Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report the results of botulinum toxin type A (Dysport, Porton Products, UK) treatment over 5 years in 107 patients with blepharospasm, Meige's syndrome, oromandibular dystonia, hemifacial spasm, cervical dystonia, and writer's cramp. Electromyography was used to localize dystonic muscles and guide Dysport injections in Meige's syndrome, oromandibular dystonia, cervical dystonia, and writer's cramp. All but 2 Meige's syndrome and 2 writer's cramp patients responded to treatment. Improvement was dramatic in blepharospasm (79%) and hemifacial spasm (90%); pronounced in cervical dystonia (74%); and moderate in Meige's syndrome (53%), oromandibular dystonia (57%), and writer's cramp (34%). Although Dysport doses were 50-75% lower than usually reported, response and improvement rates as well as relapse intervals were similar to those of others. To treat cervical dystonia relapses, only 50% of the initial dose was required for continued optimal relief of symptoms. Low-dose Dysport was associated with a very low incidence of dysphagia in cervical dystonia.
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PMID:Five-year experience in the treatment of focal movement disorders with low-dose Dysport botulinum toxin. 778 62

Secondary peristalsis was investigated in 30 patients with non-obstructive dysphagia and 20 age matched controls. Oesophageal motility was recorded at 3 cm intervals along the oesophageal body. Primary peristalsis was tested with 5 ml water swallows. Secondary peristalsis was stimulated with 10 ml boluses of air and water injected in the mid-oesophagus and by distensions (5 seconds duration) with a 3 cm balloon at the same level. Primary peristalsis was normal in 19 of the 20 control subjects and in nine of the 30 patients with dysphagia; 11 patients had diffuse spasm and 10 had non-specific abnormalities of primary peristalsis. Secondary peristalsis was triggered significantly less frequently by air and water distension in dysphagia patients (median success rate of 10% for the air boluses and 0% for the water boluses) than in control subjects (50% and 30% respectively, p < 0.005), and was abnormal in six of nine patients with normal primary peristalsis, nine of 11 patients with diffuse spasm and eight of 10 patients with non-specific motor abnormalities. The median frequency of balloon induced secondary peristalsis, however, was not significantly different in the two groups (0% controls, 40% non-obstructive dysphagia, p = 0.22). For each stimulus, there were no significant differences in the response rate in the three subgroups of patients. The major pattern of failure of secondary peristalsis in response to the air and water boluses was the complete absence of any oesophageal response. The amplitude of complete secondary peristalsis triggered by the water boluses and the balloon was greater in the patients with dysphagia (p = 0.03) than in normal subjects, while the amplitude of the secondary peristaltic responses triggered by the air boluses was similar in the two groups. Secondary peristaltic velocity was also similar in normal subjects and patients with non-obstructive dysphagia. Patients with non-obstructive dysphagia show a noticeable defect in the triggering of secondary peristalsis which may make an important contribution to the delayed oesophageal bolus transit and dysphagia seen in this condition.
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PMID:Secondary oesophageal peristalsis in patients with non-obstructive dysphagia. 782 66

Treatment of dysphagia resulting from bulbar amyotrophic lateral sclerosis has included cricopharyngeal myotomy for many years but is successful in only a minority of cases. The purpose of this study was to explore the rationale for this procedure with modern manometric techniques. The results of pharyngoesophageal manometry in 13 patients with amyotrophic lateral sclerosis were compared with 13 age- and sex-matched healthy volunteers by Mann-Whitney analysis. There was no significant difference between patients and control subjects in distal esophageal or lower esophageal sphincter motility nor any pressure parameter of pharyngoesophageal motility. Separate analysis of the seven significantly dysphagic subjects showed a significantly reduced upper esophageal sphincter after-contraction amplitude during water and bread swallows in patients than in control subjects. These data suggest that the dysphagia of amyotrophic lateral sclerosis is not due to upper esophageal sphincter spasm and that treatment by cricopharyngeal myotomy may be inappropriate.
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PMID:Analysis of the pharyngoesophageal pressure profile in amyotrophic lateral sclerosis. 783 49

After total laryngectomy, the cricopharyngeus muscle, when intact, appears to inhibit the free flow of saliva and secretions past the pharyngeal repair into the upper esophagus. The authors hypothesize that cricopharyngeus myotomy reduces sphincteric pressure, thereby diminishing forces against the pharyngeal suture line. Peak pharyngeal pressures were recorded in patients who underwent total laryngectomy with and without cricopharyngeus myotomy. In patients without concurrent myotomy, peak pharyngeal pressures were all greater than 60 mm Hg. With concurrent myotomy, peak pharyngeal pressures averaged less than 40 mm Hg. Concurrent myotomy carries with it the potential for minimizing postoperative fistulization, eliminating dysphagia of cricopharyngeus spasm, and improving the acquisition of alaryngeal speech.
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PMID:Effect of cricopharyngeus myotomy on postlaryngectomy pharyngeal contraction pressures. 842 4

In reflux disease the authors emphasize the following diagnostic procedures: a satisfactory case-history, endoscopy, aimed biopsy, radiographic evidence of reflux, radionuclide reflux scintigraphy and pH-metry. As to subsidiary examinations, they recommend Bernstein's perfusion test. In 50% of the patients with non-coronary chest pain the complaints are caused by diseases of the oesophagus. The latter include achalasia, dysphagia, idiopathic diffuse spasm, hyperdynamic oesophagus and irritable oesophagus. In the treatment of reflux disease the stage of the disease is decisive. Treatment is prolonged and the doses of drugs are higher than in duodenal ulcers. The basis are H2 blockers. In severe forms treatment with omeprazole is indicated. Surgery is indicated only in severe mucosal complications. In achalasia of the oesophagus this is disruption of the sphincter by the method of pneumatic dilatation or surgical myotomy. Idiopathic diffuse spasm and other disorders of oesophageal motility respond in different ways to treatment with calcium autagonists and nitrate treatment.
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PMID:[Diagnosis and therapy of esophageal diseases]. 850 59

