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Rodrigues CDS, Souza RKS, Rocha Neto CV, Otani RH, Batista DDM, Maia AKNDO, Filho KPDO, de Andrade TD, de Andrade Almeida E, Maciel LHG, Castro LDFAAP, Abtibol-Bernardino MR, Baia-da-Silva DC, Benzecry SG, Castilho MDC, Martínez-Espinosa FE, Alecrim MDGC, Santos RS, Botto-Menezes C. Clinical and Acoustic Alterations of Swallowing in Children Exposed to Zika Virus during Pregnancy in a Cohort in Amazonas, Brazil: A Case Series Study. Viruses 2023; 15:2363. [PMID: 38140604 PMCID: PMC10747239 DOI: 10.3390/v15122363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 12/24/2023] Open
Abstract
Oropharyngeal dysphagia (OD) is a swallowing disorder that involves difficulty in safely passing the food bolus from the oral cavity to the stomach. OD is a common problem in children with congenital Zika virus syndrome (CZS). In this case series, we describe the clinical and acoustic alterations of swallowing in children exposed to the Zika virus during pregnancy in a cohort from Amazonas, Brazil. From July 2019 to January 2020, 22 children were evaluated, 6 with microcephaly and 16 without microcephaly. The mean age among the participants was 35 months (±4.6 months). All children with microcephaly had alterations in oral motricity, mainly in the lips and cheeks. Other alterations were in vocal quality, hard palate, and soft palate. Half of the children with microcephaly showed changes in cervical auscultation during breast milk swallowing. In children without microcephaly, the most frequently observed alteration was in lip motricity, but alterations in auscultation during the swallowing of breast milk were not observed. Regarding swallowing food of a liquid and pasty consistency, the most frequent alterations were incomplete verbal closure, increased oral transit time, inadequacy in capturing the spoon, anterior labial leakage, and increased oral transit time. Although these events are more frequent in microcephalic children, they can also be seen in non-microcephalic children, which points to the need for an indistinct evaluation of children exposed in utero to ZIKV.
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Affiliation(s)
- Cristina de Souza Rodrigues
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
| | | | - Cosmo Vieira Rocha Neto
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | - Rodrigo Haruo Otani
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | - Daniel de Medeiros Batista
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | - Ana Karla Nelson de Oliveira Maia
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | | | | | | | - Luiz Henrique Gonçalves Maciel
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
| | | | - Marília Rosa Abtibol-Bernardino
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- Department of Maternal and Child Health, Medical School, Federal University of Amazonas, Manaus 69020-160, Brazil
| | - Djane Clarys Baia-da-Silva
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
- Faculty of Pharmacy, University Nilton Lins, Manaus 69058-030, Brazil; (K.P.d.O.F.); (T.D.d.A.)
- Leônidas & Maria Deane Institute, Fiocruz Amazonia, Manaus 69057-070, Brazil
| | - Silvana Gomes Benzecry
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | | | - Flor Ernestina Martínez-Espinosa
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- Leônidas & Maria Deane Institute, Fiocruz Amazonia, Manaus 69057-070, Brazil
- Tropical Medicine Foundation Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil;
| | - Maria das Graças Costa Alecrim
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- Medical Course Coordination at Manaus Metropolitan College/FAMETRO, Manaus 69050-000, Brazil
| | - Rosane Sampaio Santos
- Postgraduate Program in Communication Disorders (PPGDIC), University of Tuiuti do Paraná (UTP), Paraná 82010-210, Brazil;
| | - Camila Botto-Menezes
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
- Tropical Medicine Foundation Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil;
