Chiu Ming-Jang, Chang Yeun-Chung, Hsiao Tzu-Yu
Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
Dysphagia. 2004 Winter;19(1):52-7. doi: 10.1007/s00455-003-0029-3.
Cricopharyngeus (CP) muscle spasm can lead to severe dysphagia. Myotomy of the CP muscle was the treatment of choice. Recently, botulinum toxin type A (BtxA) has been used for CP spasm. It usually brings improvement in deglutition but most patients require reinjection in 3-5 months. We report a 35-year-old man who had an arteriovenous malformation hemorrhage in the brain stem resulting in CP spasm and consequently severe dysphagia. He received BtxA injection and deglutition and nutrition remained good one year after treatment. A literature review analyzing 28 patients and our patient showed negative correlations between age and BtxA dose and between age and duration. Efficacy was positively correlated with duration and BtxA dose was positively correlated with pretreatment severity. In conclusion, physicians would use higher doses on patients with more severe cases but use lower doses on older patients. Those who obtained better post-treatment results would enjoy longer effective duration. Thus, the effective duration of the BtxA is multifactorial.
环咽肌（CP）痉挛可导致严重吞咽困难。CP肌切开术曾是首选治疗方法。近来，A型肉毒杆菌毒素（BtxA）已用于治疗CP痉挛。它通常能改善吞咽功能，但大多数患者在3至5个月后需要再次注射。我们报告一名35岁男性，其脑干动静脉畸形出血导致CP痉挛，进而引起严重吞咽困难。他接受了BtxA注射，治疗一年后吞咽和营养状况良好。一项对28例患者及我们这位患者的文献分析显示，年龄与BtxA剂量之间以及年龄与持续时间之间呈负相关。疗效与持续时间呈正相关，BtxA剂量与治疗前严重程度呈正相关。总之，医生会对病情较重的患者使用较高剂量，但对老年患者使用较低剂量。治疗后效果较好的患者有效持续时间更长。因此，BtxA的有效持续时间受多种因素影响。
