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Donohue C, Robison R, Steele CM, Wymer JP, Plowman EK. Profiling Number of Swallows per Bolus and Residue in Individuals With Amyotrophic Lateral Sclerosis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3763-3772. [PMID: 37591233 PMCID: PMC10713014 DOI: 10.1044/2023_jslhr-23-00209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/11/2023] [Accepted: 06/13/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Swallowing efficiency impairments are the most prevalent and earliest manifestation of dysphagia in people with amyotrophic lateral sclerosis (pALS). We aimed to profile number of swallows elicited in pALS across thin liquid, moderately thick liquid, extremely thick liquid, and crackers compared to expected healthy reference data and to determine relationships between degree of pharyngeal residue, number of elicited swallows, and swallowing safety. METHOD pALS underwent standardized videofluoroscopic swallowing studies of 10 bolus trials. Trained raters performed duplicate, independent, and blinded ratings to derive Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) efficiency and safety grades and Analysis of Swallowing Physiology: Events, Kinematics, and Timing (ASPEKT) percent total pharyngeal residue. Number of swallows per bolus was quantified (1 = typical, 2 = atypically high, 3 = extremely high). Kruskal-Wallis, Pearson chi-square, and odds ratio analyses were performed at bolus and participant levels. KEY RESULTS At the bolus level (N = 2,523), number of swallows per bolus was observed to be, in rank order, as follows: atypically high (49.1%), extremely high (28.5%), and typical (22.4%). Mean number of swallows significantly differed by International Dysphagia Diet Standardisation Initiative level (p < .0001), with a higher number of swallows elicited in pALS for moderately thick versus thin liquids, extremely thick liquids, and crackers, p < .0001. Number of swallows per bolus increased with increasing DIGEST efficiency grades (p < .0001). Positive correlations were observed between ASPEKT percent residue and number of swallows for thin (r = .24) and moderately thick (r = .16) liquids, p < .05. DIGEST efficiency and safety grades were not significantly associated (p > .05). CONCLUSION AND INFERENCES pALS demonstrated a higher number of swallows per bolus compared to healthy reference data that may represent a compensation for reductions in swallowing efficiency to clear pharyngeal residue.
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Affiliation(s)
- Cara Donohue
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Breathing Research and Therapeutics Center, University of Florida, Gainesville
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
| | - Raele Robison
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Medicine, University of Wisconsin-Madison
- Center for Health Disparities Research, University of Wisconsin-Madison
| | - Catriona M. Steele
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada, Toronto, Ontario, Canada
- Canada Research Chairs, Toronto, Ontario, Canada
| | - James P. Wymer
- Department of Neurology, University of Florida, Gainesville
| | - Emily K. Plowman
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Breathing Research and Therapeutics Center, University of Florida, Gainesville
- Department of Neurology, University of Florida, Gainesville
- Department of Surgery, University of Florida, Gainesville
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Di Battista M, Grosso M, Da Rio M, De Mattia G, Marciano A, Valevich A, Grosso A, Morganti R, Volterrani D, Della Rossa A, Mosca M. Is oropharyngoesophageal scintigraphy the method of choice for assessing dysphagia in systemic sclerosis? A single center experience. Esophagus 2023:10.1007/s10388-023-00995-0. [PMID: 36933137 DOI: 10.1007/s10388-023-00995-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/03/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES To evaluate the performance of oropharyngoesophageal scintigraphy (OPES) in the assessment of dysphagia in patients with systemic sclerosis (SSc), and to compare OPES results with those of barium esophagogram. METHODS Adult SSc patients who underwent OPES for the assessment of dysphagia were enrolled. OPES was performed with both liquid and semisolid boluses and provided information regarding oropharyngeal transit time, esophageal transit time (ETT), oropharyngeal retention index (OPRI), esophageal retention index (ERI), and site of bolus retention. Barium esophagogram results were also collected. RESULTS Fifty-seven SSc patients (87.7% female, mean age 57.7 years) with dysphagia were enrolled. OPES identified at least one alteration in each patient and findings were generally worse for the semisolid bolus. Esophageal motility was widely impaired with 89.5% of patients with an increased semisolid ERI, and middle-lower esophagus was the most frequent site of bolus retention. However, oropharyngeal impairment was highlighted by widespread increased OPRI, especially in anti-topoisomerase I positivity. Older patients and with longer disease duration presented slower semisolid ETT (p = 0.029 and p = 0.002, respectively). Eleven patients with dysphagia had a negative barium esophagogram: all of them presented some alterations in OPES parameters. CONCLUSION OPES revealed a marked SSc esophageal impairment, in terms of both slowed transit time and increased bolus retention, but also shed light on oropharyngeal swallowing alterations. OPES showed high sensitivity, being able to detect swallowing alterations in dysphagic patients with negative barium esophagogram. Therefore, the use of OPES for the assessment of SSc-related dysphagia in clinical practice should be promoted.
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Affiliation(s)
- Marco Di Battista
- Rheumatology Unit, University of Pisa, Via Roma 67, 56123, Pisa, Italy. .,Department of Medical Biotechnologies, University of Siena, Siena, Italy.
| | - Mariano Grosso
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy
| | - Mattia Da Rio
- Rheumatology Unit, University of Pisa, Via Roma 67, 56123, Pisa, Italy
| | | | - Andrea Marciano
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy
| | | | - Antonio Grosso
- Department of Translational Sciences and New Technologies in Medicine and Surgery, Gastrointestinal Unit, University of Pisa, Pisa, Italy
| | | | - Duccio Volterrani
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy
| | | | - Marta Mosca
- Rheumatology Unit, University of Pisa, Via Roma 67, 56123, Pisa, Italy
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Augusto MM, da Silva RG, Teixeira Dourado Júnior ME, Godoy JF, Lopes LW, Pernambuco L. Tongue measurements and pharyngeal residue in amyotrophic lateral sclerosis. Neurodegener Dis Manag 2021; 11:459-468. [PMID: 34747630 DOI: 10.2217/nmt-2021-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We aimed to analyze the relationship between tongue measurements and vallecular residue in patients with amyotrophic lateral sclerosis (ALS). Materials & methods: Twenty-one patients with ALS were assessed for posterior maximum tongue isometric pressure (PMTIP) and posterior tongue isometric endurance (PTIE) by the Iowa Oral Performance Instrument; vallecular residue after 10 ml of moderately thickened consistency by Fiberoptic Endoscopic Evaluation of Swallowing; and tongue thickness (TT) by ultrasonography. Results: PMTIP, PTIE and TT were decreased compared with the reference values for healthy individuals and were not different between patients with and without vallecular residue. Conclusion: In ALS, PMTIP, PTIE and TT are not good predictors of vallecular residue in the tested volume and food consistency.