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Lotta S, Lisa B. Congenital or Early Developing Neuromuscular Diseases Affecting Feeding, Swallowing and Speech – A Review of the Literature from January 1998 to August 2021. J Neuromuscul Dis 2022; 9:581-596. [PMID: 35848032 PMCID: PMC9535595 DOI: 10.3233/jnd-210772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The knowledge about the impact of oral motor impairment in neuromuscular diseases (NMDs) is limited but increasing. Objective: The aim of this review was to collect and compile knowledge on how muscle weakness in congenital or early developing NMDs directly or indirectly affects feeding, swallowing, speech and saliva control. Methods: A literature search was performed in PubMed from January 1, 1998, to August 31, 2021. The keywords “feeding”, “dysphagia”, “swallowing”, “dysarthria”, “speech”, “drooling” and “sialorrhea” were used in combination with “paediatric neuromuscular disease” or specific diagnoses. Results: Sixty-five studies were selected for the review, 33 focused on feeding and swallowing, 11 on speech, four on a combination of feeding, swallowing, saliva control or speech and 17 general descriptions. Most of the studies reported on patients with a disorder affecting muscles. These studies show that muscle weakness and impaired motility affecting the muscles innervated by the cranial nerves may influence feeding, swallowing, and speech, and that respiratory function, general health and neurodevelopmental delay also influence these functions. Feeding impairment and breathing difficulties are common in NMDs. Lifesaving interventions such as tube feeding and ventilatory support are common in severe cases. Conclusions: Feeding impairment, dysphagia and dysarthria are prevalent in NMDs with congenital or early age of onset. Feeding and swallowing has been studied more than speech and saliva control. More children with NMD survive thanks to new treatment options and it is therefore urgent to follow up how these therapies may impact the development of feeding, swallowing, and speech.
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Affiliation(s)
- Sjögreen Lotta
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Medicinaregatan, Gothenburg, Sweden
| | - Bengtsson Lisa
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Medicinaregatan, Gothenburg, Sweden
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Kambayashi T, Hirano-Kawamoto A, Takahashi T, Taniguchi S, Yoshioka M, Tanaka H, Oizumi H, Totsune T, Oshiro S, Baba T, Takeda A, Hisaoka T, Ohta J, Ikeda R, Suzuki J, Kato K, Katori Y. The characteristics of dysphagia and the incidence of pneumonia in Myotonic dystrophy type 1 patients especially concerning swallowing function evaluated by endoscopy. Auris Nasus Larynx 2022; 49:1003-1008. [DOI: 10.1016/j.anl.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/10/2022] [Accepted: 04/04/2022] [Indexed: 11/26/2022]
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Audag N, Liistro G, Goubau C, Vandervelde L, Poncin W, Toussaint M, Van den Bergh P, Reychler G. Screening for oropharyngeal dysphagia in adult patients with neuromuscular diseases using the Sydney Swallow Questionnaire. Muscle Nerve 2021; 64:277-284. [PMID: 33890683 DOI: 10.1002/mus.27254] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION/AIMS Oropharyngeal dysphagia is common in patients with neuromuscular diseases (NMDs). Its early recognition is vital for proper management. We tested a large cohort of adult NMD patients for oropharyngeal dysphagia using the Sydney Swallow Questionnaire (SSQ). We also looked for possible differences in characteristics of oropharyngeal dysphagia in various NMD groups and diseases. Finally, we compared results of this screening with those from their corresponding medical records for eventual "clinical history" of dysphagia. METHODS We asked patients to fill in the SSQ during follow-up outpatient visits at our neuromuscular reference center. A total score above the cutoff score of 118.5 out of 1700 was indicative of oropharyngeal dysphagia. RESULTS Of the 304 adult patients assessed for eligibility, 201 NMD patients (96 women and 105 men, aged 49.0 ± 16.2 years) were included and tested in this study. Oropharyngeal dysphagia was detected in 45% of all the NMD patients when using the SSQ, whereas only 12% had a positive medical record for dysphagia. The median SSQ scores for patients with myotonic syndromes (including myotonic dystrophy type 1), with amyotrophic lateral sclerosis, and with facioscapulohumeral dystrophy were above the cutoff score. The SSQ scores obtained revealed distinct oropharyngeal dysphagia characteristics in the different NMD groups and diseases. DISCUSSION The SSQ tests positively for oropharyngeal dysphagia in a higher proportion of NMD patients compared with their medical records. The distinct oropharyngeal dysphagia characteristics we revealed in different NMD groups and diseases may help to elaborate adapted clinical approaches in the management of oropharyngeal dysphagia.
