Objective: 1.To determine if Botulinum toxin (BoNT) injection improves oropharyngeal swallowing in individuals with cervical dystonia (CD) as determined by objective data from videofluorographic swallowing studies (VFSS) using the Modified Barium Swallow Impairment Profile (MBSImP); 2.To determine if BoNT injection improves self-reported handicapping effects of dysphagia in individuals with CD using the Dysphagia Handicap Index (DHI), a patient self-reported outcomes measure.

Background: Cervical dystonia is the most common form of focal dystonia. Treatment for CD is BoNT injection into affected muscles. Dysphagia is the most frequent adverse effect following BoNT injection in CD, however objective data regarding changes in oropharyngeal swallowing from the VFSS using standardized rating scales has not been reported. Changes in self-perception of the handicapping effect of dysphagia in CD before and after BoNT injection using valid and reliable patient reported outcomes measures is lacking in the literature.

Method: 18 subjects (one male) with CD completed a VFSS and the DHI within two days prior to BoNT injection for CD and 14-19 days following BoNT injection. Subjects ingested a variety of barium consistencies during the VFSS.  A Speech-Language Pathologist certified in the MBSImP rated all VFSS studies blinded to BoNT injection status.  Descriptive statistics, paired t-tests, signed rank tests and Spearman’s correlations coefficients were computed for various statistical analyses. The testing level for all comparisons was 0.05.

Results: There was a significant increase in pharyngeal residue for pudding consistency after BoNT injection, p=0.015. There were significant positive associations between BoNT dose 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.

Conclusion: 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. Pharyngeal contraction efficiency may be affected by BoNT for thicker consistencies.

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2. Kessler KR, Skutta M, Benecke R. Long-term treatment of cervical dystonia with botulinum toxin A: efficacy, safety, and antibody frequency. J Neurology 1999; 246:265-274.
3. Dauer WT, Burke RE, Greene P, Fahn S. Current concepts on the clinical features, aetiology and management of idiopathic cervical dystonia. Brain 1998;121:547-560.
4. Comella CL, Tanner CM, DeFoor-Hill L, Smith C. Dysphagia after botulinum toxin injections for spasmodic torticollis: clinical and radiological findings. Neurology 1992;42:1307-1310.
5. Martin-Harris B, Brodsky M, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallowing impairment-MBSImP: establishing a standard. Dysphagia 2008; 23:392-405.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/oropharyngeal-dysphagia-before-and-after-botulinum-toxin-injection-in-cervical-dystonia/