Ann Rehabil Med.  2012 Feb;36(1):148-153. 10.5535/arm.2012.36.1.148.

Treatment of Dysphagia with Pyridostigmine Bromide in a Patient with the Pharyngeal-Cervical-Brachial Variant of Guillain-Barre Syndrome

• Lee KL
• Lim OK
• Lee JK
• Park KD

• KMID: 2266794
• DOI: http://doi.org/10.5535/arm.2012.36.1.148

Abstract

A 24-year-old male developed bulbar palsy, ophthalmoplegia, ptosis, and shoulder weakness bilaterally 2 weeks after he had experienced an upper respiratory infection. The electrodiagnostic study demonstrated axonal polyradiculoneuropathy. The repetitive nerve stimulation study (RNS) showed no significant decrement of the compound muscle action potentials (CMAPs). The videofluoroscopic swallowing study (VFSS) showed severe impairment of the pharyngeal phase of swallowing. He was diagnosed as having the pharyngeal-cervical-brachial variant of Guillain-Barre syndrome. The patient's dysphagia was not improved for 3 months. A follow up RNS showed a significant decrement of the CMAPs. Pyridostigmine bromide was tried to improve the dysphagia. The patient showed immediate improvement of his dysphagia on the VFSS after the trial with pyridostigmine bromide. Pyridostigmine bromide was given before each meal for 8 days and he showed continuous improvement of his dysphagia. The follow up VFSS after 3 months showed complete recovery of dysphagia.

Keyword

Guillain-Barre syndrome; Dysphagia; Pyridostigmine bromide

MeSH Terms

Action Potentials
Axons
Bulbar Palsy, Progressive
Deglutition
Deglutition Disorders
Follow-Up Studies
Guillain-Barre Syndrome
Humans
Male
Meals
Muscles
Ophthalmoplegia
Polyradiculoneuropathy
Pyridostigmine Bromide
Shoulder
Young Adult
Pyridostigmine Bromide

Figure

• 

  Fig. 1 (A) Barium liquid did not transfer to the esophageal phase because of pharyngeal muscle weakness. The image showed severe retention of material at the vallecula (white arrow) and the pyriform sinus (triangle). (B) The same material transferred to the esophageal phase 30 minutes after taking pyridostigmine bromide.

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