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Omari TI, Wiklendt L, Dinning P, Costa M, Rommel N, Cock C. Upper esophageal sphincter mechanical states analysis: a novel methodology to describe UES relaxation and opening. Front Syst Neurosci 2015; 8:241. [PMID: 25610376 PMCID: PMC4285690 DOI: 10.3389/fnsys.2014.00241] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/04/2014] [Indexed: 12/14/2022] Open
Abstract
The swallowing muscles that influence upper esophageal sphincter (UES) opening are centrally controlled and modulated by sensory information. Activation of neural inputs to these muscles, the intrinsic cricopharyngeus muscle and extrinsic suprahyoid muscles, results in their contraction or relaxation, which changes the diameter of the lumen, alters the intraluminal pressure and ultimately inhibits or promotes flow of content. This relationship that exists between the changes in diameter and concurrent changes in intraluminal pressure has been used previously to calculate the “mechanical states” of the muscle; that is when the muscles are passively or actively, relaxing or contracting. Diseases that alter the neural pathways to these muscles can result in weakening the muscle contractility and/or decreasing the muscle compliance, all of which can cause dysphagia. Detecting these changes in the mechanical state of the muscle is difficult and as the current interpretation of UES motility is based largely upon pressure measurement (manometry), subtle changes in the muscle function during swallow can be missed. We hypothesized that quantification of mechanical states of the UES and the pressure-diameter properties that define them, would allow objective characterization of the mechanisms that govern the timing and extent of UES opening during swallowing. To achieve this we initially analyzed swallows captured by simultaneous videofluoroscopy and UES pressure with impedance recording. From these data we demonstrated that intraluminal impedance measurements could be used to determine changes in the internal diameter of the lumen when compared to videofluoroscopy. Then using a database of pressure-impedance studies, recorded from young and aged healthy controls and patients with motor neuron disease, we calculated the UES mechanical states in relation to a standardized swallowed bolus volume, normal aging and dysphagia pathology. Our results indicated that eight different mechanical states were almost always seen during healthy swallowing and some of these calculated changes in muscle function were consistent with the known neurally dependent phasic discharge patterns of cricopharyngeus muscle activity during swallowing. Clearly defined changes in the mechanical states were observed in motor neuron disease when compared to age matched healthy controls. Our data indicate that mechanical state predictions were simple to apply and revealed patterns consistent with the known neural inputs activating the different muscles during swallowing.
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Affiliation(s)
- Taher I Omari
- Department of Human Physiology, School of Medicine, Flinders University Adelaide, SA, Australia ; Department of Gastroenterology and Hepatology, Flinders Medical Centre and School of Medicine, Flinders University Adelaide, SA, Australia
| | - Lukasz Wiklendt
- Department of Human Physiology, School of Medicine, Flinders University Adelaide, SA, Australia
| | - Philip Dinning
- Department of Human Physiology, School of Medicine, Flinders University Adelaide, SA, Australia ; Department of Gastroenterology and Hepatology, Flinders Medical Centre and School of Medicine, Flinders University Adelaide, SA, Australia
| | - Marcello Costa
- Department of Human Physiology, School of Medicine, Flinders University Adelaide, SA, Australia
| | - Nathalie Rommel
- Translational Research Center for Gastrointestinal Diseases, University of Leuven Leuven, Belgium
| | - Charles Cock
- Department of Gastroenterology and Hepatology, Flinders Medical Centre and School of Medicine, Flinders University Adelaide, SA, Australia
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Balendra R, Jones A, Jivraj N, Steen IN, Young CA, Shaw PJ, Turner MR, Leigh PN, Al-Chalabi A. Use of clinical staging in amyotrophic lateral sclerosis for phase 3 clinical trials. J Neurol Neurosurg Psychiatry 2015; 86:45-9. [PMID: 24463480 DOI: 10.1136/jnnp-2013-306865] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The use of clinical staging in the fatal neurodegenerative disease amyotrophic lateral sclerosis would have value in optimising future therapeutic trials. We aimed to use previous clinical trial data to determine the length of time patients spend in each of four proposed stages, its range and transition patterns to subsequent stages. METHODS Using databases from two multicentre clinical trials, patients were retrospectively staged through the trial course. At each stage we assessed whether patients then progressed to an earlier, consecutive or later stage or death. Duration spent in each stage before progression to a later stage was calculated. RESULTS There were 725 patients. No patients moved to an earlier stage. More patients at stages 1, 2 and 3 progressed to the consecutive stage rather than skipping a stage. 59.3% of patients at Stage 1 progressed to Stage 2, 54.0% of patients at Stage 2 progressed to Stage 3, 42.3% of patients at Stage 3 progressed to Stage 4 and 47.0% of Stage 4 patients progressed to death. Transition times between stages had a median duration of 3 to 7 months for stages 2 to 4. DISCUSSION We have shown using trial data that transition times between stages are short. Use of stage duration as an endpoint might allow a shorter trial duration. We have shown face validity in this system as most patients progress through consecutive stages, and none revert to earlier stages. Furthermore, we have shown the system is reliable across populations and therefore has content validity.