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Affiliation(s)
- Milena Magalhães Augusto
- Graduate Program in Speech, Language & Hearing Sciences (PPgFon-UFPB), Federal University of Paraíba - UFPB - João Pessoa, Paraíba, Brazil
| | - Roberta Gonçalves da Silva
- Graduate Program in Speech, Language & Hearing, Department of Speech, Language & Hearing Sciences, São Paulo State University, Marília Campus - UNESP/Marília - Marília, São Paulo, Brazil
| | - Mario Emílio Teixeira Dourado Júnior
- Onofre Lopes University Hospital (HUOL), Brazilian Hospital Services Company, Federal University of Rio Grande do Norte - UFRN - Natal, Rio Grande do Norte, Brazil
| | - Juliana Fernandes Godoy
- Department of Speech, Language & Hearing Sciences, Federal University of Rio Grande do Norte - UFRN - Natal, Rio Grande do Norte, Brazil
| | - Leonardo Wanderley Lopes
- Graduate Program in Speech, Language & Hearing Sciences (PPgFon-UFPB), Federal University of Paraíba - UFPB - João Pessoa, Paraíba, Brazil.,Department of Speech, Language & Hearing Sciences, Federal University of Paraíba - UFPB - João Pessoa, Paraíba, Brazil
| | - Leandro Pernambuco
- Graduate Program in Speech, Language & Hearing Sciences (PPgFon-UFPB), Federal University of Paraíba - UFPB - João Pessoa, Paraíba, Brazil.,Department of Speech, Language & Hearing Sciences, Federal University of Paraíba - UFPB - João Pessoa, Paraíba, Brazil
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Mariani L, Ruoppolo G, Cilfone A, Cocchi C, Preziosi Standoli J, Longo L, Ceccanti M, Greco A, Inghilleri M. Progression of Oropharyngeal Dysphagia in Amyotrophic Lateral Sclerosis: A Retrospective Cohort Study. Dysphagia 2021; 37:868-878. [PMID: 34297153 PMCID: PMC9345800 DOI: 10.1007/s00455-021-10346-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 07/08/2021] [Indexed: 01/03/2023]
Abstract
Little is known regarding the optimal timing of dysphagia assessment and PEG indication in amyotrophic lateral sclerosis (ALS). The study aims to investigate the progression of dysphagia in a cohort of ALS patients and to analyse whether there are variables linked to a faster progression of dysphagia and faster indication of PEG placement. A retrospective cohort study in 108 individuals with ALS. Fiberoptic endoscopic evaluation of swallowing was performed 6 monthly until PEG indication or death. Dysphagia severity and PEG indication were assessed using Penetration Aspiration Scale. Progression Index (PI) analysed the risk of disease progression (fast/slow) in relation to dysphagia onset and PEG indication. Patients were grouped based on ALS onset and PI. Person-time incidence rates were computed considering dysphagia onset and PEG indication from ALS symptoms during the entire observation period and have been reported as monthly and 6-month rates. Cox regression survival analysis assessed dysphagia and PEG risk factors depending on onset. Person-time incidence rates of dysphagia progression and PEG risk were increased based on type of ALS onset and PI. Patients with a fast progressing disease and with bulbar onset (BO) show statistically significant increased risk of dysphagia (BO 178.10% hazard ratio (HR) = 2.781 P < 0.01; fast 181.10% HR 2.811 P < 0.01). Regarding PEG risk, fast patients and patients with BO had a statistically significant increased risk (fast 147.40% HR 2.474 P < 0.01, BO 165.40% HR 2.654 P < 0.01). Fast PI predicts the likelihood of faster progression of dysphagia and PEG indication and should be included in multidisciplinary assessments and considered in the design of future guidelines regarding dysphagia management in ALS patients. Level of Evidence Level IV.
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Affiliation(s)
- Laura Mariani
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy.
| | - Giovanni Ruoppolo
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Armando Cilfone
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Chiara Cocchi
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Jacopo Preziosi Standoli
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Lucia Longo
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Marco Ceccanti
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Antonio Greco
- Department of Sensorial Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Maurizio Inghilleri
- Rare Neuromuscular Diseases Centre, Department of Human Neurosciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
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Schimmel M, Leuchter I, Héritier Barras AC, Leles CR, Abou-Ayash S, Viatte V, Esteve F, Janssens JP, Mueller F, Genton L. Oral function in amyotrophic lateral sclerosis patients: A matched case-control study. Clin Nutr 2021; 40:4904-4911. [PMID: 34358835 DOI: 10.1016/j.clnu.2021.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/31/2021] [Accepted: 06/19/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Patients with amyotrophic lateral sclerosis (ALS) develop swallowing difficulties with the progression of the disease. The present study aimed at comparing oral function and body composition between ALS patients and healthy controls, and at evaluating which parameters are the most discriminant between both groups. METHODS We included ALS patients at the start of their multidisciplinary follow-up at the Geneva University Hospitals and healthy age-, gender-, and dental status-matched adults. We assessed the severity of the disease through the ALS Functional Rating Scale and the swallowing difficulties through the EAT-10 score. We performed an intraoral examination of the dental status, and measured chewing performance, bite, lip and tongue force, saliva weight, and body composition. Group comparisons were performed with t-tests or Mann-Whitney tests as appropriate. Linear discriminant analysis was used to determine the most discriminant parameters between groups. RESULTS Twenty-six ALS patients (bulbar onset: n = 7, median (IQR) ALS Functional Rating Scale: 37 (11)) were included. The ALS patients had a significantly lower chewing performance (p < 0.001), lip force (p < 0.001), tongue force (p = 0.002), saliva weight (p < 0.004) and fat-free mass index (p < 0.001) as compared to the healthy individuals, and a higher EAT-10 score (p < 0.001). In ALS patients, a low chewing performance was correlated with a low bite (r = -0.45, p < 0.05)) and tongue force (r = -0.59, p < 0.05). The most discriminant parameters between both groups, by order of importance, were chewing performance, fat-free mass index and saliva weight and allowed the calculation of a discriminant function. CONCLUSION Compared to healthy controls, ALS patients have significant alterations of oral function and body composition. The most discriminant parameters between both groups were chewing performance, fat-free mass index and saliva volume. It remains to be demonstrated whether oral parameters predict outcome. CLINICAL TRIAL REGISTRY: clinicaltrials.gov, identifier: NCT01772888.
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Affiliation(s)
- Martin Schimmel
- Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Igor Leuchter
- Otorhinolaryngology, University Hospitals, Geneva, Switzerland
| | | | - Claudio R Leles
- Prevention and Oral Rehabilitation, School of Dentistry, Federal University of Goias, Goiania, Brazil
| | - Samir Abou-Ayash
- Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Valérie Viatte
- Clinical Nutrition, University Hospitals, Geneva, Switzerland
| | | | | | - Frauke Mueller
- Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, Geneva, Switzerland
| | - Laurence Genton
- Clinical Nutrition, University Hospitals, Geneva, Switzerland.
