Objective: To review a case of endoscopically-documented pharyngeal dystonia and its response to alcohol.

Background: Pharyngeal dystonia is a rare complication of neuroleptic use, resulting in dysphagia or dysphonia. Some published cases have responded to treatment with olanzapine, clozapine, or anticholinergics. There is ongoing research in the use of sodium oxybate for the treatment of spasmodic dysphonia due to laryngeal dystonia in patients whose symptoms improve with ethanol intake.

Methods: Literature review and illustrative case.

Results: The patient is a 63 year-old right-handed man presenting with an 11 month history of progressive dysphonia. His voice gradually became more strained and hoarse to the point where his occupational performance was compromised. He had transient improvement in his symptoms with escalating doses of lorazepam, and reported that his voice had markedly improved after drinking red wine. He had an extensive work-up with no cause of his symptoms found. There was no personal or family history of dystonia. There was a remote history of exposure to neuroleptics, but reported no recent use of dopamine-blocking medications. Exam was notable for severely strangulated voice, especially for vowel sounds. There was improvement in his voice when he read aloud. He had occasional blepharospasm, oral dyskinesias and some mild asymptomatic dystonic posturing of the hands. After consuming two 8 oz glasses of red wine, his voice worsened. As a result, he was deemed a poor candidate for sodium oxybate therapy and was treated with clonazepam and trihexyphenidyl. Subsequent review of pharmacy records revealed recent prescriptions for perphenazine and thiothixene, indicating that his symptoms are likely tardive in nature.

Conclusions: Pharyngeal dystonia is a recognized complication of treatment with neuroleptics. Alcohol was ineffective at treating the symptoms in this case, however its utility in idiopathic pharyngeal dystonia remains to be determined.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/endoscopically-documented-pharyngeal-dystonia-due-to-neuroleptic-use-without-response-to-alcohol/