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Elimination of dysphagia using ultrasound guidance for botulinum toxin injections in cervical dystonia

Authors

  • Justin S. Hong MD,

    1. Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, 201 Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, Pennsylvania 15213, USA
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  • Geeta G. Sathe MD,

    1. Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, 201 Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, Pennsylvania 15213, USA
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  • Christian Niyonkuru MS,

    1. Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, 201 Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, Pennsylvania 15213, USA
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  • Michael C. Munin MD

    Corresponding author
    1. Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, 201 Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, Pennsylvania 15213, USA
    • Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, 201 Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, Pennsylvania 15213, USA
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Abstract

Introduction: Dysphagia is a common side effect after botulinum toxin injections for cervical dystonia, with an incidence of 10–40%, depending upon the study and dose used. Methods: Our study consisted of 5 preselected women who met criteria for cervical dystonia and subsequent dysphagia after electromyography (EMG)-guided injections. Injections were performed with ultrasound (US) imaging, and the effects on swallowing were examined. Separately, sternocleidomastoid (SCM) thickness in healthy controls and treated patients was measured. Results: There were 34 episodes of dysphagia over 98 injection sessions using EMG guidance for a cumulative rate of 34.7%. Using US plus EMG guidance, there was 0% dysphagia across 27 injection sessions. SCM thickness was <1.1 cm. Conclusion: US combined with EMG guidance eliminated recurrent dysphagia after botulinum toxin treatment, possibly by keeping the injectate within the SCM. Muscle Nerve 46: 535–539, 2012

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