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Affiliation(s)
- Nicolas Audag
- Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, ORL & Dermatologie, Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium.,Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Haute École Léonard de Vinci, Parnasse-ISEI, Brussels, Belgium
| | - Giuseppe Liistro
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Christophe Goubau
- Unité de Pneumologie pédiatrique, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Centre de Référence Neuromusculaire, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | - William Poncin
- Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, ORL & Dermatologie, Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium.,Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | - Peter Van den Bergh
- Centre de Référence Neuromusculaire, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, ORL & Dermatologie, Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium.,Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Haute École Léonard de Vinci, Parnasse-ISEI, Brussels, Belgium
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Argov Z, de Visser M. Dysphagia in adult myopathies. Neuromuscul Disord 2020; 31:5-20. [PMID: 33334661 DOI: 10.1016/j.nmd.2020.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
Dysphagia (impaired swallowing) is not a rare problem in various neuromuscular disorders, both in the pediatric and the adult patient population. On many occasions such patients are first presented to other medical specialists or health professionals. Disorders of deglutition are probably underrecognized in patients with a neuromuscular disease as a result of patient's and doctor's delay. This review will focus on dysphagia in adults suffering from a myopathy. Dysphagia in myopathies usually affects the oropharyngeal phases which rely mostly on voluntary muscle activity of the mouth, pharynx and upper esophageal sphincter. Dysphagia is known to contribute to a reduction of quality of life and may also lead to increased morbidity and mortality. The review includes an overview on symptomatology and tools of assessments, and elaborates on dysphagia in specific hereditary and acquired myopathies.
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Affiliation(s)
- Zohar Argov
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands.
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Gutiérrez Gutiérrez G, Díaz-Manera J, Almendrote M, Azriel S, Eulalio Bárcena J, Cabezudo García P, Camacho Salas A, Casanova Rodríguez C, Cobo A, Díaz Guardiola P, Fernández-Torrón R, Gallano Petit M, García Pavía P, Gómez Gallego M, Gutiérrez Martínez A, Jericó I, Kapetanovic García S, López de Munaín Arregui A, Martorell L, Morís de la Tassa G, Moreno Zabaleta R, Muñoz-Blanco J, Olivar Roldán J, Pascual Pascual S, Peinado Peinado R, Pérez H, Poza Aldea J, Rabasa M, Ramos A, Rosado Bartolomé A, Rubio Pérez M, Urtizberea J, Zapata-Wainberg G, Gutiérrez-Rivas E. Guía clínica para el diagnóstico y seguimiento de la distrofia miotónica tipo 1, DM1 o enfermedad de Steinert. Neurologia 2020; 35:185-206. [DOI: 10.1016/j.nrl.2019.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/05/2019] [Indexed: 01/18/2023] Open
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Gutiérrez Gutiérrez G, Díaz-Manera J, Almendrote M, Azriel S, Eulalio Bárcena J, Cabezudo García P, Camacho Salas A, Casanova Rodríguez C, Cobo A, Díaz Guardiola P, Fernández-Torrón R, Gallano Petit M, García Pavía P, Gómez Gallego M, Gutiérrez Martínez A, Jericó I, Kapetanovic García S, López de Munaín Arregui A, Martorell L, Morís de la Tassa G, Moreno Zabaleta R, Muñoz-Blanco J, Olivar Roldán J, Pascual Pascual S, Peinado Peinado R, Pérez H, Poza Aldea J, Rabasa M, Ramos A, Rosado Bartolomé A, Rubio Pérez M, Urtizberea J, Zapata-Wainberg G, Gutiérrez-Rivas E. Clinical guide for the diagnosis and follow-up of myotonic dystrophy type 1, MD1 or Steinert's disease. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kitsis EA, Napier F, Juthani V, Geyer HL. Association of Sjögren's syndrome with myotonic dystrophy type 1. BMJ Case Rep 2019; 12:12/8/e229611. [PMID: 31466972 DOI: 10.1136/bcr-2019-229611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 47-year-old woman presented with sicca symptoms, polyarthralgias, polymyalgias and dysphagia. She was found to have positive antinuclear, anti-SSA-Ro and anti-SSB-La antibodies. Slit lamp exam confirmed the presence of keratoconjunctivitis sicca, and the patient was diagnosed with Sjögren's syndrome. Three years later, she was referred for evaluation of gait instability associated with recent falls. On physical examination, the patient was found to have bilateral ptosis, percussion myotonia, distal upper and lower extremity weakness, and a steppage gait. Electromyography demonstrated electrical myotonia. Genetic testing revealed expanded CTG repeats (733 and 533) in the myotonic dystrophy type 1 (DM1) protein kinase gene, confirming the diagnosis of DM1. Dysphagia, pain and eye discomfort may occur in both Sjögren's syndrome and DM1, and in this case, may have delayed the diagnosis of muscular dystrophy.
