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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
European Journal of Physical and Rehabilitation Medicine 2017 Mar 06
Copyright © 2017 EDIZIONI MINERVA MEDICA
Efficacy of BoNT-A and swallowing treatment for oropharyngeal dysphagia recovery in a patient with Lateral Medullary Syndrome: a case study
Irene BATTEL 1 ✉, Isabella KOCH 1, Federica BIDDAU 1, Carla CAROLLO 1, Francesco PICCIONE 1, Francesca MENEGHELLO 1, Merico ANTONIO 1, Katie PALMER 1, Rosario MARCHESE RAGONA 2
1 Fondazione Ospedale di Neuroriabilitazione IRCCS San Camillo, Venice, Italy; 2 Dipartimento Strutturale Aziendale Neuroscienze e Organi di Senso, Azienda Ospedaliera di Padova, Padova, 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 PRESENTATION: We reported a case of a patient (Male; 52yrs) 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 tipe 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: Lateralmedullary syndrome (LMS) - Wallenberg's syndrome (WS) - Botulinum toxin tipe A (BoNT-A) - Dysphagia - Swallowing rehabilitation - Sialorrhea