CASE REPORT   Free access

European Journal of Physical and Rehabilitation Medicine 2017 October;53(5):798-801

DOI: 10.23736/S1973-9087.17.04499-9

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Efficacy of botulinum toxin type-A and swallowing treatment for oropharyngeal dysphagia recovery in a patient with lateral medullary syndrome

Irene BATTEL ¹ ✉, Isabella KOCH ¹, Federica BIDDAU ¹, Carla CAROLLO ¹, Francesco PICCIONE ¹, Francesca MENEGHELLO ¹, Antonio MERICO ¹, Katie PALMER ¹, Rosario MARCHESE RAGONA ²

¹ Neuroriabilitation Hospital Foundation IRCCS San Camillo, Venice, Italy; ² Department of Neurosciences and Sense Organs, AO Padua, Padua, Italy

BACKGROUND: Wallenberg’s syndrome (WS) is known as posterior inferior cerebellar artery syndrome. Dysphagia has been reported from 51% to 94% of the patients, ranging from mild to severe.
CASE REPORT: We reported a case of a patient (male; 52 years) with WS. MRI showed an intense hypodense area in the dorsolateral part of the ponto-medullary junction. The clinical signs were severe dysphagia, fed by PEG (FOIS 1; PAS 7), sialorrhea, trismus and ataxia.
CLINICAL REHABILITATION IMPACT: Dysphagia was treated by botulinum toxin type-A (BoNT-A), which was injected into the parotid and submandibular salivary glands, temporalis and masseter muscles, cricopharyngeal muscle associated with specific swallowing exercise and food trails. The 3-months follow-up showed significant saliva reduction and improvement of swallowing to from PEG feeding to consistent oral intake of food (FOIS 3, PAS 5). The treatment with BoNT-A combined with swallowing rehabilitation was fundamental in order to restore the swallowing functions.

KEY WORDS: Lateral medullary syndrome - Botulinum toxins, type A - Deglutition disorders - Sialorrhea