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Affiliation(s)
- Elizabeth A Kitsis
- Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.,Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Fabreena Napier
- Neurology, Albert Einstein College of Medicine, Bronx, New York, USA.,Neurology, Jacobi Medical Center, Bronx, USA
| | - Viral Juthani
- Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Bronx, New York, USA.,Ophthalmology, Montefiore Medical Center, Bronx, New York, USA
| | - Howard L Geyer
- Neurology, Albert Einstein College of Medicine, Bronx, New York, USA.,Neurology, Montefiore Medical Center, Bronx, NY, USA
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Guía clínica para el diagnóstico y seguimiento de la distrofia miotónica tipo 1, DM1 o enfermedad de Steinert. Med Clin (Barc) 2019; 153:82.e1-82.e17. [DOI: 10.1016/j.medcli.2018.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 01/19/2023]
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10
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Franco-Guerrero AA, Márquez-Quiroz LC, Valadéz-Jiménez VM, Cortés H, Murillo-Melo NM, Muñoz B, Cisneros B, Magaña JJ. Oropharyngeal dysphagia in early stages of myotonic dystrophy type 1. Muscle Nerve 2019; 60:90-95. [PMID: 30994189 DOI: 10.1002/mus.26485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 04/08/2019] [Accepted: 04/12/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Myotonic dystrophy type 1 (DM1) is a multisystemic disorder characterized mainly by skeletal muscle alterations. Although oropharyngeal dysphagia is a prominent clinical feature of DM1, it remains poorly studied in its early disease stages. METHODS Dysphagia was investigated in 11 presymptomatic DM1 carriers, 14 patients with DM1 and 12 age-matched healthy controls, by using fiberoptic endoscopic evaluation of swallowing (FEES) and clinical scores. RESULTS Scores for the FEES variables, delayed pharyngeal reflex, posterior pooling, and postswallow residue were significantly greater in patients with DM1 and in presymptomatic DM1 carriers than in healthy controls (P < 0.05); oropharyngeal dysfunction was more severe in patients than in presymptomatic carriers. Penetration/aspiration was found altered exclusively in patients with DM1 (P < 0.05). DISCUSSION Swallowing dysfunction occurs in presymptomatic DM1 carriers. Timely diagnosis of dysphagia in preclinical stages of the disease will aid in the timely management of presymptomatic carriers, potentially preventing medical complications. Muscle Nerve, 2019.
