Botulinum Toxin Is Effective in the Management of Neurogenic Dysphagia. Clinical-Electrophysiological Findings and Tips on Safety in Different Neurological Disorders

E. Alfonsi, D. A. Restivo, G. Cosentino, R. De Icco, G. Bertino, A. Schindler, M. Todisco, M. Fresia, A. Cortese, P. Prunetti, M. C. Ramusino, A. Moglia, G. Sandrini, C. Tassorelli

Research output: Contribution to journalArticle


Background and Aims: Neurogenic dysphagia linked to failed relaxation of the upper esophageal sphincter (UES) can be treated by injecting botulinum toxin (BTX) into the cricopharyngeal (CP) muscle. We compared the effects of this treatment in different neurological disorders with dysphagia, to evaluate its efficacy over time including the response to a second injection. Materials and Methods: Sixty-seven patients with neurogenic dysphagia associated with incomplete or absent opening of the UES (24 with brainstem or hemispheric stroke, 21 with parkinsonian syndromes, 12 with multiple sclerosis, and 10 with spastic-dystonic syndromes secondary to post-traumatic encephalopathy) were treated with the injection of IncobotulinumtoxinA (dose 15-20 U) into the CP muscle under electromyographic guidance. The patients were assessed at baseline and after the first and second treatment through clinical evaluation and fiberoptic endoscopy of swallowing, while their dysphagia was quantified using the Dysphagia Outcome and Severity Scale (DOSS). An electrokinesiographic/electromyographic study of swallowing was performed at baseline. Results: Most patients responded to the first BTX treatment: 35 patients (52.2%) were classified as high responders (DOSS score increase >2 levels), while other 19 patients (28.4%) were low responders (DOSS score increase of
Original languageEnglish
Pages (from-to)80
Number of pages1
JournalFrontiers in Pharmacology
Publication statusPublished - Feb 22 2017



  • botulinum toxin
  • cricopharyngeal muscle
  • electrophysiological study of swallowing
  • neurogenic dysphagia
  • upper esophageal sphincter dysmotility

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