Botulinum Toxin A Treatment of Cricopharyngeal Dysphagia After Subarachnoid Hemorrhage
Botulinum Toxin A Treatment of Cricopharyngeal Dysphagia After Subarachnoid Hemorrhage
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DOI：
10.1007/s00455-007-9132-1
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发表时间：
2008-12-01
期刊：
影响因子：
2.6
通讯作者：
Guerkov, Robert
中科院分区：
文献类型：
--
作者：
Krause, Eike;Schirra, Joerg;Guerkov, Robert
与痉挛综合征相关的肌肉张力升高可能会导致食道上括约肌过度收缩并阻碍吞咽。一名47岁男性患者，蛛网膜下腔出血后出现下肢痉挛，严重吞咽困难和慢性唾液吸入。他依赖于带套囊的气管切开管和经皮胃肠营养管。吞钡和食道压力测量显示环咽痉挛，而喉部抬高和咽部收缩力保持良好。我们在内窥镜下将180 MU肉毒杆菌毒素A注射到鼻咽喉肌中。注射后两天，吞咽功能改善，可以口服营养。这种改善持续了六个星期。8周后再次注射后，发生了不期望的扩散到下咽部，测压显示收缩力减弱，吞咽困难没有改善。肉毒杆菌毒素治疗颈咽痉挛可改善痉挛综合征患者的吞咽功能。治疗效果持续时间有限。应避免毒素扩散到咽部。测压法对于计划和监测治疗很有用。
Elevated muscular tone associated with spastic syndromes can cause excessive contractility at the upper esophageal sphincter and impede swallowing. A 47-year-old male patient with spasticity predominantly of the lower extremities after a subarachnoid hemorrhage suffered from severe dysphagia and chronic salivary aspiration. He was dependent on a cuffed tracheostomy tube and a percutaneous enterogastric feeding tube. Barium swallow and esophageal manometry revealed cricopharyngeal spasm, while laryngeal elevation and pharyngeal contractility were well preserved. We endoscopically injected 180 MU botulinum toxin A into the cricopharyngeus muscle. Two days post injection, swallowing function had improved and oral nutrition was possible. This improvement lasted for six weeks. After another injection 8 weeks later, an undesired diffusion into the hypopharynx occurred and manometry showed diminished contractility without amelioration of dysphagia. Botulinum toxin therapy of cricopharyngeal spasm improves swallowing function in a subgroup of patients with spastic syndromes. The therapeutic effect is of limited duration. Toxin diffusion into the pharynx should be avoided. Manometry is useful in planning and monitoring the therapy.