Radiological evidence of subclinical dysphagia in motor neuron disease

Abstract

Dysphagia in motor neuron disease (MND) may lead to dangerous complications such as cachexia and aspiration pneumonia. Functional evaluation of the oropharyngeal tract is crucial for identifying specific swallowing dysfunctions and planning appropriate rehabilitation. As part of a multidisciplinary study on the treatment of dysphagia in patients with neuromuscular diseases, 23 MND patients with different degrees of dysphagia underwent videofluoroscopy, videopharyngolaryngoscopy and pharyngo-oesophageal manometry. The results of the three instrumental investigations were analysed in order (1) to define the pattern of swallowing in MND patients complaining of dysphagia; (2) to evaluate whether subclinical abnormalities may be detected; and (3) to assess the role of videofluoroscopy, videopharyngolaryngoscopy and manometry in the evaluation of MND patients with deglutition problems. Correlations between the instrumental findings and clinical features (age of the patients, duration and severity of the disease, presence and degree of dysphagia) were also assessed. The results of our study showed that: (1) The oral phase of deglutition was compromised most often, followed by the pharyngeal phase. (2) In all patients without clinical evidence of dysphagia, subclinical videofluoroscopic alterations were present in a pattern similar to that found in the dysphagic group. (3) Videofluoroscopy was the most sensitive technique in identifying oropharyngeal alterations of swallowing. Impairment of the oral phase, abnormal pharyngo-oesophageal motility and incomplete relaxation of the upper oesophageal sphincter were the changes most sensitive in detecting dysphagia. Videofluoroscopy was also capable of detecting preclinical abnormalities in non-dysphagic patients who later developed dysphagia. Practical guidelines for the use of instrumental investigations in the assessment and management of dysphagia in MND patients are proposed.

Relationship between supramaximal flow during cough and mortality in motor neurone disease

“…Most of them had abnormal cough or MEFV curves, characterized by flow limitation or oscillations. A few non-bulbar patients had similar findings, implying insidious bulbar dysfunction, which has been reported previously [15].…”

Development of a new scale for dysphagia in patients with progressive neuromuscular diseases: the Neuromuscular Disease Swallowing Status Scale (NdSSS)

“…Therefore, their swallowing functions should be carefully and appropriately evaluated and followed up during the course of the disease progression [3]. VFSS has so far been the most reliable examination to evaluate the swallowing function even in asymptomatic [3,14]. The individual parameters, such as bolus folding in the oral cavity, constriction of the pharynx, and elevation of the larynx, become worse over time following the onset of bulbar symptoms.…”

Sonographic analysis of laryngeal elevation during swallowing

“…Videofluoroscopy is also frequently performed in neurogenic dysphagia due to different diseases [36][37][38][39], but quantitative measurements of the above mentioned parameters have not been reported for this condition. Only in the study of Sundgren et al [32] was the laryngeal elevation quantified and showed no significant differences of the maximum laryngeal elevation between controls and dysphagic patients.…”