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Groher ME. Dysphagia Unplugged. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Augusto MM, Silva RGD, Rodrigues LGO, Martins PS, Dourado Júnior MET, Pernambuco L. Fiberoptic endoscopic evaluation of swallowing in patients with amyothrophic lateral sclerosis: an integrative literature review. REVISTA CEFAC 2021. [DOI: 10.1590/1982-0216/202123510221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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8
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Sood A, Gambhir S, Singh D, Kumar KU, Parihar AS, Kheruka S, Dube V, Deswal S. In-house-Prepared Semisolid Bolus for Esophageal Transit Scintigraphy in Normal Volunteers and its Comparison with Liquid Bolus. INDIAN JOURNAL OF NUCLEAR MEDICINE : IJNM : THE OFFICIAL JOURNAL OF THE SOCIETY OF NUCLEAR MEDICINE, INDIA 2020; 35:130-135. [PMID: 32351267 PMCID: PMC7182328 DOI: 10.4103/ijnm.ijnm_204_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/26/2019] [Accepted: 01/21/2020] [Indexed: 11/23/2022]
Abstract
Background/Aims: Esophageal transit scintigraphy (ETS) is a useful tool for evaluating esophageal motility disorders, although conflicting results are seen due to lack of ideal bolus. Semisolid/solid boluses have shown superiority over liquid boluses, and the present study aims to establish the utility of in-house-prepared bolus in normal volunteers and its comparison with liquid bolus. Materials and Methods: Thirty-three healthy volunteers were selected for ETS with in-house-prepared semisolid bolus jelly containing 99mTc-sulfur colloid. Dynamic studies were acquired in anterior projection with single swallow for both supine and sitting positions. T90% esophageal emptying time (EET) was calculated for whole and three equally divided segments of esophagus and also done with liquid bolus on different day. Results: The median value of EET for semisolid bolus for whole esophagus in sitting and supine positions was 11.7 s (interquartile range [IQR]: 8.0–16.7) and 17.7 s (IQR: 12.0–33.0). EET of liquid bolus for whole esophagus in sitting and supine positions was 9.3 s (IQR: 8.0–13.3) and 13.0 s (IQR: 9.7–25.0), respectively. Significantly different EET for whole esophagus and lower one-third esophagus between sitting and supine positions was seen for semisolid (whole esophagus;P = 0.003, lower one-third esophagus; P = 0.025) and liquid boluses (whole esophagus; P = 0.032, lower one-third esophagus; P = 0.016). Comparing EET using semisolid and liquid boluses, only lower one-third esophagus in supine position showed significant difference (P = 0.033). Conclusions: In-house-prepared semisolid radiolabeled jelly is inexpensive, easy to prepare with good radiolabeling. Condensed dynamic images from semisolid bolus were better, sharper, and reproducible in comparison to liquid bolus without fragmentation. This study standardized semisolid bolus and verified its suitability for clinical use.
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Affiliation(s)
- Ashwani Sood
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Gambhir
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Deepa Singh
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Utham Kumar
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashwin Singh Parihar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Kheruka
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Veeresh Dube
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Satyawati Deswal
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Gozzer MM, Cola PC, Onofri SMM, Merola BN, Silva RGD. Achados videoendoscópicos da deglutição em diferentes consistências de alimento na Esclerose Lateral Amiotrófica. Codas 2020; 32:e20180216. [DOI: 10.1590/2317-1782/20192018216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 04/26/2019] [Indexed: 12/14/2022] Open
Abstract
RESUMO Objetivo Este estudo teve por objetivo comparar os achados videoendoscópicos da deglutição orofaríngea em distintas consistências de alimento na Esclerose Lateral Amiotrófica (ELA). Método Estudo clínico retrospectivo com amostra de conveniência. Foram incluídos 20 indivíduos com diagnóstico de ELA e disfagia orofaríngea confirmada por avaliação clínica e objetiva de deglutição, independentemente do tipo, bulbar ou esquelética, e tempo de diagnóstico neurológico, 13 do sexo masculino e sete do sexo feminino, faixa etária variando de 34 a 78 anos, média de 57 anos. Foram analisados os achados da videoendoscopia de deglutição (VED) nas consistências líquida (N=18), líquida espessada (N=19) e pastosa (N=20) no volume de cinco ml. Os achados sobre escape oral posterior, resíduos faríngeos, penetração laríngea e/ou aspiração foram comparados nas três consistências de alimento e a análise estatística utilizou o teste ANOVA de Friedman. Resultados Não foi encontrada alteração na sensibilidade laríngea nessa população. Não houve diferença estatística significativa entre as consistências de alimento na presença de escape oral posterior, penetração e/ou aspiração. Houve diferença estatística significativa somente com resíduos faríngeos na consistência líquida espessada e pastosa na ELA. Conclusão Dentre os achados videoendoscópicos da deglutição na ELA, somente o resíduo faríngeo teve maior frequência na dependência da consistência de alimento.
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Affiliation(s)
- Marina Mendes Gozzer
- Universidade Estadual Júlio de Mesquita Filho, Brasil; Universidade Estadual Júlio de Mesquita Filho, Brasil
| | - Paula Cristina Cola
- Universidade Estadual Júlio de Mesquita Filho, Brasil; Universidade Estadual Júlio de Mesquita Filho, Brasil; Universidade de Marília, Brasil
| | | | - Beatriz Novaes Merola
- Universidade Estadual Júlio de Mesquita Filho, Brasil; Universidade Estadual Júlio de Mesquita Filho, Brasil
| | - Roberta Gonçalves da Silva
- Universidade Estadual Júlio de Mesquita Filho, Brasil; Universidade Estadual Júlio de Mesquita Filho, Brasil
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10
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Brandão BC, Silva MAOMD, Cola PC, Silva RGD. Relationship between oral transit time and functional performance in motor neuron disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:542-549. [PMID: 31508679 DOI: 10.1590/0004-282x20190077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 05/01/2019] [Indexed: 11/22/2022]
Abstract
Oral phase swallowing impairment in motor neuron disease (MND) is caused by tongue weakness, fasciculation and atrophy, which may compromise oral transit time and total feeding time. OBJECTIVE To describe and correlate total oral transit time (TOTT) with functional performance in MND using different food consistencies. METHODS The study was conducted on 20 patients with MND, regardless of type or duration of the disease, of whom nine were excluded due to issues on the videofluoroscopic swallowing images. The remaining 11 patients (nine men and two women) ranged from 31 to 87 years of age (mean: 57 years) with scores on the Penetration Aspiration Scale ranging from ≤ 2 to ≤ 4. The Amyotrophic Lateral Sclerosis Functional Rating Scale - revised questionnaire was applied to classify individuals according to global, bulbar and bulbar/respiratory parameters. Videofluoroscopy of swallowing using 5ml of different consistencies was performed and a quantitative temporal analysis of the TOTT was carried out with the aid of specific software. RESULTS There was a wide variation in the TOTT within the same food consistency among MND patients. There was a correlation between the TOTT and overall functional performance for the thickened liquid consistency (r = -0.691) and between the TOTT and bulbar performance for the pureed consistency (r = -0.859). CONCLUSION Total oral transit time in MND varies within the same food consistency and the longer the TOTT, regardless of food consistency, the lower the functional performance in MND.
