Dysphagia and nutritional status in multiple sclerosis

Abstract

In this observational study of patients with multiple sclerosis (MS) admitted to a regional neurology centre we assessed the frequency of dysphagia (objectively defined), dysphagia related symptoms, bulbar signs and nutritional status. We studied 79 consecutive admissions with MS (24 at diagnostic admission and 55 more advanced cases admitted for treatment and/or rehabilitation): normative swallowing data were from 181 healthy controls. Swallowing symptoms and signs were semi-quantitatively measured and compared to healthy controls. Dysphagia was defined by a quantitative water test. Disability was determined by Kurtzke's Expanded Disability Status Scale and Barthel's index. Nutritional status was assessed by body mass index, estimated percentage body fat from skin fold thickness measurements at four sites, a global evaluation of nutrition, the presence of pressure sores and the pressure sore risk using the Waterlow score. Patients with MS were more likely to complain of abnormal swallowing, of coughing when eating, and of food 'going down the wrong way' than healthy controls (P < 0.005). These significantly associated symptoms had high specificity but relatively low sensitivity. 43% of patients had abnormal swallowing, almost half of whom did not complain of it: abnormal swallowing was associated with several factors including abnormal brainstem/cerebellar function, disability, vital capacity, and depression score. Those with abnormal swallowing had higher Waterlow scores (P < 0.001), but, overall, abnormal swallowing was not associated with a difference in nutritional indices or incidence of pressure sores. In summary, abnormal swallowing is common in MS although often not complained of. It is associated with disordered brainstem/cerebellar function, overall disability, depressed mood and low vital capacity. It was not associated with major nutritional failure or pressure sores in this study.

Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis

“…Among these, 2 papers were high quality and another 13 papers were moderate quality. However, within these studies, two reports were prospective cohort studies [17,18] and one was case-control study [1] the checklist was also used for quality assessment (Table 1).…”

“…All 15 studies enrolled consecutive patients from MS center or neurology center. Of these, twelve studies from subjective group used questionnaire survey tools to detect dysphagia, four of which were screened by DYMUS questionnaire [8,17,18,29], eight studies used other swallowing questionnaire [1,3,10,[30][31][32][33][34] and only one papers used water swallowing test [1]. Because of one study provided screening and assessment results [18], there were four papers from assessment group applying clinical or instrumental measurements, such as clinical bedside examination, VED, and FESS, to identify dysphagia.…”

“…Dysphagia is a common life-threatening symptom frequently underestimated in patients with multiple sclerosis (MS) [1][2][3][4]. Several potential factors, such as involvement of the corticobulbar tracts, cerebellar and brainstem dysfunctions, lower cranial nerves paresis and cognitive impairment, can impair swallowing physiology [4].…”

Perceptions of the Impact of Speech, Language, Swallowing, and Hearing Difficulties on Quality of Life of a Group of South African Persons with Multiple Sclerosis

“…Thomas and Wiles [44] also found that patients with MS complained of abnormal swallowing, of coughing when eating, and of food 'going down the wrong way'. These researchers then compared these patients' selfreports with an assessment of their swallowing functions.…”

Dietary Practices of People With Multiple Sclerosis

“…34 MS patients who have difficulty swallowing may require a modified diet customized for liquid viscosity and food texture 35 ; if dysphagia progresses, a feeding tube may be necessary to prevent or alleviate malnutrition and weight loss. 25 However, Thomas and Wiles 36 reported that abnormal swallowing in MS patients was not associated with nutritional deficiencies. Fatigue can lead to decreased activity and, in turn, decreased calorie expenditure.…”