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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

lingua: Inglese

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


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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

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