injection into the common extensor tendon can be a good treatment option for chronic lateral epicondylitis. The 50-IU BTX-A injection achieved a better outcome than the 10-IU injection.

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