Conclusion: Botulinum toxin can improve severe dysphagia with elective hyperactivity of the upper esophageal sphincter in patients with or without unilateral paresis of the inferior constrictor muscle and in absence of a nuclear involvement of the IXth and Xth cranial nerves. In seven cases it was possible to remove percutaneous endoscopic gastrostomy. Two patients showed long lasting functional benefits after only one botulinum toxin injection, while seven patients required further treatments to maintain an adequate oral intake. Results: A total of 75% of patients (9 of 12) had favourable outcomes. Outcomes were measured after two weeks and through a long follow up programme, which ranged from two to ten years. Botulinum toxin was injected percutaneously under electromyographic guide. Methods: All patients underwent clinical examination, videofluoroscopic study of swallowing and electromyography. Subjects: Twelve patients with long standing dysphagia after brainstem vascular injury admitted to the rehabilitation department of a medical centre. Objective: To evaluate botulinum toxin treatment of hyperactive upper esophageal sphincter after firsttime brainstem stroke. Keywords: Deglutition Disorders Brainstem Stroke Upper Esophageal Sphincter Rehabilitation Botulinum Toxins Electromyography Gastrostomy Received 30 August 2013 revised 29 September 2013 accepted 6 October 2013 This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1Department of Rehabilitation, Fondazione Poliambulanza, Brescia, ItalyĮmail: © 2013 Domenico De Grandis et al.
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