Use of bilateral suture lateralisation technique in severe paradoxical vocal fold movement, allowing removal of long-term tracheostomy: case report

2012 ◽  
Vol 126 (3) ◽  
pp. 328-330 ◽  
Author(s):  
J van Griethuysen ◽  
C Al Yaghchi ◽  
G Sandhu
Keyword(s):  
Case Report ◽  
Botulinum Toxin ◽  
Vocal Fold ◽  
Botulinum Toxin Injection ◽  
Rare Condition ◽  
Behaviour Therapy ◽  
Emergency Tracheostomy ◽  
Cognitive Behaviour ◽  
Paradoxical Vocal Fold Movement

AbstractObjective:We report a novel bilateral suture lateralisation technique that allowed permanent tracheostomy decannulation in a patient with severe paradoxical vocal fold movement.Case report:A 45-year-old woman presented to the accident and emergency department with worsening shortness of breath. Flexible nasoendoscopy revealed limited vocal fold abduction and an emergency tracheostomy was sited; this was subsequently changed to a long-term Silver Negus tube. Her tracheostomy care was complicated by discomfort and dislodgement. The diagnosis of paradoxical vocal fold movement was only made when the patient presented to our department. Cognitive behaviour therapy and botulinum toxin injection were tried without success. A right vocal fold lateralisation procedure was performed, which enabled temporary tracheostomy decannulation. A left vocal fold lateralisation procedure was subsequently performed and the patient was successfully decannulated, with significant improvement in quality of life.Conclusion:Paradoxical vocal fold movement is a rare condition that is most commonly managed by biofeedback sessions, relaxation manoeuvres or botulinum toxin injection. However, in cases similar to ours in which these treatments are unsuccessful, we suggest a ‘last resort’ technique to manage this rare condition.

scholarly journals Severe dysphagia due to a huge epiphrenic diverticulum: long-term treatment with balloon dilation and botulinum toxin injection: a case report

Cases Journal ◽  
2009 ◽  
Vol 2 (1) ◽  
pp. 7418 ◽  
Author(s):  
Panagiotis Katsinelos ◽  
Grigoris Chatzimavroudis ◽  
Kostas Fasoulas ◽  
Ioannis Pilpilidis ◽  
Georgia Lazaraki ◽  
...  
Keyword(s):  
Case Report ◽  
Botulinum Toxin ◽  
Botulinum Toxin Injection ◽  
Balloon Dilation ◽  
Term Treatment ◽  
Epiphrenic Diverticulum ◽  
Severe Dysphagia ◽  
Long Term Treatment

scholarly journals Essential Palatal Myoclonus

2017 ◽  
Vol 5 (1) ◽  
pp. 41
Author(s):  
Bhuwan Raj Pandey ◽  
Anup Acharya ◽  
Madan Mohan Singh
Keyword(s):  
Case Report ◽  
Botulinum Toxin ◽  
Low Dose ◽  
Botulinum Toxin Injection ◽  
Treatment Options ◽  
Rare Condition ◽  
Young Female ◽  
Palatal Myoclonus ◽  
Rhythmic Contraction ◽  
Nose And Throat

Introduction: Palatal myoclonus is a rare condition presenting with clicking sound in ear or muscle tremor in pharynx. There are two varieties: essential and symptomatic. Various treatment options exists ranging from watchful observation to botulinum toxin injection. We have not found any reported case of palatal myoclonus from our country. Here we present a case of essential palatal myoclonus managed with clonazepam. Case report: A young female presented in Ear Nose and Throat clinic with complain of auditory click and spontaneous rhythmic movement of throat muscles for eight months. On examination, there was involuntary, rhythmic contraction of bilateral soft-palate, uvula, and base of tongue. Neurological, eye, and peripheral examination were normal. A diagnosis of essential palatal myoclonus was made. It was managed successfully with clonazepam; patient was still on low dose clonazepam at the time of making this report. Conclusion: Essential palatal myoclonus can be clinically diagnosed and managed even in settings where MRI is not available or affordable.

scholarly journals Hereditary geniospasm in a mother and son treated with botulinum toxin injection: A case report

2021 ◽  
Vol 9 ◽  
pp. 2050313X2199359
Author(s):  
Clare Perkins ◽  
Wei Jia ◽  
James Rainsbury ◽  
Andrew Lux
Keyword(s):  
Case Report ◽  
Botulinum Toxin ◽  
Side Effects ◽  
Beta Blockers ◽  
Botulinum Toxin Injection ◽  
Treatment Options ◽  
Benign Disorder ◽  
The World ◽  
Botulinum Toxin Injections

