Progression of Oropharyngeal Dysphagia in Patients with Multiple System Atrophy

Jae, Hui; Seo, Han Gil; Lee, Hyun Haeng; Oh, Byung Mo; Kim, Yoon; Kim, Aryun; Kim, Han Joon; Jeon, Beomseok; Han, Tai Ryoon

doi:10.1007/s00455-019-09990-z

Cited by 19 publications

(25 citation statements)

References 25 publications

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“…A previous study on dysphagia in MSA reported that dysphagia was mostly limited to aspiration symptoms in MSA-C, while difficulty in swallowing, increased mealtime, and drooling were frequent in MSA-P [6]. In another study, the latency from the onset of dysphagia symptoms to the onset of dietary modification was 2.3 years in MSA-P and 5.1 years in MSA-C [24]. In a similar vein, our study showed the frequency of dysphagia was higher in the MSA-P than in the MSA-C group.…”

Section: Discussionmentioning

confidence: 87%

Various Motor and Non-Motor Symptoms in Early Multiple System Atrophy

et al. 2019

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Background: Multiple system atrophy (MSA) patients present a variety of symptoms other than autonomic dysfunctions, parkinsonism, and cerebellar ataxia. The aim of this study was to evaluate the frequency of various motor and non-motor symptoms including so-called "red flags" in patients with early MSA and to determine whether the frequency of these symptoms was different between the parkinsonian (MSA-P) and cerebellar (MSA-C) subtypes. Methods: Sixty-one probable or possible MSA patients with disease duration of 3 years or less were included. Patients were classified into MSA-P, MSA-C, and MSA-PC. The frequency of 13 features including various motor and non-motor symptoms that commonly occur in MSA was assessed. Results: Dysarthria was the most prevalent feature (98.4%) followed by sexual dysfunction (95.1%). Probable REM sleep behavior disorder was present in 90.2%. The frequency of constipation (82.0%), dysphagia (68.9%), and snoring (70.5%) was also high. Stridor was present in 42.6% and more common in MSA-C than in MSA-P. Conclusions: Increasing awareness of various motor and non-motor symptoms may assist clinicians to make an early, accurate diagnosis and to improve management of patients with MSA. We suggest that the diagnostic accuracy can be improved if these features are appropriately reflected in the new diagnostic criteria for MSA.

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Section: Discussionmentioning

confidence: 87%

Various Motor and Non-Motor Symptoms in Early Multiple System Atrophy

et al. 2019

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“…For example, if the raphe regions identified herein receive projections from swallowing-related cortical areas and send efferent projections to the swCPG in NTS, they might be involved in volitional control of swallowing. Loss of medullary serotonergic raphe neurons occurs in multiple system atrophy [ 24 ], and patients with this disease also suffer from dysphagia [ 25 ]. In addition, breathing and feeding difficulties are frequently observed in Prader–Willi syndrome (PWS) and Shaaf–Yang syndrome [ 84 ], and several alterations in raphe nuclei have been demonstrated in mice models for PWS [ 85 , 86 , 87 ].…”

Section: Discussionmentioning

confidence: 99%

“…The aims of our study were (1) to investigate the effects of QPZ on swallowing and breathing in situ, (2) to compare swallowing motor patterns and swallow-breathing phase relationship between spontaneous and QPZ-induced swallows, and (3) to identify brainstem nuclei mediating the stimulatory effect of QPZ on swallowing. Identifying both the neural structures and neurotransmitters (or neuromodulators) involved in swallowing represents one of the challenges to better understand this important function, and to find therapeutic strategies for patients suffering from swallowing disorders [ 1 , 2 , 3 , 24 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Quipazine Elicits Swallowing in the Arterially Perfused Rat Preparation: A Role for Medullary Raphe Nuclei?

