Occurrence of Dysphagia Following Botulinum Toxin Injection in Parkinsonism-related Cervical Dystonia: A Retrospective Study

• Main Authors: Addie Patterson, Leonardo Almeida, Christopher W. Hess, Daniel Martinez-Ramirez, Michael S. Okun, Ramon L. Rodriguez, Valerie Rundle-Gonzalez, Aparna Wagle Shukla, Irene A. Malaty
• Format: Article
• Language: English
• Published: Ubiquity Press 2016-11-01
• Series: Tremor and Other Hyperkinetic Movements
• Online Access: https://tremorjournal.org/index.php/tremor/article/view/379

<p><strong>Background:</strong> The aim was to compare the occurrence of post-injection dysphagia in parkinsonism-related cervical dystonia (PRCD) versus cervical dystonia (CD) of other etiologies (non-PRCD). A secondary objective was to explore potential clinical differences between PRCD and non-PRCD and their respective responses to botulinum toxin (BoNT).</p> <p><strong>Methods:</strong> A cross-sectional chart review was carried out of patients treated for CD with Onabotulinumtoxin A at the University of Florida. We collected demographic information, dose of BoNT injected, patient-reported presence of dysphagia as a side effect, patient-perceived duration of benefit and efficacy according to the Clinical Global Impression Scale (CGIS).</p> <p><strong>Results:</strong> Of the 144 patients included, 24 patients were diagnosed with PRCD and 120 were diagnosed as non-PRCD. Data analysis showed no significant differences in number of weeks of benefit from BoNT (PRCD 9.1&plusmn;3.7 versus non-PRCD 9.4&plusmn;3.7 weeks, p = 0.830), BoNT dosage (PRCD 235.0&plusmn;95.6 versus non-PRCD 263.7&plusmn;101.3 units, p = 0.181), median CGIS score (median = 2 or &ldquo;much improved&rdquo; for both groups, p = 0.88), or the presence of dysphagia after BoNT (PRCD 17% versus non-PRCD 19 %, p = 0.753, n = 132). In a subgroup analysis of the non-PRCD group, patients who experienced dysphagia were older than those who did not (63.9&plusmn;8.9 years versus 58.1&plusmn;14.4 years, p = 0.02).</p> <p><strong>Discussion:</strong> Despite an increased baseline risk of dysphagia in patients with PRCD, BoNT appears to be equally safe and equally beneficial in PRCD and non-PRCD patients.</p>