Onabotulinum Toxin A (Botox) in the Treatment of Pharyngo-esophageal Dysphagia

Inclusion Criteria: * Patients attending neurology OPD with swallowing dysfunction due to central nervous system dysfunction * At least 14 years of age of all sexes * mRS (modified Rankin scale) of ≤3 at time of study enrolment * In case of post stroke dysphagia, at least 6 months have passed following stroke * Willing to undergo swallowing assessment clinically and with video fluoroscopy, flexible upper GI endoscopy and esophageal manometry before and after the injection * Above investigations show impaired cricopharyngeal relaxation, adequate pharyngeal strength and anterocephalad laryngeal movement * Ready to provide consent for Botulinum neurotoxin injection. * Willing to adhere to protocol and comply with follow up visits * No major neurologic or systemic medical condition that reduces life expectancy to less than 1 year based on clinical prediction scores Exclusion Criteria: * Diagnosed cases of neuromuscular disorders of the peripheral nervous system and ALS * mRS at time of enrolment \>3 * Patients with expected life expectancy less than 1 year due to primary disease or co morbidity based on clinical prediction scores * Known allergy to botulinum neurotoxin or its preservatives/excipients * Received botulinum toxin for any indication in the last 12 weeks * Those with known antibodies against Botulinum neurotoxin A * Those who underwent myotomy of the cricopharyngeus muscle * Those who had undergone procedures like denervation of the cervical musculature * Dysphagia of other causes not fulfilling inclusion criteria * Women of childbearing potential who are not using adequate contraception or who are pregnant and lactating * Not willing to provide consent