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Affiliation(s)
| | - Luz C Márquez-Quiroz
- Department of Genetics and Molecular Biology, CINVESTAV-IPN, Mexico City, Mexico.,Departamento de Genética, Instituto Nacional de Rehabilitación, Calz. México-Xochimilco No. 289, Col. Arenal Guadalupe, 14389 Ciudad de México (CDMX), México
| | | | - Hernán Cortés
- Departamento de Genética, Instituto Nacional de Rehabilitación, Calz. México-Xochimilco No. 289, Col. Arenal Guadalupe, 14389 Ciudad de México (CDMX), México
| | - Nadia M Murillo-Melo
- Departamento de Genética, Instituto Nacional de Rehabilitación, Calz. México-Xochimilco No. 289, Col. Arenal Guadalupe, 14389 Ciudad de México (CDMX), México.,Biomedical Sciences Program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Balam Muñoz
- Department of Bioengineering, School of Engineering and Sciences, Tecnológico de Monterrey, Mexico City, Mexico
| | - Bulmaro Cisneros
- Department of Genetics and Molecular Biology, CINVESTAV-IPN, Mexico City, Mexico
| | - Jonathan J Magaña
- Departamento de Genética, Instituto Nacional de Rehabilitación, Calz. México-Xochimilco No. 289, Col. Arenal Guadalupe, 14389 Ciudad de México (CDMX), México
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Affiliation(s)
- Garth W Strohbehn
- From the Department of Veterans Affairs (VA) Health Services Internal Medicine Service (G.W.S., S.S.), the Departments of Internal Medicine (G.W.S., S.S.) and Neurology (H.P.), and the Audiology and Speech-Language Pathology Service (J.M.), University of Michigan Medical School, and the Ann Arbor VA Health Services Research and Development Center of Excellence (S.S.) - all in Ann Arbor; and the Medical Service, San Francisco VA Medical Center, and the Department of Medicine, University of California, San Francisco - both in San Francisco (G.D.)
| | - Gurpreet Dhaliwal
- From the Department of Veterans Affairs (VA) Health Services Internal Medicine Service (G.W.S., S.S.), the Departments of Internal Medicine (G.W.S., S.S.) and Neurology (H.P.), and the Audiology and Speech-Language Pathology Service (J.M.), University of Michigan Medical School, and the Ann Arbor VA Health Services Research and Development Center of Excellence (S.S.) - all in Ann Arbor; and the Medical Service, San Francisco VA Medical Center, and the Department of Medicine, University of California, San Francisco - both in San Francisco (G.D.)
| | - Henry Paulson
- From the Department of Veterans Affairs (VA) Health Services Internal Medicine Service (G.W.S., S.S.), the Departments of Internal Medicine (G.W.S., S.S.) and Neurology (H.P.), and the Audiology and Speech-Language Pathology Service (J.M.), University of Michigan Medical School, and the Ann Arbor VA Health Services Research and Development Center of Excellence (S.S.) - all in Ann Arbor; and the Medical Service, San Francisco VA Medical Center, and the Department of Medicine, University of California, San Francisco - both in San Francisco (G.D.)
| | - Joseph Murray
- From the Department of Veterans Affairs (VA) Health Services Internal Medicine Service (G.W.S., S.S.), the Departments of Internal Medicine (G.W.S., S.S.) and Neurology (H.P.), and the Audiology and Speech-Language Pathology Service (J.M.), University of Michigan Medical School, and the Ann Arbor VA Health Services Research and Development Center of Excellence (S.S.) - all in Ann Arbor; and the Medical Service, San Francisco VA Medical Center, and the Department of Medicine, University of California, San Francisco - both in San Francisco (G.D.)
| | - Sanjay Saint
- From the Department of Veterans Affairs (VA) Health Services Internal Medicine Service (G.W.S., S.S.), the Departments of Internal Medicine (G.W.S., S.S.) and Neurology (H.P.), and the Audiology and Speech-Language Pathology Service (J.M.), University of Michigan Medical School, and the Ann Arbor VA Health Services Research and Development Center of Excellence (S.S.) - all in Ann Arbor; and the Medical Service, San Francisco VA Medical Center, and the Department of Medicine, University of California, San Francisco - both in San Francisco (G.D.)