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Affiliation(s)
- Bárbara Carolina Brandão
- Universidade Estadual Paulista, Centro de Pesquisa e Reabilitação em Disfagia do Departamento de Fonoaudiologia, Marília SP, Brasil.,Faculdade de Medicina de São José do Rio Preto, Hospital de Base, São José do Rio Preto SP Brasil
| | | | - Paula Cristina Cola
- Universidade Estadual Paulista, Centro de Pesquisa e Reabilitação em Disfagia do Departamento de Fonoaudiologia, Marília SP, Brasil.,Universidade de Marília, Marília SP, Brasil
| | - Roberta Gonçalves da Silva
- Universidade Estadual Paulista, Centro de Pesquisa e Reabilitação em Disfagia do Departamento de Fonoaudiologia, Marília SP, Brasil
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11
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Barsotti S, Puccini G, Tripoli A, Cardelli C, Minichilli F, Volterrani D, Mosca M, Grosso M, Neri R. Assessment of swallowing function with oro-pharyngeal-esophageal scintigraphy in patients with idiopathic inflammatory myopathies. Neurogastroenterol Motil 2019; 31:e13599. [PMID: 31012534 DOI: 10.1111/nmo.13599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Swallowing impairment is frequently present in patients with idiopathic inflammatory myopathies (IIMs), and it represents an important cause of morbidity, dramatically reducing the quality of life of patients. Moreover, dysphagia is associated to a worst prognosis. Unfortunately, no standardized instrumental techniques for the assessment of the upper gastrointestinal tract in IIM patients are available. In this study, we explored the characteristics of the alterations in the upper gastrointestinal tract using oro-pharyngeal-esophageal scintigraphy (OPES) in a cohort of IIM patients and we correlated the alterations with clinical parameters. METHODS A total of 51 IIM patients were examined with OPES, both with liquids and semisolids, and the data acquired were examined to compute the transit time and the percentage of retention at oral, pharyngeal, and esophageal level. Patient-reported outcome data (PRO) on dysphagia, disease activity, and clinical parameters were collected. KEY RESULTS Oro-pharyngeal-esophageal scintigraphy identified at least one alteration in all patients, particularly with the semisolid test and oral and pharyngeal levels presented a higher frequency of involvement compared to the esophageal tract (P < 0.05). A very good correlation between dysphagia severity assessed by PRO and many OPES results was identified. In patients with a shorter disease duration, there was a higher prevalence of alterations at the oral and pharyngeal level and they were correlated to higher swallowing difficulties and higher disease activity parameters. CONCLUSIONS & INFERENCES Our results showed that OPES may represent a novel reproducible tool to assess dysphagia in IIM patients, thus opening new possibilities to evaluate dysphagia in these patients.
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Affiliation(s)
- Simone Barsotti
- Rheumatology Unit, University of Pisa, Pisa, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Giulia Puccini
- Nuclear Medicine Unit, Pisa University Hospital, Pisa, Italy
| | | | | | | | | | - Marta Mosca
- Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Mariano Grosso
- Nuclear Medicine Unit, Pisa University Hospital, Pisa, Italy
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Zuercher P, Moret CS, Dziewas R, Schefold JC. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:103. [PMID: 30922363 PMCID: PMC6438038 DOI: 10.1186/s13054-019-2400-2] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/18/2019] [Indexed: 12/14/2022]
Abstract
Dysphagia may present in all critically ill patients and large-scale clinical data show that e.g. post-extubation dysphagia (PED) is commonly observed in intensive care unit (ICU) patients. Recent data demonstrate that dysphagia is mostly persisting and that its presence is independently associated with adverse patient-centered clinical outcomes. Although several risk factors possibly contributing to dysphagia development were proposed, the underlying exact mechanisms in ICU patients remain incompletely understood and no current consensus exists on how to best approach ICU patients at risk.From a clinical perspective, dysphagia is well-known to be associated with an increased risk of aspiration and aspiration-induced pneumonia, delayed resumption of oral intake/malnutrition, decreased quality of life, prolonged ICU and hospital length of stay, and increased morbidity and mortality. Moreover, the economic burden on public health care systems is high.In light of high mortality rates associated with the presence of dysphagia and the observation that dysphagia is not systematically screened for on most ICUs, this review describes epidemiology, terminology, and potential mechanisms of dysphagia on the ICU. Furthermore, the impact of dysphagia on affected individuals, health care systems, and society is discussed in addition to current and future potential therapeutic approaches.
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Affiliation(s)
- Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland.
| | - Céline S Moret
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland
| | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland
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Luchesi KF, Silveira IC. Cuidados paliativos, esclerose lateral amiotrófica e deglutição: estudo de caso. Codas 2018; 30:e20170215. [DOI: 10.1590/2317-1782/20182017215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/06/2018] [Indexed: 02/07/2023] Open
Abstract
RESUMO Tem-se por objetivo discutir aspectos da atuação fonoaudiológica em disfagia, voltada para os cuidados paliativos e a qualidade de vida em deglutição. Trata-se de um estudo de quatro casos com esclerose lateral amiotrófica (ELA) em acompanhamento fonoaudiológico. Foi aplicado o questionário de qualidade de vida em disfagia (SWAL-QOL), realizada entrevista estruturada, classificação da funcionalidade da deglutição pela Funcional Oral Intake Scale (FOIS), aplicação da escala de gravidade da ELA (EGELA), realizada videofluoroscopia da deglutição e classificação da severidade da disfagia pela Dysphagia Outcome Severity Scale (DOSS). Observou-se que os casos apresentavam tempo de doença entre 12 e 35 meses e possuíam o desejo de manter uma via oral de alimentação, mesmo que mínima, em caso de aceitação da via alternativa de alimentação. Quanto à severidade da disfagia, observada por meio do exame de videofluoroscopia e classificada pela DOSS, apresentavam desde deglutição funcional até disfagia leve a moderada. O impacto na qualidade de vida em deglutição foi mensurado entre discreto e severo. Nem todos apresentavam correspondência entre a severidade da disfagia e a qualidade de vida em deglutição, sendo observado impacto na qualidade de vida, mesmo nos casos com menor grau de disfagia. Os participantes relataram que se sentiriam desconfortáveis em caso de alimentação exclusiva por via alternativa e que a ingestão de alimentos por via oral, mesmo que mínima, apenas pelo prazer da alimentação, refletiria em sua qualidade de vida.
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Andrenelli E, Galli FL, Gesuita R, Skrami E, Logullo FO, Provinciali L, Capecci M, Ceravolo MG, Coccia M. Swallowing impairments in Amyotrophic Lateral Sclerosis and Myotonic Dystrophy type 1: Looking for the portrait of dysphagic patient in neuromuscular diseases. NeuroRehabilitation 2018; 42:93-102. [DOI: 10.3233/nre-172272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, “Politecnica delle Marche” University, Ancona, Italy
| | - Federica Lucia Galli
- Department of Neuroscience, Neurorehabilitation Clinic, AziendaOspedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Rosaria Gesuita
- Center of Epidemiology, Biostatistics and Medical Information Technology, “Politecnica delle Marche” University, Ancona, Italy
| | - Edlira Skrami
- Center of Epidemiology, Biostatistics and Medical Information Technology, “Politecnica delle Marche” University, Ancona, Italy
| | - Francesco Ottavio Logullo
- Department of Experimental and Clinical Medicine, Neurological Clinic, “Politecnica delle Marche” University, Ancona, Italy
| | - Leandro Provinciali
- Department of Experimental and Clinical Medicine, Neurological Clinic, “Politecnica delle Marche” University, Ancona, Italy
| | - Marianna Capecci
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, “Politecnica delle Marche” University, Ancona, Italy
| | - Maria Gabriella Ceravolo
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, “Politecnica delle Marche” University, Ancona, Italy
| | - Michela Coccia
- Department of Neuroscience, Neurorehabilitation Clinic, AziendaOspedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
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15
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Fattori B, Giusti P, Mancini V, Grosso M, Barillari MR, Bastiani L, Molinaro S, Nacci A. Comparison between videofluoroscopy, fiberoptic endoscopy and scintigraphy for diagnosis of oro-pharyngeal dysphagia. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 36:395-402. [PMID: 27958600 PMCID: PMC5225795 DOI: 10.14639/0392-100x-829] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 06/09/2016] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to compare videofluoroscopy (VFS), fiberoptic endoscopic evaluation of swallowing (FEES) and oro-pharyngo- oesophageal scintigraphy (OPES) with regards to premature spillage, post-swallowing residue and aspiration to assess the reliability of these tests for detection of oro-pharyngeal dysphagia. Sixty patients affected with dysphagia of various origin were enrolled in the study and submitted to VFS, FEES and OPES using a liquid and semi-solid bolus. As a reference, we used VFS. Both the FEES and the OPES showed good sensitivity with high overall values (≥ 80% and ≥ 90% respectively). The comparison between FEES vs VFS concerning drop before swallowing showed good specificity (84.4% for semi-solids and 86.7% for liquids). In the case of post-swallowing residue, FEES vs VFS revealed good overall validity (75% for semi-solids) with specificity and sensitivity well balanced for the semi-solids. OPES vs. VFS demonstrated good sensitivity (88.6%) and overall validity (76.7%) for liquids. The analysis of FEES vs. VFS for aspiration showed that the overall validity was low (≤ 65%). On the other hand, OPES demonstrated appreciable overall validity (71.7%). VFS, FEES and OPES are capable of detecting oro-pharyngeal dysphagia. FEES gave significant results in the evaluation of post-swallowing residues.