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Affiliation(s)
- Rubika Balendra
- King's College London, Institute of Psychiatry, Department of Clinical Neuroscience, London, UK
| | - Ashley Jones
- King's College London, Institute of Psychiatry, Department of Clinical Neuroscience, London, UK
| | - Naheed Jivraj
- Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK
| | - I Nick Steen
- Institute of Health and Safety, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Pamela J Shaw
- Academic Neurology Unit, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - P Nigel Leigh
- Brighton and Sussex Medical School, Trafford Centre for Biomedical Research, University of Sussex, Falmer, East Sussex, UK
| | - Ammar Al-Chalabi
- King's College London, Institute of Psychiatry, Department of Clinical Neuroscience, London, UK
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Earliest Videofluoromanometric Pharyngeal Signs of Dysphagia in ALS Patients. Dysphagia 2014; 29:539-44. [DOI: 10.1007/s00455-014-9542-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/22/2014] [Indexed: 12/11/2022]
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Ngo S, Steyn F, McCombe P. Body mass index and dietary intervention: Implications for prognosis of amyotrophic lateral sclerosis. J Neurol Sci 2014; 340:5-12. [DOI: 10.1016/j.jns.2014.02.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 02/21/2014] [Accepted: 02/25/2014] [Indexed: 12/12/2022]
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Ruoppolo G, Schettino I, Frasca V, Giacomelli E, Prosperini L, Cambieri C, Roma R, Greco A, Mancini P, De Vincentiis M, Silani V, Inghilleri M. Dysphagia in amyotrophic lateral sclerosis: prevalence and clinical findings. Acta Neurol Scand 2013; 128:397-401. [PMID: 23668293 DOI: 10.1111/ane.12136] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To characterize swallowing deficits in amyotrophic lateral sclerosis (ALS); investigate the delay in dysphagia onset; estimate correlations between dysphagia severity and patients' functional status; identify the symptom(s) most likely to predict dysphagia. MATERIALS AND METHODS A group of 49 consecutive patients with ALS, 14 with bulbar onset and 35 with spinal onset, underwent swallowing evaluation including bedside and fiberoptic endoscopic examination to detect dysphagia. RESULTS Patients with dysphagia were more likely than those without to have bulbar onset ALS (P = 0.02); more severely impaired chewing (P = 0.01); and tongue muscle deficits (P = 0.001). The only variable measured at first examination significantly associated with dysphagia was a more than mild tongue muscle deficit. The only variable useful in predicting dysphagia was a chewing deficit. In 10 of the 49 patients studied, swallowing evaluation disclosed an impaired cough reflex. CONCLUSIONS Dysphagia in patients with ALS correlates significantly with bulbar onset and with oral swallowing impairment. Fiberoptic swallowing evaluation is a useful tool for detecting swallowing deficits and laryngeal sensitivity in patients with ALS. An impaired cough reflex is an unexpected finding in many patients with ALS.
