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Comparison of Oropharyngeal Dysphagia Before and After Botulinum Toxin Injection in Cervical Dystonia

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Abstract

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.

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Funding

This study was funded by the Research Proposal Development Program, Henry Ford Health.

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Authors and Affiliations

  1. Department of Neurology, Division of Speech-Language Sciences and Disorders, Henry Ford Health, 6777 West Maple Road, West Bloomfield, MI, 48322, USA

    Alice K. Silbergleit, Jennifer Turnbull, Erica Boettcher & Ramya Konnai

  2. Department of Neurology, Division of Speech-Language Sciences and Disorders, Henry Ford Health, 2799 West Grand Blvd, Detroit, MI, 48202, USA

    Krysten Isabell

  3. Department of Neurology, Division of Movement Disorders, Henry Ford Health, 6777 West Maple Road, West Bloomfield, MI, 48322, USA

    Neepa Patel

  4. Department of Neurology, Rush University Medical Center, 1620 W Harrison St, Chicago, IL, 60612, USA

    Neepa Patel

  5. Department of Diagnostic Radiology, Henry Ford Health, 6777 West Maple Road, West Bloomfield, MI, 48322, USA

    Denise Collins

  6. Department of Neurology, Michigan State University, 788 Service Road, Room B-446, East Lansing, MI, 48824, USA

    Christos Sidiropoulos

  7. Department of Public Health Sciences, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA

    Lonni Schultz

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  1. Alice K. Silbergleit
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Silbergleit, A.K., Isabell, K., Turnbull, J. et al. Comparison of Oropharyngeal Dysphagia Before and After Botulinum Toxin Injection in Cervical Dystonia. Dysphagia 38, 1421–1429 (2023). https://doi.org/10.1007/s00455-023-10571-4

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