Department of Neurology, MSC 10 5620, 1 University of New Mexico, Albuquerque, New Mexico, 87131.
Muscle Nerve. 2014 Apr;49(4):601-3. doi: 10.1002/mus.24123. Epub 2014 Feb 25.
Despite multiple studies reporting marked benefit of botulinum toxin (BTX) for treatment of cricopharyngeal dysphagia, little is known about its safety for this indication. We examined the safety of cricopharyngeal BTX for dysphagia in oculopharyngeal muscular dystrophy (OPMD).
We reviewed records of patients with OPMD who received cricopharyngeal BTX.
Twenty-four patients underwent 66 procedures. Overall adverse event frequency was 44%. The most common adverse events were dysphonia (24%) and worsened dysphagia (14%). Logistic regression demonstrated that dose was a significant predictor of worsened dysphagia (P = 0.036) and of the composite event of dysphonia or worsened dysphagia (P = 0.009). There was a nonsignificant trend for dose as a predictor of dysphonia (P = 0.073). 59% of procedures were associated with symptomatic improvement.
While BTX appears to be beneficial for treatment of dysphagia in OPMD, caution is warranted when injecting the cricopharyngeus muscle due to dose-related risk of dysphonia or worsened dysphagia.
尽管多项研究报告称肉毒毒素 (BTX) 对治疗环咽肌失弛缓症有显著疗效，但对于其在该适应证下的安全性知之甚少。我们研究了 BTX 治疗肌萎缩性侧索硬化症 (OPMD) 所致吞咽困难的安全性。
我们回顾了接受环咽肌 BTX 治疗的 OPMD 患者的病历。
24 名患者共接受了 66 次治疗。总体不良事件发生率为 44%。最常见的不良事件是发声困难 (24%) 和吞咽困难加重 (14%)。Logistic 回归分析表明，剂量是吞咽困难加重 (P = 0.036) 和发声困难或吞咽困难加重复合事件 (P = 0.009) 的显著预测因素。剂量对发声困难的预测有一定的趋势 (P = 0.073)。59%的治疗与症状改善相关。
虽然 BTX 似乎对治疗 OPMD 引起的吞咽困难有效，但由于剂量相关的发声困难或吞咽困难加重风险，在注射环咽肌时应谨慎。