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Affiliation(s)
- G. Ruoppolo
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - I. Schettino
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - V. Frasca
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | - E. Giacomelli
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | - L. Prosperini
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | - C. Cambieri
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | - R. Roma
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - A. Greco
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - P. Mancini
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - M. De Vincentiis
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - V. Silani
- Department of Neurological Sciences; University of Milan; Milan Italy
| | - M. Inghilleri
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
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THEME 2 RESPIRATORY AND NUTRITIONAL MANAGEMENT. Amyotroph Lateral Scler Frontotemporal Degener 2013. [DOI: 10.3109/21678421.2013.838416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
In recent years nutrition assessment and management in amyotrophic lateral sclerosis (ALS) have drawn increased attention. Frequent evaluation of nutrition status is warranted in ALS, given the common occurrence of dysphagia and hypermetabolism and varying disease progression rates. Nutrition management includes dietary and swallow strategies, possible gastrostomy tube placement, and recommendations for vitamin and mineral supplementation. Strategies to assess and optimize nutrition status and prolong survival in ALS patients are reviewed with recommendations based on current research.
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Zhang L, Sanders L, Fraser RJL. Nutritional support teams increase percutaneous endoscopic gastrostomy uptake in motor neuron disease. World J Gastroenterol 2012; 18:6461-6467. [PMID: 23197892 PMCID: PMC3508641 DOI: 10.3748/wjg.v18.i44.6461] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine factors influencing percutaneous endoscopic gastrostomy (PEG) uptake and outcomes in motor neuron disease (MND) in a tertiary care centre.
METHODS: Case notes from all patients with a confirmed diagnosis of MND who had attended the clinic at the Repatriation General Hospital between January 2007 and January 2011 and who had since died, were audited. Data were extracted for demographics (age and gender), disease characteristics (date of onset, bulbar or peripheral predominance, complications), date and nature of discussion of gastrostomy insertion, nutritional status [weight measurements, body mass index (BMI)], date of gastrostomy insertion and subsequent progress (duration of survival) and quality of life (QoL) [Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R)]. In addition, the type of clinician initiating the discussion regarding gastrostomy was recorded as Nutritional Support Team (involved in providing nutrition input viz Gastroenterologist, Speech Pathologist, Dietitian) and other (involved in non-nutritional aspects of patient care). Factors affecting placement and outcomes including length of survival, change in weight and QoL were determined.
RESULTS: Case records were available for all 86 patients (49 men, mean age at diagnosis 66.4 years). Thirty-eight patients had bulbar symptoms and 48 had peripheral disease as their presenting feature. Sixty-six patients reported dysphagia. Thirty-one patients had undergone gastrostomy insertion. The major indications for PEG placement were dysphagia and weight loss. Nine patients required immediate full feeding, whereas 17 patients initially used the gastrostomy to supplement oral intake, 4 for medication administration and 1 for hydration. Initially the PEG regime met 73% ± 31% of the estimated total energy requirements, increasing to 87% ± 32% prior to death. There was stabilization of weight in patients undergoing gastrostomy [BMI at 3 mo (22.6 ± 2.2 kg/m2) and 6 mo (22.5 ± 2.0 kg/m2) after PEG placement compared to weight at the time of the procedure (22.5 ± 3.0 kg/m2)]. However, weight loss recurred in the terminal stages of the illness. There was a strong trend for longer survival from diagnosis among MND in PEG recipients with limb onset presentation compared to similar patients who did not undergo the procedure (P = 0.063). Initial discussions regarding PEG insertion occurred earlier after diagnosis when seen by nutrition support team (NST) clinicians compared to other clinicians. (5.4 ± 7.0 mo vs 11.9 ± 13.4 mo, P = 0.028). There was a significant increase in PEG uptake (56% vs 24%, P = 0.011) if PEG discussions were initiated by the NST staff compared to other clinicians. There was no change in the ALSFRS-R score in patients who underwent PEG (pre 34.1 ± 8.6 vs post 34.8 ± 7.4), although in non-PEG recipients there was a non-significant fall in this score (33.7 ± 7.9 vs 31.6 ± 8.8). Four patients died within one month of the procedure, 4 developed bacterial site infection requiring antibiotics and 1 required endoscopic therapy for gastric bleeding. Less serious complications attributed to the procedure included persistent gastrostomy site discomfort, poor appetite, altered bowel function and bloating.
