Efficacy and Safety of Onabotulinum Toxin A (Botox) Injections in the Upper Esophageal Sphincter for the Treatment of Pharyngo-esophageal Dysphagia Due to Cricopharyngeal Dysfunction- A Randomized Double Blinded Placebo Controlled Trial
Dysphagia in patients with stroke, multiple sclerosis, parkinsonism or dystonia can occur due to relative hypertonia of the cricopharyngeus muscle. In the resting state, muscle is contracted and relaxes only during deglutition. Treatment of dysphagia by injecting botulinum toxin in the cricopharyngeus was described by Schneider et al. in 1994. More than 100 cases have been described after that, however there are no randomized controlled trials. A meta-analysis from Cochrane has also concluded that there is no sufficient evidence to conclude regarding the efficacy and safety of Botulinum toxin injection in cricopharyngeal dysfunction. So this study is necessary to fill this void in knowledge
• Patients attending neurology OPD with swallowing dysfunction due to central nervous system dysfunction
• At least 14 years of age of all sexes
• mRS (modified Rankin scale) of ≤3 at time of study enrolment
• In case of post stroke dysphagia, at least 6 months have passed following stroke
• Willing to undergo swallowing assessment clinically and with video fluoroscopy, flexible upper GI endoscopy and esophageal manometry before and after the injection
• Above investigations show impaired cricopharyngeal relaxation, adequate pharyngeal strength and anterocephalad laryngeal movement
• Ready to provide consent for Botulinum neurotoxin injection.
• Willing to adhere to protocol and comply with follow up visits
• No major neurologic or systemic medical condition that reduces life expectancy to less than 1 year based on clinical prediction scores