Hereditary geniospasm is a rare and benign disorder that can cause distress and social embarrassment to patients. There are only a handful of possible treatment options available. Due to the rarity of the condition, practices differ across the world and the results are varied. These include beta-blockers, benzodiazepines and anti-epileptics. These treatments can have significant side-effects when used long term. However, botulinum toxin injections have been successfully used in a handful of cases. We report a successful botulinum treatment of hereditary geniospasm in a mother and son, with the injection protocols.

scholarly journals Constraint-Induced Movement Therapy After Injection of Botulinum Toxin Type A for a Patient With Chronic Stroke: One-Year Follow-up Case Report

2015 ◽  
Vol 95 (7) ◽  
pp. 1039-1045 ◽  
Author(s):  
Satoru Amano ◽  
Takashi Takebayashi ◽  
Keisuke Hanada ◽  
Atsushi Umeji ◽  
Kohei Marumoto ◽  
...  
Keyword(s):  
Case Report ◽  
Botulinum Toxin ◽  
Muscle Tone ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Movement Therapy ◽  
Chronic Stroke ◽  
Constraint Induced Movement Therapy ◽  
Arm Function

Background and Purpose Spasticity, an aspect of upper motor neuron syndrome, is a widespread problem in patients with stroke. To date, no study has reported the long-term (up to 1 year) outcomes of botulinum toxin (BTX) injection in combination with constraint-induced movement therapy in patients with chronic stroke. In this case report, the long-term (1 year) effects of the combination of BTX type A injection and constraint-induced movement therapy on spasticity and arm function in a patient with chronic stroke and arm paresis are described. Case Description The patient was a 66-year-old man who had had an infarction in the right posterior limb of the internal capsule 4 years before the intervention. At screening, the patient was not able to voluntarily extend his interphalangeal or metacarpophalangeal joints beyond the 10 degrees required for constraint-induced movement therapy. From 12 days after BTX type A injection, the patient received 5 hours of constraint-induced movement therapy for 10 weekdays. Outcomes All outcome measures (Modified Ashworth Scale, Fugl-Meyer Assessment, Action Research Arm Test, and amount of use scale of the Motor Activity Log) improved substantially over the 1-year period (before intervention to 1 year after intervention). Repeat BTX type A injections were not necessary because muscle tone and arm function did not worsen during the observation period. Discussion The improved arm function may have reflected improvements in volitional movements and coordination or speed of movements in the paretic arm as a result of a reduction in spasticity, a reduction of learned nonuse behaviors, or use-dependent plasticity after the combination of BTX type A injection and constraint-induced movement therapy. In addition, the possibility of an influence of the passage of time or the Hawthorne effect cannot be ruled out. If this approach proves useful in future controlled studies, it may reduce the rising medical costs of the treatment of stroke.

scholarly journals Does cognitive-behavioural therapy influence the long-term outcome of generalized anxiety disorder? An 8–14 year follow-up of two clinical trials

2003 ◽  
Vol 33 (3) ◽  
pp. 499-509 ◽  
Author(s):  
R. C. DURHAM ◽  
J. A. CHAMBERS ◽  
R. R. MACDONALD ◽  
K. G. POWER ◽  
K. MAJOR
Keyword(s):  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Secondary Care ◽  
Generalized Anxiety ◽  
Behaviour Therapy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cognitive Behaviour

Background. Generalized anxiety disorder is a common condition of excessive worry and tension which tends to run a chronic course associated with significant psychiatric and medical problems. Cognitive behaviour therapy (CBT) has been shown to be of clinical value in about 50% of cases with treatment gains maintained over follow-up periods ranging from 6 to 12 months. The potential value of CBT over the longer term has not been subject to rigorous investigation.Method. Results are reported of 8–14 year follow-up of two randomized controlled trials of cognitive-behaviour therapy for generalized anxiety disorder employing structured interview with an assessor blind to initial treatment condition. Comparison groups included medication and placebo in one study based in primary care, and analytical psychotherapy in the other based in secondary care. Follow-up samples (30% and 55% of trial entrants) were broadly representative of the original cohorts.Results. Overall, 50% of participants were markedly improved of whom 30–40% were recovered (i.e. free of symptoms). Outcome was significantly worse for the study based in secondary care in which the clinical presentation of participants was more complex and severe. For a minority (30–40%), mainly from the secondary care study, outcome was poor. Treatment with CBT was associated with significantly lower overall severity of symptomatology and less interim treatment, in comparison with non-CBT conditions, but there was no evidence that CBT influenced diagnostic status, probability of recovery or patient perceptions of overall improvement.Conclusions. Both CBT and the complexity and severity of presenting problems appear to influence the long-term outcome of GAD.

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