CONCLUSION: Initial discussion with NST clinicians increases PEG uptake in MND. Gastrostomy stabilizes patient weight but weight loss recurs with advancing disease.
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Morimoto N, Yamashita T, Sato K, Kurata T, Ikeda Y, Kusuhara T, Murata N, Abe K. Assessment of swallowing in motor neuron disease and Asidan/SCA36 patients with new methods. J Neurol Sci 2012; 324:149-55. [PMID: 23146615 DOI: 10.1016/j.jns.2012.10.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 10/18/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND We report on a unique complication of cerebellar ataxia and motor neuron disease named Asidan/SCA36 with a high frequency of tongue atrophy. We aimed to elucidate dysphagia in amyotrophic lateral sclerosis (ALS) and spinal, bulbar muscular atrophy (SBMA), and Asidan/SCA36 patients with new methods. METHODS Patients diagnosed with ALS (n=20), SBMA (n=6), and Asidan (n=12) were included. A videofluoroscopic swallow study (VFS), an assessment of maximal tongue pressure (MTP), and impedance pharyngography (IPG) were applied. RESULTS The frequencies of VFS abnormalities were 70%, 50%, and 33% in ALS, SBMA, and Asidan/SCA36, respectively. Compared with control subjects (31.6 ± 6.3 kPa, mean ± SD), MTP was significantly decreased in ALS patients and SBMA patients, but was relatively preserved in Asidan patients. ALS patients performed more swallowing actions (Ns) detected by IPG than did control subjects, but SBMA and Asidan/SCA36 patients performed similar Ns to control subjects. CONCLUSIONS VFS showed a higher frequency of swallowing abnormalities in ALS patients. MTP and IPG measurements showed the most severe involvement in ALS patients and a relatively preserved swallowing function in SBMA and Asidan/SCA36 patients.
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Affiliation(s)
- Nobutoshi Morimoto
- Department of Neurology Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama University, Okayama, Japan
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Use of palatal augmentation prostheses to maintain speech and swallowing function in patients with amyotrophic lateral sclerosis. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2012. [DOI: 10.1016/j.ajoms.2011.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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González-Fernández M, Sein MT, Palmer JB. Clinical experience using the Mann assessment of swallowing ability for identification of patients at risk for aspiration in a mixed-disease population. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2011; 20:331-336. [PMID: 21813822 DOI: 10.1044/1058-0360(2011/10-0082)] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To determine the clinical performance characteristics of the Mann Assessment of Swallowing Ability (MASA) for predicting aspiration (determined by videofluoroscopic swallowing study [VFSS]) in a mixed population. METHOD We selected 133 cases clinically evaluated using MASA and VFSS from January through June 2007. Ordinal risk rating (ORR) and total numeric score (TNS) were evaluated as predictors of aspiration on VFSS. To account for missing items, the maximum possible score was determined and a weighted percentage score calculated for each patient. We used receiver operating characteristic (ROC) analysis to compare the sensitivity and specificity of ORR and TNS for predicting aspiration. RESULTS VFSS identified 51 (38.4%) aspirators, while ORR identified 54 (40.6%) as probable or definite aspiration and TNS 19 (14.3%) as moderate to severe aspiration risk. ROC analysis demonstrated an area under the curve of 0.74, 95% CI [0.66, 0.82], for ORR and 0.51, 95% CI [0.41, 0.61], for TNS. These ROC scores suggest that the MASA ORR is better at predicting aspiration on VFSS than the numeric score. CONCLUSION In this sample, the subjective ORR had good predictive ability, while the percentage TNS failed to predict aspiration on VFSS. The MASA ORR assessment was a better predictor for a patient's aspiration risk in this population.