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Affiliation(s)
- B Fattori
- ENT, Audiology and Phoniatric Unit, Department of Neurosciences, University of Pisa, Italy
| | - P Giusti
- Department of Diagnostic and Interventional Radiology, University of Pisa, Italy
| | - V Mancini
- ENT, Audiology and Phoniatric Unit, Department of Neurosciences, University of Pisa, Italy
| | - M Grosso
- Regional Centre of Nuclear Medicine, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - M R Barillari
- Audiology and Phoniatric Unit, University of Napoli 2, Italy
| | - L Bastiani
- Institute of Clinical Physiology of the Italian National Research Council (IFC-CNR), Pisa, Italy
| | - S Molinaro
- Institute of Clinical Physiology of the Italian National Research Council (IFC-CNR), Pisa, Italy
| | - A Nacci
- ENT, Audiology and Phoniatric Unit, Department of Neurosciences, University of Pisa, Italy
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Trends in Research Literature Describing Dysphagia in Motor Neuron Diseases (MND): A Scoping Review. Dysphagia 2017; 32:734-747. [PMID: 28664472 DOI: 10.1007/s00455-017-9819-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 06/21/2017] [Indexed: 12/11/2022]
Abstract
Dysphagia in motor neuron diseases (MNDs) is highly complex, affecting all stages of swallowing and leading to impaired swallowing safety and efficiency. In order to explore the degree to which research is capturing the symptom of dysphagia in MND, we conducted a scoping review of the existing literature. The primary aims of this review were to identify common themes within the literature on dysphagia in MND, explore patterns and trends in research focus, and identify if any imbalances exist between the research themes related to dysphagia description and management. A comprehensive search strategy yielded 1690 unique articles for review. Following relevance screening, a total of 157 articles were included in the synthesis. Relevant data and keywords were extracted from each article and grouped into themes. Frequency estimates were calculated for each theme to identify trends across research literature. Swallowing impairment in MNDs is described in a variety of ways across current research. The most commonly reported theme was Aspiration/Penetration, mentioned in 73.2% of all included articles; a significant imbalance was identified between reports of swallowing safety and efficiency (p = 0.008). The most frequently reported theme related to dysphagia management was Enteral Nutrition, and very few studies have reported on the efficacy of Rehabilitation/Compensatory recommendations. It is suggested that researchers and clinicians remain mindful of imbalances and gaps in research, and aim to characterize dysphagia in MNDs in a comprehensive manner. Further research investigating discrete, measureable changes in swallowing pathophysiology would be beneficial to delineate the key factors contributing to impaired swallowing safety and efficiency.
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Dysphagia in Amyotrophic Lateral Sclerosis: Relationships between disease progression and Fiberoptic Endoscopic Evaluation of Swallowing. Auris Nasus Larynx 2017; 44:306-312. [DOI: 10.1016/j.anl.2016.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 06/19/2016] [Accepted: 07/05/2016] [Indexed: 12/14/2022]
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Vrijsen B, Buyse B, Belge C, Vanpee G, Van Damme P, Testelmans D. Randomized cross-over trial of ventilator modes during non-invasive ventilation titration in amyotrophic lateral sclerosis. Respirology 2017; 22:1212-1218. [DOI: 10.1111/resp.13046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 01/31/2017] [Accepted: 02/02/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Bart Vrijsen
- Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS); University Hospitals Leuven; Leuven Belgium
- Faculty of Kinesiology and Rehabilitation Sciences; KU Leuven; Leuven Belgium
| | - Bertien Buyse
- Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS); University Hospitals Leuven; Leuven Belgium
- Department of Clinical and Experimental Medicine; KU Leuven; Leuven Belgium
| | - Catharina Belge
- Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS); University Hospitals Leuven; Leuven Belgium
- Department of Clinical and Experimental Medicine; KU Leuven; Leuven Belgium
| | - Goele Vanpee
- Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS); University Hospitals Leuven; Leuven Belgium
- Faculty of Kinesiology and Rehabilitation Sciences; KU Leuven; Leuven Belgium
| | - Philip Van Damme
- Department of Neurology; University Hospitals Leuven; Leuven Belgium
- Department of Neurosciences; KU Leuven - University of Leuven, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND); Leuven Belgium
| | - Dries Testelmans
- Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS); University Hospitals Leuven; Leuven Belgium
- Department of Clinical and Experimental Medicine; KU Leuven; Leuven Belgium
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The importance of the reproducibility of oropharyngeal swallowing in amyotrophic lateral sclerosis. An electrophysiological study. Clin Neurophysiol 2017; 128:792-798. [PMID: 28319880 DOI: 10.1016/j.clinph.2017.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/29/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate electrophysiologically the reproducibility of oropharyngeal swallowing in patients with ALS. METHODS We enrolled 26 ALS patients, both with and without clinical signs of dysphagia, and 30 age-matched controls. The reproducibility of the electrophysiological signals related to the oral phase (electromyographic activity of the submental/suprahyoid muscles) and the pharyngeal phase (laryngeal-pharyngeal mechanogram) of swallowing across repeated swallows was assessed. To do this we computed two similarity indexes (SI) by using previously described mathematical algorithms. RESULTS The reproducibility of oropharyngeal swallowing was significantly reduced both in patients with and in those without clinical signs of dysphagia, with more marked alterations being detected in the dysphagic group. The SI of both phases of swallowing, oral and pharyngeal, correlated significantly with dysphagia severity and disease severity. CONCLUSIONS In ALS different pathophysiological mechanisms can alter the stereotyped motor behaviors underlying normal swallowing, thus reducing the reproducibility of the swallowing act. A decrease in swallowing reproducibility could be a preclinical sign of dysphagia and, beyond a certain threshold, a pathological hallmark of oropharyngeal dysphagia. SIGNIFICANCE Electrophysiological assessment is a simple and useful tool for the early detection of swallowing abnormalities, and for the management of overt dysphagia in ALS.
