What is the use of Botox (Botulinum toxin) for dysphagia?

From the Guidelines

Botox (botulinum toxin) is not recommended for the treatment of dysphagia, as the provided evidence does not support its use for this condition, and instead, it is recommended for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia, as stated in the clinical practice guideline 1. The treatment of dysphagia typically involves other approaches, such as swallowing exercises, dietary modifications, and in some cases, medications or interventions to manage underlying conditions, as suggested by the evidence on stroke rehabilitation 1 and clinical nutrition in neurology 1. Some key points to consider in the management of dysphagia include:

• The importance of thorough evaluation with videofluoroscopic swallow studies to ensure appropriate patient selection and target identification.
• The potential benefits of treatments such as chin tuck against resistance and respiratory muscle strength training in improving oropharyngeal swallow function, as mentioned in the stroke rehabilitation guidelines 1.
• The need for a multidisciplinary approach to manage dysphagia, involving specialists such as gastroenterologists, otolaryngologists, neurologists, and speech-language pathologists.
• The consideration of the underlying cause of dysphagia, such as neurological disorders, and the potential impact on nutrition and quality of life, as discussed in the clinical nutrition in neurology guideline 1.

From the FDA Drug Label

Treatment with botulinum toxin products, including JEUVEAU, can result in swallowing or breathing difficulties. Patients with preexisting swallowing or breathing difficulties may be more susceptible to these complications In most cases, this has been a consequence of weakening of muscles in the area of injection that are involved in breathing or oropharyngeal muscles that control swallowing or breathing [see Warnings and Precautions (5. 1)]. Deaths as a complication of severe dysphagia have been reported after treatment with botulinum toxin. Dysphagia may persist for several months, and require use of a feeding tube to maintain adequate nutrition and hydration. Patients treated with botulinum toxin products, including JEUVEAU, may require immediate medical attention should they develop problems with swallowing, speech, or breathing These reactions can occur within hours to weeks after injection with botulinum toxin [see Warnings and Precautions (5.1)].

Botox is not approved for the treatment of dysphasia. The use of botulinum toxin products, including JEUVEAU, can result in swallowing or breathing difficulties, and patients with preexisting swallowing or breathing difficulties may be more susceptible to these complications. Dysphagia and breathing difficulties are potential risks of treatment with botulinum toxin products. Patients may require immediate medical attention if they develop problems with swallowing, speech, or breathing after injection with botulinum toxin 2 2.

From the Research

Botox for Dysphasia

• Dysphasia, also known as spasmodic dysphonia, is a neurological voice disorder that causes involuntary spasms of the vocal cord muscles, impacting speech to varying degrees 3.
• Botox has been used to treat dysphasia, with studies showing significant improvement in vocal symptoms in individuals with spasmodic dysphonia 4, 5, 3.
• The efficacy of Botox in treating dysphasia has been documented in several studies, with results depending on factors such as the general health of the patient, onset and severity of the condition, dosage, interval between injections, and expertise of the practitioner 3.
• While Botox injections may show vocal improvement in both adductor and abductor forms of spasmodic dysphonia, results can vary, and some patients may experience adverse effects such as extended breathy dysphonia and mild choking on fluids 4.

Adverse Effects of Botox for Dysphasia

• Mild and transient dysphasia has been reported in some patients treated with Botox for lingual dystonia, but this typically resolves spontaneously within several days to two weeks 6.
• Other potential adverse effects of Botox for dysphasia include transient focal weakness, but serious complications are rare 7.
• The safety and efficacy of Botox for treating dysphasia and other focal dystonias have been supported by numerous studies, with Botox injections becoming a widely used treatment option for these conditions 4, 5, 7.

Treatment Outcomes

• Studies have reported significant improvements in vocal symptoms and quality of life for patients with dysphasia treated with Botox, with some patients experiencing benefits for over a year 4, 7.
• The average duration of maximum improvement after Botox injection can vary, but some patients have reported sustained benefits for several months 4, 7.
• Individualized Botox injection methods, such as those used for lingual dystonia, can be effective and safe, with comprehensive improvement rates of up to 77.6% reported in some studies 6.