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Souza GADD, Gozzer MM, Cola PC, Onofri SMM, Gonçalves da Silva R. Desempenho longitudinal da deglutição orofaríngea na distrofia miotônica tipo 1. ACTA ACUST UNITED AC 2019. [DOI: 10.1590/2317-6431-2018-2114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
RESUMO Este estudo teve por objetivo descrever o desempenho longitudinal da deglutição orofaríngea em indivíduo com distrofia miotônica tipo 1. Estudo de caso único de indivíduo de 66 anos, sexo masculino, com diagnóstico neurológico em 2010. Realizou a primeira avaliação clínica e objetiva da deglutição após quatro anos do diagnóstico neurológico. Foram realizadas sete avaliações objetivas da deglutição, por meio de videoendoscopia de deglutição, nas consistências pastosa, líquida espessada e líquida, com 3, 5, 10 ml, durante o processo de diagnóstico e gerenciamento da deglutição, por um ano e dois meses. Foram analisados sensibilidade laríngea, escape oral posterior, resíduos faríngeos, por meio da Yale Pharyngeal Residue Severity Rating Scale, penetração laríngea e/ou aspiração laringotraqueal, com aplicação da Penetration-Aspiration Scale (PAS). Constatou-se, durante o período de estudo, que não houve alteração na sensibilidade laríngea. Escape oral posterior, resíduos faríngeos e penetração laríngea estiveram presentes desde o início das avaliações objetivas. Após quatro meses da primeira avaliação, na consistência pastosa, o nível de resíduos faríngeos passou de vestígio residual para moderado, em recessos piriformes, já em valéculas, e o aumento no índice da gravidade evidenciou-se no último mês. Houve aumento na PAS em todas as consistências de alimento testadas. A presença de aspiração laringotraqueal ocorreu com líquido ralo, no último mês. Durante o período de acompanhamento da deglutição orofaríngea na distrofia miotônica tipo 1, os resíduos faríngeos e a penetração laríngea estiveram presentes desde o início das avaliações, porém, a aspiração laringotraqueal somente ocorreu no último mês do acompanhamento, com líquido ralo.
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Affiliation(s)
| | | | - Paula Cristina Cola
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brasil; Universidade de Marília, Brasil
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Hilbert JE, Thornton CA, Moxley RT. Author response: High frequency of gastrointestinal manifestations in myotonic dystrophy type 1 and type 2. Neurology 2018; 90:814. [DOI: 10.1212/wnl.0000000000005370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hilbert JE, Barohn RJ, Clemens PR, Luebbe EA, Martens WB, McDermott MP, Parkhill AL, Tawil R, Thornton CA, Moxley RT. High frequency of gastrointestinal manifestations in myotonic dystrophy type 1 and type 2. Neurology 2017; 89:1348-1354. [PMID: 28855409 PMCID: PMC5649763 DOI: 10.1212/wnl.0000000000004420] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/07/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To analyze gastrointestinal (GI) manifestations, their progression over time, and medications being used to treat GI symptoms in a large cohort of patients with myotonic dystrophy types 1 (DM1) and 2 (DM2). METHODS We analyzed patient-reported data and medical records in a national registry cohort at baseline and 5 years. RESULTS At baseline, the majority of patients reported trouble swallowing in DM1 (55%; n = 499 of 913) and constipation in DM2 (53%; n = 96 of 180). Cholecystectomy occurred in 16.5% of patients with DM1 and 12.8% of patients with DM2, on average before 45 years of age. The use of medications indicated for gastroesophageal reflux disease was reported by 22.5% of DM1 and 18.9% of patients with DM2. Greater risk of a GI manifestation was associated with higher body mass index and longer disease duration in DM1 and female sex in DM2. At the 5-year follow-up, the most common new manifestations were trouble swallowing in patients with DM1 and constipation in patients with DM2. CONCLUSIONS GI manifestations were common in both DM1 and DM2, with a relatively high frequency of gallbladder removal in DM1 and DM2 occurring at a younger age compared to normative data in the literature. Studies are needed to determine the pathomechanism of how sex, weight gain, and duration of disease contribute to GI manifestations and how these manifestations affect quality of life and clinical care for patients with DM1 and DM2.
