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Dysphagia after botulinum toxin injections for spasmodic torticollis

Clinical and radiologic findings

Departments of Neurological Sciences (Drs. Comella and Tanner), Speech and Hearing (L. DeFoor-Hill), and Radiology (Dr. Smith), Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL; and the Clinical Center for Parkinson's Disease and Movement Disorders (Dr. Tanner), San Jose, CA.

We prospectively evaluated the frequency, severity, and radiologic features of swallowing abnormalities following Botox treatment of spasmodic torticollis. We performed both clinical and radiologic evaluations of swallowing before and following Botox in 18 consecutive cervical dystonia patients receiving their first Botox treatment. Before Botox, 11% of the patients had clinical symptoms of dysphagia and 22% had radiologic signs of a peristaltic abnormality. After Botox, the signs and symptoms of dysphagia in these patients did not change, but an additional 33% developed new dysphagic symptoms and 50% of the patients developed new peristaltic abnormalities by radiologic studies. Complaints of swallowing difficulty were always associated with abnormal radiologic findings. Neither the total Botox dose nor Hotox into particular muscles differed between those with dysphagia and those without.

Address correspondence and reprint requests to Dr. Cynthia L. Comella, Department of Neurological Sciences, Rush-Presbyterian-St. Luke's Medical Center, 1725 West Harrison Avenue, Chicago, IL 60612.

Presented in part at the 42nd annual meeting of the American Academy of Neurology, Miami Beach. FL, April 1990.

Received September 3, 1991. Accepted for publication in final form December 10, 1991.

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