Botulinum Toxin Is Effective in the Management of Neurogenic Dysphagia. Clinical-Electrophysiological Findings and Tips on Safety in Different Neurological Disorders.
Botulinum Toxin Is Effective in the Management of Neurogenic Dysphagia. Clinical-Electrophysiological Findings and Tips on Safety in Different Neurological Disorders.
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DOI：
10.3389/fphar.2017.00080
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发表时间：
2017
影响因子：
5.6
通讯作者：
Tassorelli C
中科院分区：
文献类型：
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作者：
Alfonsi E;Restivo DA;Cosentino G;De Icco R;Bertino G;Schindler A;Todisco M;Fresia M;Cortese A;Prunetti P;Ramusino MC;Moglia A;Sandrini G;Tassorelli C
背景和目的：与上食管括约肌（UES）松弛失败相关的神经性吞咽困难可以通过向环咽（CP）肌肉注射肉毒杆菌毒素（BTX）来治疗。我们比较了这种治疗方法对不同吞咽困难神经系统疾病的效果，以评估其随时间的推移的疗效，包括对第二次注射的反应。材料和方法：67 例与 UES 开放不完全或缺失相关的神经源性吞咽困难患者（24 例脑干或半球中风，21 例帕金森综合征，12 例多发性硬化症，10 例继发于创伤后脑病的痉挛肌张力障碍综合征）接受了 CP 肌肉注射 IncobotulinumtoxinA（剂量 15-20 U）的治疗在肌电图指导下。通过临床评估和吞咽光纤内窥镜检查，在基线时以及第一次和第二次治疗后对患者进行评估，同时使用吞咽困难结果和严重程度量表（DOSS）对他们的吞咽困难进行量化。在基线时进行吞咽运动电图/肌电图研究。结果：大多数患者对首次 BTX 治疗有反应：35 名患者（52.2%）被列为高反应者（DOSS 评分增加 >2 级），而其他 19 名患者（28.4%）为低反应者（DOSS 评分增加≤2 级）。第一次治疗的效果通常持续超过 4 个月 (67%)，在某些情况下可达一年。第二次注射后治疗效果仍然很高：31名患者（46.3%）为高反应者，另外22名患者（32.8%）为低反应。仅在帕金森综合症组中，我们观察到与第一次治疗相比，高反应者的百分比有所下降。副作用大多是轻微的，并且在第一次注射后无反应者中报告。两名患者在注射第二次 BTX 后观察到严重的副作用，包括摄入性肺炎，而这两名患者对第一次注射均无反应。无反应者的肌电图特征是口咽间隔值较高。结论：这些结果证实了 IncobotulinumtoxinA 注射液在治疗因 UES 过度活跃和松弛失败导致的神经性吞咽困难方面的有效性。对于第一次治疗无反应的患者再次注射应谨慎。
Background and Aims: Neurogenic dysphagia linked to failed relaxation of the upper esophageal sphincter (UES) can be treated by injecting botulinum toxin (BTX) into the cricopharyngeal (CP) muscle. We compared the effects of this treatment in different neurological disorders with dysphagia, to evaluate its efficacy over time including the response to a second injection. Materials and Methods: Sixty-seven patients with neurogenic dysphagia associated with incomplete or absent opening of the UES (24 with brainstem or hemispheric stroke, 21 with parkinsonian syndromes, 12 with multiple sclerosis, and 10 with spastic-dystonic syndromes secondary to post-traumatic encephalopathy) were treated with the injection of IncobotulinumtoxinA (dose 15–20 U) into the CP muscle under electromyographic guidance. The patients were assessed at baseline and after the first and second treatment through clinical evaluation and fiberoptic endoscopy of swallowing, while their dysphagia was quantified using the Dysphagia Outcome and Severity Scale (DOSS). An electrokinesiographic/electromyographic study of swallowing was performed at baseline. Results: Most patients responded to the first BTX treatment: 35 patients (52.2%) were classified as high responders (DOSS score increase >2 levels), while other 19 patients (28.4%) were low responders (DOSS score increase of ≤2 levels). The effect of the first treatment usually lasted longer than 4 months (67%), and in some cases up to a year. The treatment efficacy remained high also after the second injection: 31 patients (46.3%) qualified as high responders and other 22 patients (32.8%) showed a low response. Only in the parkinsonian syndromes group we observed a reduction in the percentage of high responders as compared with the first treatment. Side effects were mostly mild and reported in non-responders following the first injection. A severe side effect, consisting of ingestion pneumonia, was observed following the second BTX injection in two patients who had both been non-responders to the first. Non-responders were characterized electromyographically by higher values of the oropharyngeal interval. Conclusion: These findings confirm the effectiveness of IncobotulinumtoxinA injection in the treatment of neurogenic dysphagia due to hyperactivity and relaxation failure of the UES. Caution should be used as regards, the re-injection in non-responders to the first treatment.