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Teismann IK, Warnecke T, Suntrup S, Steinsträter O, Kronenberg L, Ringelstein EB, Dengler R, Petri S, Pantev C, Dziewas R. Cortical processing of swallowing in ALS patients with progressive dysphagia--a magnetoencephalographic study. PLoS One 2011; 6:e19987. [PMID: 21625445 PMCID: PMC3098861 DOI: 10.1371/journal.pone.0019987] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 04/20/2011] [Indexed: 11/29/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a rare disease causing degeneration of the upper and lower motor neuron. Involvement of the bulbar motor neurons often results in fast progressive dysphagia. While cortical compensation of dysphagia has been previously shown in stroke patients, this topic has not been addressed in patients suffering from ALS. In the present study, we investigated cortical activation during deglutition in two groups of ALS patients with either moderate or severe dysphagia. Whole-head MEG was employed on fourteen patients with sporadic ALS using a self-paced swallowing paradigm. Data were analyzed by means of time-frequency analysis and synthetic aperture magnetometry (SAM). Group analysis of individual SAM data was performed using a permutation test. We found a reduction of cortical swallowing related activation in ALS patients compared to healthy controls. Additionally a disease-related shift of hemispheric lateralization was observed. While healthy subjects showed bilateral cortical activation, the right sensorimotor cortex was predominantly involved in ALS patients. Both effects were even stronger in the group of patients with severe dysphagia. Our results suggest that bilateral degeneration of the upper motor neuron in the primary motor areas also impairs further adjusted motor areas, which leads to a strong reduction of ‘swallowing related’ cortical activation. While both hemispheres are affected by the degeneration a relatively stronger activation is seen in the right hemisphere. This right hemispheric lateralization of volitional swallowing observed in this study may be the only sign of cortical plasticity in dysphagic ALS patients. It may demonstrate compensational mechanisms in the right hemisphere which is known to predominantly coordinate the pharyngeal phase of deglutition. These results add new aspects to our understanding of the pathophysiology of dysphagia in ALS patients and beyond. The compensational mechanisms observed could be relevant for future research in swallowing therapies.
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Affiliation(s)
- Inga K Teismann
- Department of Neurology, University of Muenster, Muenster, Germany.
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Zhang XY, Wang LP, Zhang J, Shen Y, Fan DS. Factors affecting acceptance of percutaneous endoscopic gastrostomy in patients with amyotrophic lateral sclerosis. Shijie Huaren Xiaohua Zazhi 2011; 19:749-753. [DOI: 10.11569/wcjd.v19.i7.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the conditions of use of percutaneous endoscopic gastrostomy (PEG) in Chinese patients with amyotrophic lateral sclerosis (ALS) and to analyze factors affecting acceptance of PEG in ALS patients.
METHODS: A total of 472 Chinese patients with ALS diagnosed from January 2005 to December 2007 were investigated using a specially designed questionnaire which contained 16 items pertaining to information about use of PEG. The investigation was performed via face to face/telephone/internet. The acquired data were analyzed and compared.
RESULTS: The overall percentage of ALS patients using PEG was 4.45% (21/472). This percentage year by year was 1.85% (1/54) in 2005, 1.66% (2/120) in 2006, and 6.04% (18/298) in 2007. Primary factor that made patients to receive PEG was doctors' advices (19/21, 90.5%), and other important causes were dysphagia (15/21, 71.4%) and propagating materials (10/21, 47.6%). The key ingredients preventing patients from using PEG were absence of doctors' advices (228/451, 50.6%), incomprehension to PEG (178/451, 39.5%), dread of risk and pain from PEG operation (178/451, 39.5%), and thought of incommodiousness post PEG (177/451, 39.2%).
CONCLUSION: The percentage of use of PEG in Chinese patients with ALS is low. The predominant factors affecting use of PEG in Chinese patients with ALS is doctors'advices.
