Objective: To determine if individuals with cervical dystonia perceive changes in swallowing skills following botulinum toxin (BoTN) injection.

Background: Cervical dystonia (CD) is known to be the most common form of focal dystonia, with numbers suggesting 28-183 cases/million [1]. Swallowing function in CD has not been robustly studied. Anterior injections of the cervical musculature with BoNT have been associated with dysphagia however there is limited information on pre-treatment swallowing function. Abnormal position of neck musculature leading to anatomical asymmetry of the swallowing mechanism raises concern for under recognized dysphagia prior to treatment with BoNT. In addition, there is limited information regarding self-perception of dysphagia in individuals with CD and the effects of BoTN on perceived swallowing changes. The Dysphagia Handicap Index (DHI) [2], is a 25 item self-assessment questionnaire divided into subscales of the physical, emotional and functional handicapping effects of dysphagia. A total score and patient perceived severity rating are also obtained. To date, use of a valid and reliable patient reported outcomes measure to assess changes in self-perception of swallowing function following BoTN injection for CD has not been reported.

Method: The Dysphagia Handicap Index (DHI) was administered to 17 individuals with CD within one month prior to their BoTN injection and two weeks following BoTN injection. Subjects completed the DHI through an online survey or in person during their clinic appointments. Paired t-tests were done to compare the pre and post DHI physical, functional, emotional and grand total measurements. For self-reported severity, a signed rank test was done to compare the pre and post measurements.

Results: There were no significant differences in DHI subscale or total scores between pre and post BoTN injection (physical, p= 0.44, functional, p=0.83, emotional, p >0.99, total score, p= 0.61). There were no differences in the self-severity rating of dysphagia before or after BoTN (p>0.99).

Conclusion: Self-perception of the handicapping effects of dysphagia appears to remain unaffected by BoTN injection in individuals with CD. The results of this study add to the knowledge base of the risks and benefits of BoTN injection in indivduals with CD. A larger sample size is warranted to further explore the effect of BoTN on self-perceptions of dysphagia in CD.

References: 1. Defazio G, Jankovic J, Geil JL, Papapetropoulos S. Descriptive epidemiology of cervical dystonia. Tremor Other Hyperkinet Mov. 2013, doi:10.7916/D8OC4TGJ. 2. Silbergleit AK, Schultz L, Jacobson B, Beardsley T, Johnson A. The Dysphagia Handicap Index: Development and Validation. Dysphagia, 2012, 27(1), 46-52.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/self-perception-of-dysphagia-before-and-after-botulinum-toxin-injection-for-cervical-dystonia/