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Vandoorne E, Vrijsen B, Belge C, Testelmans D, Buyse B. Noninvasive ventilation in amyotrophic lateral sclerosis: effects on sleep quality and quality of life. Acta Clin Belg 2016; 71:389-394. [PMID: 27112318 DOI: 10.1080/17843286.2016.1173941] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Little is known about the effects of noninvasive ventilation (NIV) on sleep quality in amyotrophic lateral sclerosis (ALS). We aim to evaluate the long-term effects of NIV on sleep quality and quality of life in patients with ALS. METHODS In this prospective observational study, 13 ALS patients were followed for one year after initiating NIV. We evaluated sleep quality, quality of life and functional status with several questionnaires: Epworth sleepiness Scale (ESS), Pittsburg sleep quality index (PSQI), Short Form 36 Health Questionnaire (SF-36), McGill Quality of Life questionnaire (McGillQoL) and revised Amyotrophic Lateral Sclerosis Functional Rating Scale scores (ALSFRS-R). RESULTS Median and interquartile range (IQR) at the start of NIV was 59 (53-65) years. The ALSFRS-R at start was 30 (24-37) (median, IQR), with three patients having severe bulbar impairment (ALSFRS-R-bulbar ≤ 9). The PaCO2 at start of NIV treatment was 48 (43-52) mmHg (median, IQR). During the one-year follow-up period, a significant decrease in the ALSFRS-R was observed. The impact of NIV in a short term (1 month) revealed a statistically significant decrease in ESS, decrease in total PSQI and of four PSQI subscales and improvement of almost all subscales of the McGill questionnaire. Long-term analyses (9 months to 1 year) revealed that amelioration in ESS and total PSQI was sustained. CONCLUSION We conclude that accurately titrated NIV in ALS patients can stabilize sleep quality and quality of life for at least one year, despite significant disease progression.
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Nacci A, Matteucci J, Romeo SO, Santopadre S, Cavaliere MD, Barillari MR, Berrettini S, Fattori B. Complications with Fiberoptic Endoscopic Evaluation of Swallowing in 2,820 Examinations. Folia Phoniatr Logop 2016; 68:37-45. [DOI: 10.1159/000446985] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Crescimanno G, Greco F, Arrisicato S, Morana N, Marrone O. Effects of positive end expiratory pressure administration during non-invasive ventilation in patients affected by amyotrophic lateral sclerosis: A randomized crossover study. Respirology 2016; 21:1307-13. [DOI: 10.1111/resp.12836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/17/2016] [Accepted: 03/27/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Grazia Crescimanno
- Italian National Research Council; Institute of Biomedicine and Molecular Immunology; Palermo Italy
- Regional Center for Prevention and Treatment of Respiratory Complications of Rare Genetic Neuromuscular Diseases; Villa Sofia-Cervello Hospital; Palermo Italy
| | - Francesca Greco
- Italian Union Against Muscular Dystrophy (UILDM); Palermo Italy
| | - Salvo Arrisicato
- Regional Center for Prevention and Treatment of Respiratory Complications of Rare Genetic Neuromuscular Diseases; Villa Sofia-Cervello Hospital; Palermo Italy
| | - Noemi Morana
- Italian Union Against Muscular Dystrophy (UILDM); Palermo Italy
| | - Oreste Marrone
- Italian National Research Council; Institute of Biomedicine and Molecular Immunology; Palermo Italy
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Vrijsen B, Testelmans D, Belge C, Vanpee G, Van Damme P, Buyse B. Patient-ventilator asynchrony, leaks and sleep in patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:343-50. [DOI: 10.3109/21678421.2016.1170149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Bart Vrijsen
- Department of Pulmonology and Leuven University Centre for Sleep and Wake disorders (LUCS) - University Hospitals Leuven,
- Faculty of Kinesiology and Rehabilitation Sciences – KU Leuven,
| | - Dries Testelmans
- Department of Pulmonology and Leuven University Centre for Sleep and Wake disorders (LUCS) - University Hospitals Leuven,
- Department of Clinical and Experimental Medicine – KU Leuven,
| | - Catharina Belge
- Department of Pulmonology and Leuven University Centre for Sleep and Wake disorders (LUCS) - University Hospitals Leuven,
- Department of Clinical and Experimental Medicine – KU Leuven,
| | - Goele Vanpee
- Department of Pulmonology and Leuven University Centre for Sleep and Wake disorders (LUCS) - University Hospitals Leuven,
- Faculty of Kinesiology and Rehabilitation Sciences – KU Leuven,
| | - Philip Van Damme
- Department of Neurology – University Hospitals Leuven,
- Department of Neurosciences, KU Leuven – University of Leuven, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), and
- Laboratory of Neurobiology, Vesalius Research Centre, VIB, Leuven, Belgium
| | - Bertien Buyse
- Department of Pulmonology and Leuven University Centre for Sleep and Wake disorders (LUCS) - University Hospitals Leuven,
- Department of Clinical and Experimental Medicine – KU Leuven,
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Ursino S, Seccia V, Cocuzza P, Ferrazza P, Briganti T, Matteucci F, Fatigante L, Giusti P, Grosso M, Locantore L, Morganti R, Nacci A, Sellari Franceschini S, Paiar F, Caramella D, Fattori B. How does radiotherapy impact swallowing function in nasopharynx and oropharynx cancer? Short-term results of a prospective study. ACTA OTORHINOLARYNGOLOGICA ITALICA 2016; 36:174-84. [PMID: 27070541 PMCID: PMC4967765 DOI: 10.14639/0392-100x-640] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 02/02/2016] [Indexed: 12/14/2022]
Abstract
The objective of this study is to report the initial results of a prospective trial assessing instrumental deglutition function in nasopharynx and oropharynx cancers after radio or chemoradiotherapy using intensity-modulated radiotherapy (IMRT). IMRT was delivered aiming to spare the swallowing organ at risk (SWOARs) for Stage II-IV naso- and oropharynx cancer. Objective instrumental assessment included videofluoroscopy (VFS), fiberoptic endoscopic evaluation of swallowing (FEES) and oro-pharyngeal-oesophageal scintigraphy (OPES) at baseline and at 1 month after radiotherapy. Dysphagia parameter scores were calculated at each exam after liquid (L) and semi-liquid (SL) bolus intake: pre-deglutition penetration, aspiration, pharyngeal transit time (PTT) and hypopharyngeal retention index (HPRI). Overall, 20 patients (6 nasophaynx and 14 oropharynx) completed treatment and instrumental assessment after 1 month. Comparison between pre- and post-treatment HPRI score values showed a significant worsening in both FEES-L (p = 0.021) and SL (p = 0.02) and at VFS-L (p = 0.008) and SL (p = 0.005). Moreover, a relationship between HPRI worsening at FEES-L and FEES-SL (p = 0.005) as well as at VFS-L and VFS-SL (p < 0.001) was observed. PTT was not significantly affected by radiotherapy (p > 0.2). Only a few patients experienced pre-deglutition penetration (1 patient with base of tongue cancer at FEES-L and SL) and aspiration (1 patient with nasopharynx cancer at OPES-L and FEES-SL) after radiotherapy. Our early results showed that IMRT-SWOARs sparing caused a significant increase in the post-deglutition HPRI score. Longer follow-up will be necessary to evaluate if the increase of HPRI is related to a high risk of developing late aspiration.
