M Basciani and D Intiso
Background: Botulinum toxin type A (BoNT-A) has been used in treating dysphagia due to spasticity of upper oesophageal sphincter (UES). However, the doses commonly injected could result ineffective. A case of dysphagia treated successfully by high dosage of BoNT-A is described. Case report: A 50 year-old male subject with tetraparesis and dysphagia due to severe spasticity of UES following encephalitis. No bolus transit was observed to videofluoroscopy (VS). Because of severe UES spasticity, it was not possible to perform oesophageal manometry. Growing BoNT-A dosage of 10 U (Botox) and 100 U (Xeomin) injected into cricopharingeal muscle (CM) had no benefit. Since negative effect of previous doses, BoNT-A (Xeomin) high dosage of 200 U was injected into CM. After neurotoxin injections,VS showed significant dysphagia improvement lasting eight months. Transient paresis of the right vocal cord occurred. A second BoNT-A injection session with same dosage and modalities was performed efficaciously. Conclusion: High dose of 200 U of BoNT-A (Xeomin) was efficacious and safe in treating refractory dysphagia due to severe spasticity of UES. High dosage of neurotoxin should be considered when common doses were ineffective
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