Pilot cohort study of endoscopic botulinum neurotoxin injection in Parkinson's disease
| Autor: | Carrolee Barlow, Rita Gandhy, George Triadafilopoulos |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Gastroparesis Pilot Projects Cohort Studies Dyssynergia 03 medical and health sciences 0302 clinical medicine medicine Humans Botulinum Toxins Type A Aged Retrospective Studies Aged 80 and over business.industry Parkinson Disease Middle Aged Anal canal Pylorus medicine.disease Dysphagia Surgery medicine.anatomical_structure Neuromuscular Agents Neurology Anismus Tolerability Female 030211 gastroenterology & hepatology Esophageal spasm Neurology (clinical) Geriatrics and Gerontology medicine.symptom Deglutition Disorders business Constipation 030217 neurology & neurosurgery |
| Zdroj: | Parkinsonism & Related Disorders. 44:33-37 |
| ISSN: | 1353-8020 |
| DOI: | 10.1016/j.parkreldis.2017.08.020 |
| Popis: | Background Gastrointestinal symptoms, such as dysphagia, postprandial bloating, and defecatory straining are common in Parkinson's Disease (PD) and they impact quality of life. Endoscopic botulinum neurotoxin (BoNT) injection has been used in the treatment of dysphagia, gastroparesis and chronic anismus. Aims To examine the feasibility, safety and efficacy of endoscopically delivered BoNT injection to distal esophagus, pylorus or anal canal aiming at relieving regional gastrointestinal symptoms in patients with PD. Methods This is a retrospective open cohort pilot study to assess the clinical response to endoscopic BoNT injection on selected PD patients with symptoms and identifiable abnormalities on high-resolution manometry and wireless motility capsule, to generate early uncontrolled data on feasibility, tolerability, safety and efficacy. Baseline symptoms and response to therapy were assessed by questionnaires. Results Fourteen PD patients (10 M:4 F), mean age 73 (range: 62-93) were treated. Three patients had esophageal Botox for ineffective esophageal motility (IEM) (n = 1), esophago-gastric junction outlet obstruction (EGJOO) & IEM (n = 1), and diffuse esophageal spasm (DES) (n = 1). Nine patients were treated with pyloric BoNT injection for gastroparesis with mean gastric transit time of 21.2 h; range 5.2–44.2 h. Two patients received anal Botox for defecatory dyssynergia ((Type I) (n = 1) and overlap (slow-transit and dyssynergic) constipation (n = 1). Endoscopic BoNT injection (100-200 units) was well tolerated and there were no significant adverse events. Conclusions Endoscopic BoNT injection to esophagus, pylorus or anal canal is safe, well-tolerated and leads to symptomatic improvement that lasts up to several months. The procedure can be repeated as needed and combined with other therapies. |
| Databáze: | OpenAIRE |
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