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Affiliation(s)
- S Ursino
- Department of Radiation Oncology, University Hospital S. Chiara, Pisa, Italy
| | - V Seccia
- First Otorhinolaryngology Unit, University Hospital Cisanello, Pisa, Italy
| | - P Cocuzza
- Department of Radiation Oncology, University Hospital S. Chiara, Pisa, Italy
| | - P Ferrazza
- Department of Radiation Oncology, University Hospital S. Chiara, Pisa, Italy
| | - T Briganti
- First Otorhinolaryngology Unit, University Hospital Cisanello, Pisa, Italy
| | - F Matteucci
- Department of Radiation Oncology, University Hospital S. Chiara, Pisa, Italy
| | - L Fatigante
- Department of Radiation Oncology, University Hospital S. Chiara, Pisa, Italy
| | - P Giusti
- Department of Radiology, University Hospital Cisanello, Pisa, Italy
| | - M Grosso
- Department of Nuclear Medicine, University Hospital S. Chiara, Pisa,Italy
| | - L Locantore
- Department of Nuclear Medicine, University Hospital S. Chiara, Pisa,Italy
| | - R Morganti
- Biostatistical Consulting, Department of Oncology, University Hospital S.Chiara, Pisa, Italy
| | - A Nacci
- Otorhinolaryngology-Audiology-Phoniatric Unit, University Hospital Cisanello, Pisa, Italy
| | | | - F Paiar
- Department of Radiation Oncology, University Hospital S. Chiara, Pisa, Italy
| | - D Caramella
- Department of Radiology, University Hospital Cisanello, Pisa, Italy
| | - B Fattori
- Otorhinolaryngology-Audiology-Phoniatric Unit, University Hospital Cisanello, Pisa, Italy
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26
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Groher ME, Puntil-Sheltman J. Dysphagia Unplugged. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Murono S, Hamaguchi T, Yoshida H, Nakanishi Y, Tsuji A, Endo K, Kondo S, Wakisaka N, Yamada M, Yoshizaki T. Evaluation of dysphagia at the initial diagnosis of amyotrophic lateral sclerosis. Auris Nasus Larynx 2015; 42:213-7. [DOI: 10.1016/j.anl.2014.10.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 10/23/2014] [Accepted: 10/24/2014] [Indexed: 12/12/2022]
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28
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Vrijsen B, Buyse B, Belge C, Robberecht W, Van Damme P, Decramer M, Testelmans D. Noninvasive ventilation improves sleep in amyotrophic lateral sclerosis: a prospective polysomnographic study. J Clin Sleep Med 2015; 11:559-66. [PMID: 25766713 DOI: 10.5664/jcsm.4704] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/26/2015] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVE To evaluate the effects of noninvasive ventilation (NIV) on sleep in patients with amyotrophic lateral sclerosis (ALS) after meticulous titration with polysomnography (PSG). METHODS In this prospective observational study, 24 ALS patients were admitted to the sleep laboratory during 4 nights for in-hospital NIV titration with PSG and nocturnal capnography. Questionnaires were used to assess subjective sleep quality and quality of life (QoL). Patients were readmitted after one month. RESULTS In the total group, slow wave sleep and REM sleep increased and the arousal-awakening index improved. The group without bulbar involvement (non-bulbar) showed the same improvements, together with an increase in sleep efficiency. Nocturnal oxygen and carbon dioxide levels improved in the total and non-bulbar group. Except for oxygen saturation during REM sleep, no improvement in respiratory function or sleep structure was found in bulbar patients. However, these patients showed less room for improvement. Patient-reported outcomes showed improvement in sleep quality and QoL for the total and non-bulbar group, while bulbar patients only reported improvements in very few subscores. CONCLUSIONS This study shows an improvement of sleep architecture, carbon dioxide, and nocturnal oxygen saturation at the end of NIV titration and after one month of NIV in ALS patients. More studies are needed to identify the appropriate time to start NIV in bulbar patients. Our results suggest that accurate titration of NIV by PSG improves sleep quality. COMMENTARY A commentary on this article appears in this issue on page 511.
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Affiliation(s)
- Bart Vrijsen
- Leuven University Centre for Sleep/Wake Disorders, Department of Pulmonology, University Hospitals Leuven, Belgium.,Department of Pulmonology, University of Leuven, Belgium
| | - Bertien Buyse
- Leuven University Centre for Sleep/Wake Disorders, Department of Pulmonology, University Hospitals Leuven, Belgium.,Department of Pulmonology, University of Leuven, Belgium
| | - Catharina Belge
- Leuven University Centre for Sleep/Wake Disorders, Department of Pulmonology, University Hospitals Leuven, Belgium.,Department of Pulmonology, University of Leuven, Belgium
| | - Wim Robberecht
- Department of Neurology, University of Leuven, Belgium.,Experimental Neurology (Department of Neurosciences) and Leuven Research Institute for Neuroscience and Disease (LIND), University of Leuven (KU Leuven), Belgium
| | - Philip Van Damme
- Department of Neurology, University of Leuven, Belgium.,Experimental Neurology (Department of Neurosciences) and Leuven Research Institute for Neuroscience and Disease (LIND), University of Leuven (KU Leuven), Belgium.,Laboratory of Neurobiology, Vesalius Research Center, VIB, Leuven, Belgium
| | - Marc Decramer
- Department of Pulmonology, University of Leuven, Belgium
| | - Dries Testelmans
- Leuven University Centre for Sleep/Wake Disorders, Department of Pulmonology, University Hospitals Leuven, Belgium.,Department of Pulmonology, University of Leuven, Belgiumd
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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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Rassameehiran S, Klomjit S, Mankongpaisarnrung C, Rakvit A. Postextubation Dysphagia. Proc (Bayl Univ Med Cent) 2015; 28:18-20. [PMID: 25552788 DOI: 10.1080/08998280.2015.11929174] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Postextubation dysphagia (PED) is a common problem in critically ill patients with recent intubation. Although several risk factors have been identified, most of them are nonmodifiable preexisting or concurrent conditions. Early extubation, small endotracheal tube size, and small bore of nasogastric tube potentially decrease the risk of PED. The majority of patients receive treatment based on only bedside swallow evaluations, which has an uncertain diagnostic accuracy as opposed to gold standard instrumental tests. Therefore, the treatment decision for patients may not be appropriately directed for each individual. Current treatments are mainly focused on dietary modifications and postural changes/compensatory maneuvers rather than interventions, but recent studies have shown limited proven benefits. Direct therapies in oromotor control, such as therapeutic exercises and neuromuscular stimulations, should be considered as potential effective treatments.
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Affiliation(s)
- Supannee Rassameehiran
- Department of Internal Medicine (Rassameehiran, Klomjit, Mankongpaisarnrung) and Division of Gastroenterology (Rakvit), Texas Tech University Health Science Center, Lubbock, Texas
| | - Saranapoom Klomjit
- Department of Internal Medicine (Rassameehiran, Klomjit, Mankongpaisarnrung) and Division of Gastroenterology (Rakvit), Texas Tech University Health Science Center, Lubbock, Texas
| | - Charoen Mankongpaisarnrung
- Department of Internal Medicine (Rassameehiran, Klomjit, Mankongpaisarnrung) and Division of Gastroenterology (Rakvit), Texas Tech University Health Science Center, Lubbock, Texas
| | - Ariwan Rakvit
- Department of Internal Medicine (Rassameehiran, Klomjit, Mankongpaisarnrung) and Division of Gastroenterology (Rakvit), Texas Tech University Health Science Center, Lubbock, Texas
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Luchesi KF, Kitamura S, Mourão LF. Management of dysphagia in Parkinson's disease and amyotrophic lateral sclerosis. Codas 2014; 25:358-64. [PMID: 24408486 DOI: 10.1590/s2317-17822013000400010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 09/05/2013] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To describe swallowing management in patients with amyotrophic lateral sclerosis (ALS) and Parkinson' disease (PD), to investigate whether physiopathology determines the choice of therapeutic approaches, and to investigate whether the disease duration modifies the therapeutic approaches. METHODS This is a long-term study comprising 24 patients with idiopathic PD and 27 patients with ALS. The patients were followed-up in a dysphagia outpatient clinic between 2006 and 2011. The patients underwent clinic evaluation and Fiberoptic Endoscopic Evaluation of Swallowing, Functional Oral Intake Scale, and therapeutic intervention every 3 months. The swallowing management was based on orientation about the adequate food consistency and volume, besides the necessary maneuvers or exercises to improve swallowing functionality. An exploratory analysis of data was used to investigate associations between the groups of disease (PD or ALS) and clinic aspects and to know about the association between the groups of diseases and the application of maneuver or exercises over the follow-up. RESULTS The most frequent recommended maneuvers in PD were bolus effect (83.3%), bolus consistency (79.2%), and swallowing frequency (79%). To patients with ALS, the bolus consistency (92%) and the bolus effect (74.1%) were more recommended. Strengthening-tongue (p=0.01), tongue control (p=0.05), and vocal exercises (p<0.001) were significantly more recommended in PD than in ALS. CONCLUSION Compensatory and sensorial maneuvers are more recommended to rehabilitee program in both diseases. The physiopathology of the diseases determined the choice of therapeutic approaches. The disease duration of the patients did not interfere directly in the therapeutic approaches.