Bergé-Laval¹,

Gestreau²

2020

IJMS

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Pharmacological neuromodulation of swallowing may represent a promising therapeutic option to treat dysphagia. Previous studies suggested a serotonergic control of swallowing, but mechanisms remain poorly understood. Here, we investigated the effects of the serotonergic agonist quipazine on swallowing, using the arterially perfused working heart-brainstem (in situ) preparation in rats. Systemic injection of quipazine produced single swallows with motor patterns and swallow-breathing coordination similar to spontaneous swallows, and increased swallow rate with moderate changes in cardiorespiratory functions. Methysergide, a 5-HT2 receptor antagonist, blocked the excitatory effect of quipazine on swallowing, but had no effect on spontaneous swallow rate. Microinjections of quipazine in the nucleus of the solitary tract were without effect. In contrast, similar injections in caudal medullary raphe nuclei increased swallow rate without changes in cardiorespiratory parameters. Thus, quipazine may exert an excitatory effect on raphe neurons via stimulation of 5-HT2A receptors, leading to increased excitability of the swallowing network. In conclusion, we suggest that pharmacological stimulation of swallowing by quipazine in situ represents a valuable model for experimental studies. This work paves the way for future investigations on brainstem serotonergic modulation, and further identification of neural populations and mechanisms involved in swallowing and/or swallow-breathing interaction.

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“…Further in the early stage of the disease, the swallowing dysfunction induced by parkinsonism in MSA-P patients appears worse than the dysfunction induced by cerebellar impairment in MSA-C patients, and progressive worsening of dysphagia in MSA-C seems related to overlapping parkinsonism [12,21,24]. A recent cross-sectional and longitudinal study retrospectively comparing the progression of oropharyngeal dysphagia in MSA subtypes found that patients with MSA-P required diet modification earlier than those with MSA-C, but no significant difference between the two groups was found in the latency of tube feeding onset [25].…”

Section: Diagnosis Of Dysphagia In Msamentioning

confidence: 99%

“…As dysphagia in MSA occurs early and develops progressively, it is prudent to screen patients both at the time of diagnosis and periodically thereafter to prevent complications and improve disease management [23,25,34].…”

Section: Tablementioning

confidence: 99%

Dysphagia in multiple system atrophy consensus statement on diagnosis, prognosis and treatment

Calandra‐Buonaura

Alfonsi

Vignatelli

et al. 2021

Parkinsonism & Related Disorders

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Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by a combination of autonomic failure plus cerebellar syndrome and/or parkinsonism. Dysphagia is a frequent and disabling symptom in MSA and its occurrence within 5 years of motor onset is an additional diagnostic feature. Dysphagia can lead to aspiration pneumonia, a recognized cause of death in MSA. Guidelines for diagnosis and management of dysphagia in MSA are lacking. An International Consensus Conference among experts with methodological support was convened in Bologna to reach consensus statements for the diagnosis, prognosis, and treatment of dysphagia in MSA. Abnormalities of the oral and pharyngeal phases of swallowing, esophageal dysfunction and aspiration occur in MSA and worsen as the disease progresses. According to the consensus, dysphagia should be investigated through available screening questionnaires and clinical and instrumental assessment (videofluoroscopic study or fiberoptic endoscopic evaluation of swallowing and manometry) at the time of MSA diagnosis and periodically thereafter. There is evidence that dysphagia is associated with poor survival in MSA, however effective treatments for dysphagia are lacking. Compensatory strategies like diet modification, swallowing maneuvers and head postures should be applied and botulinum toxin injection may be effective in specific conditions. Percutaneous endoscopic gastrostomy may be performed when there is a severe risk of malnutrition and pulmonary complications, but its impact on survival is undetermined. Several research gaps and unmet needs for research involving diagnosis, prognosis, and treatment were identified.

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Progression of Oropharyngeal Dysphagia in Patients with Multiple System Atrophy

Cited by 19 publications

References 25 publications

Various Motor and Non-Motor Symptoms in Early Multiple System Atrophy

Various Motor and Non-Motor Symptoms in Early Multiple System Atrophy

Quipazine Elicits Swallowing in the Arterially Perfused Rat Preparation: A Role for Medullary Raphe Nuclei?

Dysphagia in multiple system atrophy consensus statement on diagnosis, prognosis and treatment

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