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Affiliation(s)
- James E Hilbert
- From the Departments of Neurology (J.E.H., E.A.L., W.B.M., M.P.M., R.T., C.A.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), University of Rochester Medical Center, NY; Department of Neurology (R.J.B.), University of Kansas Medical Center, Kansas City; Department of Neurology (P.R.C.), University of Pittsburgh and Department of Veterans Affairs Medical Center, PA; and Wegmans School of Pharmacy (A.L.P.), St. John Fisher College, Rochester, NY.
| | - Richard J Barohn
- From the Departments of Neurology (J.E.H., E.A.L., W.B.M., M.P.M., R.T., C.A.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), University of Rochester Medical Center, NY; Department of Neurology (R.J.B.), University of Kansas Medical Center, Kansas City; Department of Neurology (P.R.C.), University of Pittsburgh and Department of Veterans Affairs Medical Center, PA; and Wegmans School of Pharmacy (A.L.P.), St. John Fisher College, Rochester, NY
| | - Paula R Clemens
- From the Departments of Neurology (J.E.H., E.A.L., W.B.M., M.P.M., R.T., C.A.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), University of Rochester Medical Center, NY; Department of Neurology (R.J.B.), University of Kansas Medical Center, Kansas City; Department of Neurology (P.R.C.), University of Pittsburgh and Department of Veterans Affairs Medical Center, PA; and Wegmans School of Pharmacy (A.L.P.), St. John Fisher College, Rochester, NY
| | - Elizabeth A Luebbe
- From the Departments of Neurology (J.E.H., E.A.L., W.B.M., M.P.M., R.T., C.A.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), University of Rochester Medical Center, NY; Department of Neurology (R.J.B.), University of Kansas Medical Center, Kansas City; Department of Neurology (P.R.C.), University of Pittsburgh and Department of Veterans Affairs Medical Center, PA; and Wegmans School of Pharmacy (A.L.P.), St. John Fisher College, Rochester, NY
| | - William B Martens
- From the Departments of Neurology (J.E.H., E.A.L., W.B.M., M.P.M., R.T., C.A.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), University of Rochester Medical Center, NY; Department of Neurology (R.J.B.), University of Kansas Medical Center, Kansas City; Department of Neurology (P.R.C.), University of Pittsburgh and Department of Veterans Affairs Medical Center, PA; and Wegmans School of Pharmacy (A.L.P.), St. John Fisher College, Rochester, NY
| | - Michael P McDermott
- From the Departments of Neurology (J.E.H., E.A.L., W.B.M., M.P.M., R.T., C.A.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), University of Rochester Medical Center, NY; Department of Neurology (R.J.B.), University of Kansas Medical Center, Kansas City; Department of Neurology (P.R.C.), University of Pittsburgh and Department of Veterans Affairs Medical Center, PA; and Wegmans School of Pharmacy (A.L.P.), St. John Fisher College, Rochester, NY
| | - Amy L Parkhill
- From the Departments of Neurology (J.E.H., E.A.L., W.B.M., M.P.M., R.T., C.A.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), University of Rochester Medical Center, NY; Department of Neurology (R.J.B.), University of Kansas Medical Center, Kansas City; Department of Neurology (P.R.C.), University of Pittsburgh and Department of Veterans Affairs Medical Center, PA; and Wegmans School of Pharmacy (A.L.P.), St. John Fisher College, Rochester, NY
| | - Rabi Tawil
- From the Departments of Neurology (J.E.H., E.A.L., W.B.M., M.P.M., R.T., C.A.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), University of Rochester Medical Center, NY; Department of Neurology (R.J.B.), University of Kansas Medical Center, Kansas City; Department of Neurology (P.R.C.), University of Pittsburgh and Department of Veterans Affairs Medical Center, PA; and Wegmans School of Pharmacy (A.L.P.), St. John Fisher College, Rochester, NY
| | - Charles A Thornton
- From the Departments of Neurology (J.E.H., E.A.L., W.B.M., M.P.M., R.T., C.A.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), University of Rochester Medical Center, NY; Department of Neurology (R.J.B.), University of Kansas Medical Center, Kansas City; Department of Neurology (P.R.C.), University of Pittsburgh and Department of Veterans Affairs Medical Center, PA; and Wegmans School of Pharmacy (A.L.P.), St. John Fisher College, Rochester, NY
