Dysphagia after botulinum toxin injections for spasmodic torticollis

Abstract

We prospectively evaluated the frequency, severity, and radiologic features of swallowing abnormalities following Botox treatment of spasmodic torticollis. We performed both clinical and radiologic evaluations of swallowing before and following Botox in 18 consecutive cervical dystonia patients receiving their first Botox treatment. Before Botox, 11% of the patients had clinical symptoms of dysphagia and 22% had radiologic signs of a peristaltic abnormality. After Botox, the signs and symptoms of dysphagia in these patients did not change, but an additional 33% developed new dysphagic symptoms and 50% of the patients developed new peristaltic abnormalities by radiologic studies. Complaints of swallowing difficulty were always associated with abnormal radiologic findings. Neither the total Botox dose nor Botox into particular muscles differed between those with dysphagia and those without.

Swallowing in torticollis before and after rhizotomy

“…Therefore, we suggest that preoperative dysphagia can be purely postural in nature, but appears to have a neurogenic component in some patients. The neurogenic interpretation for dysphagia in torticollis before surgery [5,6] is not inconsistent with causal theories about spasmodic torticollis that implicate the basal ganglia and brainstem [1,3]. The dysphagia we observed in torticollis patients is reminiscent of "spasmodic dysphagia in Meige syndrome" described by Kakigi and colleagues [15].…”

“…We review the innervation of intrinsic and extrinsic pharyngeal musculature, and suggest that C1-3 rhizotomies and selective sectioning of the spinal accessory nerve are responsible for aggravation of pharyngeal swallowing dysfunction in the acute postsurgical period. Only recently have investigators prospectively described dysphagia in spasmodic torticollis using radiologic methods [5,6], despite a long-standing recognition of this disorder [7]. We describe subjective and objective characteristics of swallowing in 41 patients with adult onset spasmodic torticollis before and after ventral rhizotomy.…”

Swallowing, speech, and brainstem auditory-evoked potentials in spasmodic torticollis

“…Riski and colleagues [22] observed such neurogenic signs frequently in a series of 43 torticollis patients evaluated before surgery, as did Horner and colleagues [26] in a unique series of torticollis patients undergoing rhizotomy. Comella and colleagues [31] also observed defective peristalsis in 4 of 15 torticollis patients before botulinum toxin injections. Patterns of dysfunction observed in the present sample lead us to suggest that two patients showed signs of neurogenic dysphagia only; two patients, postural dysphagia only; and two patients, combined postural and neurogenic.…”

How Effective and Safe is Botulinum Toxin Therapy in Cervical Dystonia: The Current Stand

“…Dysphagia was most frequently related to bilateral injection into sternocleidomastoid muscles [55,56]. Measures to minimize these adverse events include always using the lowest efective dose.…”