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Lima NMFV, Guerra CC, Teixeira LDC, Silva LBDC, Sordi MD, Mourão L, Nucci A. Tradução e validação da versão brasileira da escala de gravidade na esclerose lateral amiotrófica (Egela). FISIOTERAPIA E PESQUISA 2009. [DOI: 10.1590/s1809-29502009000400006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo do trabalho foi traduzir a Amyotrophic Lateral Sclerosis Severity Scale para o português, como Escala de gravidade da esclerose lateral amiotrófica (Egela), além de validar e estudar sua confiabilidade. A escala foi submetida à versão e retroversão por tradutores bilíngües e três fisioterapeutas treinaram para padronizar sua aplicação. Foram avaliados 22 pacientes (5 mulheres, 17 homens, média de idade 45,9 anos) pela Egela e pela medida de independência funcional (MIF); 11 foram examinados para classificação de disfagia. Os coeficientes de correlação intraclasse dos domínios da Egela foram acima de 0,89. Foi constatada alta consistência interna em todos os seus domínios e para cada avaliador; foram encontradas fortes correlações entre a MIF motora e o escore espinhal da Egela (r=0.87 e p<0,0001), o domínio deglutição da Egela com as classificações de disfagia (r= -0.88 e p=0.0015), e o domínio fala da Egela com MIF expressão (r=0,76 e p<0.001). A Egela mostrou significativa confiabilidade inter-examinador e consistência interna, além de correlação com os escores da escala MIF e de disfagia, permitindo sua validação e confiabilidade como instrumento de avaliação fucional de pacientes com esclerose lateral amiotrófica.
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González-Fernández M, Daniels SK. Dysphagia in stroke and neurologic disease. Phys Med Rehabil Clin N Am 2008; 19:867-88, x. [PMID: 18940646 DOI: 10.1016/j.pmr.2008.07.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dysphagia is a common problem in neurologic disease. The authors describe rates of dysphagia in selected neurologic diseases, and the evaluation and treatment of dysphagia in this population. Applicable physiology and aspects of neural control are reviewed. The decision-making process to determine oral feeding versus alternative means of alimentation is examined.
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Affiliation(s)
- Marlís González-Fernández
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, School of Medicine, 600 North Wolfe Street, Phipps 174, Baltimore, MD 21287, USA.
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Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2008; 4:366-74. [DOI: 10.1038/ncpneuro0853] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 05/12/2008] [Indexed: 11/08/2022]
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Lo Re G, Galia M, La Grutta L, Russo S, Runza G, Taibbi A, D'Agostino T, Lo Greco V, Bartolotta TV, Midiri M, Cardinale AE, De Maria M, Lagalla R. Digital cineradiographic study of swallowing in patients with amyotrophic lateral sclerosis. Radiol Med 2007; 112:1173-87. [PMID: 18080096 DOI: 10.1007/s11547-007-0214-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 02/26/2007] [Indexed: 12/11/2022]
Abstract
PURPOSE This study was performed to evaluate the usefulness of digital cineradiography in detecting swallowing disorders in dysphagic patients affected by amyotrophic lateral sclerosis (ALS) with a view to planning an adequate therapeutic approach. MATERIAL AND METHODS From January 2005 to September 2006, 23 patients (10 men and 13 women; mean age 41.3+/-8.6 years) affected by ALS were evaluated with digital cineradiography to assess the grade of dysphagia. All patients were classified using the Hillel ALS Severity Scale (ALSSS). All examinations were performed with radiocontrolled equipment provided with a digital C-arm. RESULTS The cineradiographic technique enabled us to differentiate patients with disorders of the oral (17/23) and/or pharyngeal (19/23) swallowing phase from those without swallowing dysfunction (4/23). In 14/23 patients, passage of contrast medium into the upper airways was observed during swallowing, whereas in 5/23 cases, aspiration of contrast medium into the lower airways was recorded. CONCLUSIONS The videofluoroscopic swallowing study has high diagnostic capabilities in the evaluation of swallowing disorders, as it is able to identify the degree and causes of impairment. In addition, the study proved useful for planning speech therapy and for follow-up in patients with ALS.
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Affiliation(s)
- G Lo Re
- Sezione di Scienze Radiologiche del Dipartimento di Biotecnologie Mediche e Medicina Legale, via del Vespro 127, Palermo, Italy.
