Successful treatment of post COVID-19 neurogenic dysphagia with botulinum toxin
  • Riccardo Canta
    Department of Neuroscience (DINOGMI), University of Genoa, Genova, Italy; Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
  • Lucilla Vestito
    Department of Neuroscience (DINOGMI), University of Genoa, Genova, Italy; Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
  • Paola Castellini
    IRCCS Ospedale Policlinico San Martino, Genova, Italy; SSD Foniatria, Genova, Italy
  • Carlo Trompetto
    Department of Neuroscience (DINOGMI), University of Genoa, Genova, Italy; Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
  • Laura Mori
    Department of Neuroscience (DINOGMI), University of Genoa, Genova, Italy; Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
  • Anna De Giovanni
    Department of Neuroscience (DINOGMI), University of Genoa, Genova, Italy; Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
  • Luca Puce
    Department of Neuroscience (DINOGMI), University of Genoa, Genova, Italy; Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
  • Lucio Marinelli
    Department of Neuroscience (DINOGMI), University of Genoa, Genova, Italy; Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Division of Clinical Neurophysiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy

Keywords

COVID-19, dysphagia, botulinum toxin, EMG

Abstract

Introduction: Dysphagia in post COVID-19 patients could be caused by several factors, including reduced pharyngolaryngeal coordination due to SARS-CoV-2 tropism to the central and/or peripheral nervous system. To our knowledge, this is the first reported case of COVID-19-related dysphagia successfully treated with botulinum toxin type A injection.
Case description: We report the case of a patient with severe oropharyngeal dysphagia due to COVID-19 confirmed by fibre endoscopy. As a result, the patient required an enteral feeding tube. After two months of traditional swallowing therapies, there was only limited improvement. An electrophysiologic evaluation of the cricopharyngeal muscle was performed and showed a normal inhibition of the cricopharyngeal muscle, followed by a hypertonic rebound. Based on this result, we decided to perform a unilateral laryngeal injection of botulinum toxin type A. After the injection, the patient’s swallowing function improved significantly, allowing him to return to oral feeding.
Discussion: Newly diagnosed oropharyngeal dysphagia was found in 35.3% of hospitalised patients with COVID-19. There are several possible causes of COVID-19-associated dysphagia, including stroke, encephalitis, critical illness neuropathy, Guillain-Barré syndrome and skeletal muscle injury. In our case, since stroke was excluded by brain MRI, cranial nerve injury was a possible explanation for the difficult recovery of swallowing despite daily swallowing therapy.
Conclusion: We suggest that electrophysiology is a valid tool for the diagnosis and follow-up of patients with oropharyngeal dysphagia.

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    Published: 2023-11-27
    Issue: 2023: Vol 10 No 12 (view)


    How to cite:
    1.
    Canta R, Vestito L, Castellini P, Trompetto C, Mori L, De Giovanni A, Puce L, Marinelli L. Successful treatment of post COVID-19 neurogenic dysphagia with botulinum toxin. EJCRIM 2023;10 doi:10.12890/2023_004105.