Unit of Functional Digestive Rehabilitation, Institut Guttmann, Neurorehabilitation Hospital, University Institute affiliated with the Autonomous University of Barcelona, Badalona, Spain.
Neurogastroenterol Motil. 2013 Nov;25(11):896-e702. doi: 10.1111/nmo.12213. Epub 2013 Aug 29.
In a previous pilot study, we demonstrated that a single injection of botulinum toxin A (BTX-A) in the cricopharyngeus muscle is effective in patients with neurologic dysphagia with upper esophageal sphincter (UES) opening dysfunction and presence of some pharyngeal contraction (>25 mmHg). The aim of this study was to confirm the long-lasting efficacy of this procedure after stroke.
We prospectively studied 23 patients with stroke for at least 6 months before administration of a BTX-A injection. Baseline diagnosis of UES opening dysfunction and presence of some pharyngeal contraction were assessed by videofluoroscopy (VFS) and esophageal manometry (EM). Clinical and VFS follow-up was made at 3 weeks and 3, 6, and 12 months postinjection.
Eighteen patients (78%) were fed by gastrostomy tube prior to treatment. Videofluoroscopy showed UES relaxation impairment, residue in pyriform sinuses, and aspiration in all cases. After BTX-A, the number of patients with aspiration and pharyngeal residue decreased to 52% and 70%, respectively (p < 0.05 for both); residue was severe in only 4%. Esophageal manometry showed a mean pharyngeal amplitude 66.8 mmHg (range: 25-120 mmHg). We observed a significant improvement in feeding mode during follow-up: after 3 months, 70% of patients were eating exclusively by mouth. Lower residual pressure and minor pharyngeal delay time at baseline were all predictive factors for treatment effectiveness.
CONCLUSIONS & INFERENCES: A single injection of BTX-A is efficacious for a period of at least 12 months in improving oropharyngeal dysphagia in stroke patients with UES opening dysfunction and some pharyngeal contraction (>25 mmHg).
在之前的一项初步研究中，我们证明了在环咽肌单次注射肉毒毒素 A（BTX-A）对于上食管括约肌（UES）开放功能障碍和存在部分咽收缩（>25mmHg）的神经源性吞咽困难患者是有效的。本研究的目的是确认这种方法在中风后长期有效。
我们前瞻性地研究了 23 例中风患者，这些患者在接受 BTX-A 注射前至少有 6 个月的病史。UES 开放功能障碍和存在部分咽收缩的基线诊断通过视频透视（VFS）和食管测压（EM）进行评估。在注射后 3 周、3、6 和 12 个月进行临床和 VFS 随访。
18 例（78%）患者在治疗前通过胃造口管喂养。VFS 显示 UES 松弛障碍、梨状窦残留和所有病例均有吸入。BTX-A 治疗后，吸入和咽残留的患者数量分别减少到 52%和 70%（均<0.05）；残留严重的仅占 4%。食管测压显示咽幅值平均为 66.8mmHg（范围：25-120mmHg）。我们观察到在随访期间喂养方式有显著改善：3 个月后，70%的患者完全经口进食。较低的基础残余压力和较小的咽延迟时间都是治疗效果的预测因素。
在至少 12 个月的时间内，单次注射 BTX-A 可有效改善 UES 开放功能障碍和存在部分咽收缩（>25mmHg）的中风患者的口咽吞咽困难。