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Luchesi KF, Kitamura S, Mourão LF. Higher risk of complications in odynophagia-associated dysphagia in amyotrophic lateral sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:203-7. [DOI: 10.1590/0004-282x20130244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 11/22/2013] [Indexed: 12/13/2022]
Abstract
Objective This investigation aimed to identify associated factors with dysphagia severity in amyotrophic lateral sclerosis (ALS). Method We performed a cross-sectional study of 49 patients with ALS. All patients underwent fiberoptic endoscopy evaluation of swallowing and answered a verbal questionnaire about swallowing complaints. The patients were divided into groups according to dysphagia severity. Results Among the factors analyzed, only odynophagia was associated with moderate or severe dysphagia. Conclusion Odynophagia was associated with moderate and severe dysphagia in ALS and suggests a high risk of pulmonary and nutritional complications.
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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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The Value of Pharyngeal Scintigraphy in Predicting Videofluoroscopic Findings. Am J Phys Med Rehabil 2013; 92:1075-83. [DOI: 10.1097/phm.0b013e31829e77e3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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D'Ottaviano FG, Linhares Filho TA, Andrade HMTD, Alves PCL, Rocha MSG. Fiberoptic endoscopy evaluation of swallowing in patients with amyotrophic lateral sclerosis. Braz J Otorhinolaryngol 2013; 79:349-53. [PMID: 23743751 PMCID: PMC9443862 DOI: 10.5935/1808-8694.20130061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 03/04/2013] [Indexed: 12/14/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive degenerative motor neuron disease that adversely affects the muscles responsible for swallowing. Objective To assess the oral preparatory, oral transit and pharyngeal phases of swallowing in ALS patients through endoscopic evaluation. Method This cross-sectional historical cohort study included ALS patients submitted to endoscopic examination. Eleven patients (six males and five females; mean age of 61.7 years) were enrolled in the study from january to december of 2011. Results All patients had alterations in phases of the swallowing process, but only 72.7% complained of dysphagia. The oral preparatory phase was altered in 63.6% of the subjects; the oral transit and pharyngeal phases were altered in all studied individuals, regardless of food consistency. Laryngeal penetration or tracheal aspiration were seen in 90.9% of the patients during the pharyngeal phase while they were swallowing fluids. Conclusion Even in the absence of complaints, dysphagia is a frequent comorbidity in ALS patients. The oral transit and pharyngeal phases were the most frequently affected. Laryngeal penetration or tracheal aspiration occurred more frequently during the pharyngeal phase while patients were swallowing fluids.
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Walterfang M, Chien YH, Imrie J, Rushton D, Schubiger D, Patterson MC. Dysphagia as a risk factor for mortality in Niemann-Pick disease type C: systematic literature review and evidence from studies with miglustat. Orphanet J Rare Dis 2012; 7:76. [PMID: 23039766 PMCID: PMC3552828 DOI: 10.1186/1750-1172-7-76] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 09/24/2012] [Indexed: 02/06/2023] Open
Abstract
Niemann-Pick disease type C (NP-C) is a rare neurovisceral disease characterised by progressive neurological deterioration and premature death, and has an estimated birth incidence of 1:120,000. Mutations in the NPC1 gene (in 95% of cases) and the NPC2 gene (in approximately 4% of cases) give rise to impaired intracellular lipid metabolism in a number of tissues, including the brain. Typical neurological manifestations include vertical supranuclear gaze palsy, saccadic eye movement abnormalities, cerebellar ataxia, dystonia, dysmetria, dysphagia and dysarthria. Oropharyngeal dysphagia can be particularly problematic as it can often lead to food or fluid aspiration and subsequent pneumonia. Epidemiological data suggest that bronchopneumonia subsequent to food or fluid aspiration is a major cause of mortality in NP-C and other neurodegenerative disorders. These findings indicate that a therapy capable of improving or stabilising swallowing function might reduce the risk of aspiration pneumonia, and could have a positive impact on patient survival. Miglustat, currently the only approved disease-specific therapy for NP-C in children and adults, has been shown to stabilise key neurological manifestations in NP-C, including dysphagia. In this article we present findings from a systematic literature review of published data on bronchopneumonia/aspiration pneumonia as a cause of death, and on the occurrence of dysphagia in NP-C and other neurodegenerative diseases. We then examine the potential links between dysphagia, aspiration, pneumonia and mortality with a view to assessing the possible effect of miglustat on patient lifespan.
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Affiliation(s)
- Mark Walterfang
- Royal Melbourne Hospital and Melbourne Neuropsychiatry Centre, Melbourne 3050, Australia
| | - Yin-Hsiu Chien
- Departments of Paediatrics and Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Derren Rushton
- Actelion Pharmaceuticals Pty Ltd, New South Wales, Australia
| | - Danielle Schubiger
- Royal Melbourne Hospital and Melbourne Neuropsychiatry Centre, Melbourne 3050, Australia
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Silva LBDC, Mourão LF, Silva AA, Lima NMFV, Almeida SR, Franca Jr MC, Nucci A, Amaya-Farfán J. Amyotrophic lateral sclerosis: combined nutritional, respiratory and functional assessment. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 66:354-9. [DOI: 10.1590/s0004-282x2008000300014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 04/23/2008] [Indexed: 12/14/2022]
Abstract
OBJECTIVE: To establish correlations between nutritional, functional and respiratory indices of patients with amyotrophic lateral sclerosis (ALS). METHOD: Twenty patients (13 appendicular - GA and 7 bulbar - GB) were included in the multidisciplinary study at the Neurological Clinic Ambulatory of the University of Campinas Hospital. RESULTS: Among the GA type significant correlation was observed between maximal inspiratory (MIP) and expiratory (MEP) pressure (r= -0.76), MEP and pulse oxymetry (r=0.58), MIP and percent weight loss (%WL; r=0.59), and between MIP, total and subscale respiratory scores (ALSFRS-R) with %WL. With regard to the GB, correlation was found between MEP and body mass index (BMI) (r=0.97). In both GA and GB correlations were noticed between the BMI and the variables mass (kg), fat (%), arm and wrist circumference (cm), and tricipital, subscapular and supra-iliac skinfolds (mm), as well as the arm muscle circumference (cm) and fatty arm muscular area (mm²). CONCLUSION: It is suggested that the application of simple anthropometric measurements could be useful in routine monitoring of patients with ALS.
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