Safety of botulinum toxin for dysphagia in oculopharyngeal muscular dystrophy

Abstract

Introduction 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). Methods We reviewed records of patients with OPMD who received cricopharyngeal BTX. Results 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. Conclusions 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.

Reply

“…Restivo and Marchese-Ragona for their comments on our study. 1 We agree that botulinum toxin (BTX) volume influences local diffusion independently of dose. With identical doses of BTX, there may be greater local diffusion and a larger area of effect when a larger diluent volume (lower concentration) is used, 2 which can lead to adverse events (AEs).…”

Dysphagia with fatal choking in oculopharyngeal muscular dystrophy

“…[ 13 ] The complication rate reported in literature reviews is, and the reported complication are mainly temporary unilateral vocal cord palsy, [ 14 ] dysphonia, or worsened dysphagia. [ 15 ]…”

Safety of botulinum toxin for dysphagia in oculopharyngeal muscular dystrophy

“…reviewed the health records of their patients with oculopharyngeal muscular dystrophy who had at least 1 cricopharyngeal (CP) botulinum toxin (BTX) injection for treatment of dysphagia. They sought to better characterize the risks associated with CP myotomy by BTX in these patients . The following variables were evaluated: age; gender; dose; procedure type; injection site; and time since last injection .…”

“…They sought to better characterize the risks associated with CP myotomy by BTX in these patients . The following variables were evaluated: age; gender; dose; procedure type; injection site; and time since last injection . They was found that worsened dysphagia and dysphonia are dose‐related adverse events (AEs) and provide estimates for the magnitude of AE risk at different doses .…”

“…The following variables were evaluated: age; gender; dose; procedure type; injection site; and time since last injection . They was found that worsened dysphagia and dysphonia are dose‐related adverse events (AEs) and provide estimates for the magnitude of AE risk at different doses . We consider these results to be unsurprising.…”