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Jungheim M, Kühn D, Ptok M. [High resolution manometry study of pharyngeal function in patients with myotonic dystrophy]. DER NERVENARZT 2016. [PMID: 26215144 DOI: 10.1007/s00115-015-4397-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with myotonic dystrophy (MD) are known to suffer from oropharyngeal dysphagia and esophageal motility disorders, which are often the cause of aspiration pneumonia. So far only little is known about the pharyngeal contractility and the function of the upper esophageal sphincter in these patients, in particular only few data are available for manometric investigations allowing assessment of the pharyngeal pressure build-up during swallowing. The aim of this study was to collect such data in patients with MD using high resolution manometry. METHOD In two patients with MD high resolution manometry studies were performed during swallowing and phonation to determine pressure-dependent parameters. The results were compared with normal values from healthy subjects. RESULTS In both patients a reduced pressure in the entire pharynx during swallowing was determined. The duration of the contraction in the velopharynx and tongue base region was shortened. The structural course of the swallowing process and the opening and closing functions of the upper esophageal sphincter were regular. During realization of closed vowels a reduced pressure build-up in the velopharyngeal region was observed. CONCLUSION The force of contraction and the associated pharyngeal pressure build-up during swallowing were reduced resulting in an incomplete clearing of the pharynx. Beside myopathic disorders, neuromuscular disorders also have to be considered. The functional course of the swallowing process and the swallowing pattern was retained. The reduced pressure build-up in the velopharyngeal region can be considered as the cause for rhinophonia. To evaluate the pharyngeal function in patients with MD, high resolution manometry is a useful tool for assessing the pharyngeal function besides the basic diagnostics.
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Affiliation(s)
- M Jungheim
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland,
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Verdonschot RJCG, Baijens L, Vanbelle S, Florie M, Kremer B, Leue C. The relationship between fiberoptic endoscopic evaluation of swallowing outcome and symptoms of anxiety and depression in dysphagic patients. Laryngoscope 2015; 126:E199-207. [PMID: 26451747 DOI: 10.1002/lary.25698] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 08/18/2015] [Accepted: 08/31/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Affective complaints are involved in bothersome oropharyngeal dysphagia (OD). The aim was to determine the relationship between the severity of OD and affective symptoms. STUDY DESIGN Prospective cohort study. METHODS One hundred seven patients underwent a standardized examination protocol including the Hospital Anxiety and Depression Scale and fiberoptic endoscopic evaluation of swallowing (FEES). Two observers independently assessed patient performance on four ordinal FEES-variables (for thin and thick liquid consistency, blindly assessed). The relationship between FEES outcome and the presence of clinically relevant symptoms of anxiety and depression was analyzed using binary logistic regression. RESULTS Significant associations were found between clinically relevant symptoms of anxiety and two variables: piecemeal deglutition (thin liquid consistency only) (P = .026) and postswallow vallecular pooling (thick liquid consistency only) (P = .015). The probability of presenting with anxiety symptoms decreased as the severity of piecemeal deglutition and postswallow vallecular pooling increased. No significant association was found between clinically relevant symptoms of depression and any specific FEES variable. CONCLUSIONS These data revealed few associations between anxiety symptoms and the measured FEES variables. However, the more severe the score on FEES variables, the less important the affective complaints were. Anxiety seems to play a role in OD, but no causal relationship was found, commensurate with a cross-sectional study design. The contribution of affective symptoms to the development and treatment of OD warrants longitudinal research. LEVEL OF EVIDENCE 2b Laryngoscope, 126:E199-E207, 2016.
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Affiliation(s)
- Rob J C G Verdonschot
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,Emergency Department, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Laura Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sophie Vanbelle
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Michelle Florie
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Carsten Leue
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
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