The case of a 76 year old patient diagnosed of severe dysphagia by familiar oculopharyngeal muscular dystrophy is presented. Central venous catheterization (right internal jugular) was required for parenteral nutrition. A few minutes after catheterization, the patient developed respiratory arrest and coma and later cerebral vascular accident with left flaccid hemiplegia, with the ischemic lesion being focalized in the right parietooccipital region as well as in the left of the posterior fossa were observed. Aneurismatic dissection of the bilateral vertebral artery during lateralization of the head may be a cause of the lesions presented by the patient associated to arterial spasm or not. In central venous catheterization the possible complications derived from the position of the neck may carry must be taken into account.
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PMID:[Cerebral infarction, respiratory arrest, and coma after percutaneous catheterization of the right internal jugular vein]. 851 27

Adductor spasmodic dysphonia (SD) is a speech disorder resulting from involuntary contractions of the laryngeal muscles. Botulinum toxin (BT) injection of the thyroarytenoid muscle is an effective, though temporary, treatment for most SD patients. Though there are reports of objective improvements in voice quality, there are no large studies of patients' subjective responses to treatment over time. In the present study, patients were given voice diaries to rate vocal spasms, hoarseness, breathiness, volume problems, and dysphagia before and the after treatment. Analysis of these diaries revealed that: (1) most side effects had resolved 4 to 6 weeks after injection, whereas vocal spasm relief persisted; (2) vocal spasm relief and severity of side effects peaked within 1 week; and (3) unilateral injections, though as effective in relieving vocal spasms, caused less volume and swallowing problems than did bilateral injections.
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PMID:Prospective study of patients' subjective responses to botulinum toxin injection for spasmodic dysphonia. 868 55

Botulinum toxin has become the initial treatment of choice for the management of essential blepharospasm, hemifacial spasm and other craniocervical dystonias. Numerous studies have confirmed a 90% to 95% response rate. Although a number of common side effects have been reported, the occurrence and incidence of rare local complications remains poorly understood. More importantly, the acute and chronic distant effects of botulinum toxin have not been clearly elucidated. A better understanding of such effects is essential if clinicians are to appropriately advise patients on the use of this therapeutic modality. This article is based on the Duke University experience in the management of over 500 patients with craniocervical spasm disorders, combined with a review of the published literature. These disorders include essential blepharospasm, oromandibular dystonia, hemifacial spasm, and torticollis. The incidence of side effects following more than 6000 treatments with botulinum toxin is presented. Pertinent research relating to the causes of these complications is also reviewed. The most common complications of treatment with botulinum toxin are related to acute local effects resulting from chemodenervation. The most important clinical effect in this group is weakening of the levator muscle resulting in ptosis, and the corneal consequences of lagophthalmos. The latter includes exposure keratitis, dry eyes, blurred vision, and hypersecretion epiphora. Less common local effects include facial numbness, diplopia, and ectropion. Some distant effects are being observed with increasing frequency. These include pruritus, dysphagia, nausea, and a flu-like syndrome. Most significant, however, are the rare reports of generalized weakness and the documentation of EMG abnormalities distant to the site of toxin injection. This has been seen with injections for both blepharospasm and torticollis. Until further studies on the long-term distant complications of botulinum toxin are available, it is recommended that patients receive as few life-time doses of toxin as possible, consistent with adequate management of their spasms. The practice of reinjecting patients routinely every three months, or at the first return of mild spasms should be discouraged.
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PMID:Botulinum-A toxin in the treatment of craniocervical muscle spasms: short- and long-term, local and systemic effects. 882 30

Cricopharyngeal achalasia produces dysphagia in many patients. The spasm has been treated in the past with medication, bouginage, pharyngeal plexus neurectomy, and cricopharyngeal myotomy. In some patients the cause of dysphagia may be elusive, or the patient may be a poor risk for a surgical intervention. We have found that cricopharyngeal muscle injections of botulinum toxin can be useful in the diagnosis and therapy of cricopharyngeal spasm.
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PMID:Use of botulinum toxin for diagnosis and management of cricopharyngeal achalasia. 912 84

Botulinum toxin A is the more efficient therapy of focal dystonias and hemifacial spasm. Our experience with botulinum toxin A injections in 115 patients is reported. Marked or total improvement was achieved in all 45 patients with hemifacial spasm, in 70% of 20 patients with essential blepharospasm and in 71.4% of 14 patients with Meige's syndrome. In 65.2% of 23 patients with cervical dystonia marked but no total improvement was obtained. The worse results were seen in the 6 patients with hand dystonia (writers cramp), in whom marked improvement was obtained in just two. Mild and transient complications occurred in up to 24.4%, eyelid ptosis and eyelid weakness being the most frequent. One patient with Meige's syndrome had an aspiration pneumonia following dysphagia. Our results are in agreement with others, showing that botulinun toxin A is a useful and safe treatment for these conditions.
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PMID:[Botulinum toxin A: experience in the treatment of 115 patients]. 962 4


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