Department of Neurology, Division of Speech-Language Sciences and Disorders, Henry Ford Health, 6777 West Maple Road, West Bloomfield, MI, 48322, USA.
Department of Neurology, Division of Speech-Language Sciences and Disorders, Henry Ford Health, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
Dysphagia. 2023 Oct;38(5):1421-1429. doi: 10.1007/s00455-023-10571-4. Epub 2023 Apr 18.
Cervical dystonia (CD) is the most common form of focal dystonia with Botulinum neurotoxin (BoNT) being a frequent method of treatment. Dysphagia is a common side effect of BoNT treatment for CD. Instrumental evaluation of swallowing in CD using standardized scoring for the videofluoroscopic swallowing study (VFSS) and validated and reliable patient-reported outcomes measures is lacking in the literature. (1) to determine if BoNT injections change instrumental findings of swallowing function using the Modified Barium Swallow Impairment Profile (MBSImP) in individuals with CD; (2) to determine if BoNT injections change self-perception of the psychosocial handicapping effects of dysphagia in individuals with CD, using the Dysphagia Handicap Index (DHI); (3) to determine the effect of BoNT dosage on instrumental swallowing evaluation and self-reported swallowing outcomes measures. 18 subjects with CD completed a VFSS and the DHI before and after BoNT injection. There was a significant increase in pharyngeal residue for pudding consistency after BoNT injection, p = 0.015. There were significant positive associations between BoNT dosage and self-perception of the physical attributes of the handicapping effect of dysphagia, the grand total score and patient self-reported severity of dysphagia on the DHI; p = 0.022; p = 0.037; p = 0.035 respectively. There were several significant associations between changes in MBSImP scores and BoNT dose. Pharyngeal efficiency of swallowing may be affected by BoNT for thicker consistencies. Individuals with CD perceive greater physical handicapping effects of dysphagia with increased amounts of BoNT units and have greater self-perceptions of dysphagia severity with increased amounts of BoNT units.
颈肌张力障碍（CD）是局灶性肌张力障碍中最常见的形式，肉毒毒素（BoNT）是一种常见的治疗方法。吞咽困难是 CD 患者接受 BoNT 治疗的常见副作用。使用视频透视吞咽研究（VFSS）的标准化评分以及经过验证和可靠的患者报告结果测量来评估 CD 患者的吞咽功能的仪器评估在文献中缺乏。（1）确定 BoNT 注射是否会改变 CD 患者使用改良钡吞咽障碍概况（MBSImP）的吞咽功能的仪器检查结果；（2）确定 BoNT 注射是否会改变 CD 患者对吞咽困难的心理社会致残影响的自我感知，使用吞咽障碍 handicap 指数（DHI）；（3）确定 BoNT 剂量对仪器吞咽评估和自我报告的吞咽结果测量的影响。18 名 CD 患者在 BoNT 注射前后完成了 VFSS 和 DHI。BoNT 注射后布丁稠度的咽部残留显着增加，p=0.015。BoNT 剂量与对吞咽困难致残影响的身体属性的自我感知、DHI 的总评分以及患者自我报告的吞咽困难严重程度之间存在显着的正相关；p=0.022；p=0.037；p=0.035 分别。MBSImP 评分的变化与 BoNT 剂量之间存在多种显着关联。吞咽较稠物质时，咽部效率可能会受到 BoNT 的影响。CD 患者感知到更多的物理残疾影响吞咽困难，并且随着 BoNT 单位数量的增加，吞咽困难的严重程度自我感知也更大。