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Abstract
Although amyotrophic lateral sclerosis and its variants are readily recognised by neurologists, about 10% of patients are misdiagnosed, and delays in diagnosis are common. Prompt diagnosis, sensitive communication of the diagnosis, the involvement of the patient and their family, and a positive care plan are prerequisites for good clinical management. A multidisciplinary, palliative approach can prolong survival and maintain quality of life. Treatment with riluzole improves survival but has a marginal effect on the rate of functional deterioration, whereas non-invasive ventilation prolongs survival and improves or maintains quality of life. In this Review, we discuss the diagnosis, management, and how to cope with impaired function and end of life on the basis of our experience, the opinions of experts, existing guidelines, and clinical trials. We highlight the need for research on the effectiveness of gastrostomy, access to non-invasive ventilation and palliative care, communication between the care team, the patient and his or her family, and recognition of the clinical and social effects of cognitive impairment. We recommend that the plethora of evidence-based guidelines should be compiled into an internationally agreed guideline of best practice.
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Affiliation(s)
- Aleksandar Radunović
- MRC Centre for Neurodegeneration Research, Department of Clinical Neuroscience, PO 41, Institute of Psychiatry, King's College London, London, UK
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70
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Bergquist H, Andersson M, Ejnell H, Hellström M, Lundell L, Ruth M. Functional and Radiological Evaluation of Free Jejunal Transplant Reconstructions After Radical Resection of Hypopharyngeal or Proximal Esophageal Cancer. World J Surg 2007; 31:1988-95. [PMID: 17676378 DOI: 10.1007/s00268-007-9162-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Cancer of the pharyngoesophageal junction (PEJ) is associated with late onset of symptoms, high morbidity, and a dismal prognosis. Radical surgery with pharyngolaryngectomy and reconstruction with a free vascularized jejunal transplant has been increasingly practiced in the treatment of these patients. This strategy is not devoid of challenges, and the present study is aimed at evaluating the long-term functional outcome among patients who have undergone such surgical treatment. Ten patients (mean age 59 years) with a mean follow-up time of 54 months were included. Clinical assessment, health-related quality of life (HRQL) questionnaires, and a standardized radiography examination were used for evaluation. The Karnofsky index ranged from 60 to 90 (mean 82). Global QL scores (EORTC QLQ-C30) had a mean value of 74, and the mean scores for dysphagia-related items of the EORTC QLQ OES-18 questionnaire were within the lower range. Radiographic signs of disturbed bolus transport through the jejunal transplant were found in all patients examined despite the grading of dysphagia from 0 to 1. The Watson dysphagia score varied between 0.5 and 45.0 (mean 16.2). No correlations were found between radiographic findings and the clinical evaluations or the outcomes assessed by the HRQL questionnaires. HRQL was found to be generally good after cancer of the PEJ and jejunal transplant insertion. Most patients reported mild dysphagia. Radiologic signs of disturbed bolus passage were common, but their clinical impact seemed questionable.
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Affiliation(s)
- H Bergquist
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, 413 45, Göteborg, Sweden.
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71
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Sancho PO, Boisson D. Quelles sont les modalités de la prise en charge orthophonique dans la sclérose latérale amyotrophique ? Rev Neurol (Paris) 2006. [DOI: 10.1016/s0035-3787(06)75199-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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72
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Robert D, Bianco-Blache A, Spezza C, Verschueren A, Pouget J, Giovanni A. Évaluation des troubles de la parole et de la déglutition chez les patients atteints de sclérose latérale amyotrophique. Rev Neurol (Paris) 2006; 162:445-53. [PMID: 16585905 DOI: 10.1016/s0035-3787(06)75035-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Swallowing and speech disorders are the dramatic consequences of bulbar and pseudo-bulbar syndrome in ALS. Evaluation is necessary to guide speech therapy and to measure the effects of treatment. This article revues the different examinations used to assess bulbar and pseudobulbar involvement in an ALS patient: oromotor assessment, evaluation of the functions with self assessment, perceptive and objective evaluation of speech disorders, fiberoptic endoscopic evaluation of dysphagia (FEES) and videofluoroscopy.
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Affiliation(s)
- D Robert
- Fédération ORL, CHU La Timone, 264, rue Saint-Pierre, 13385 Marseille Cedex 5
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