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Altinkaynak M, Gok GK, Ozmen B, Buyukdemir S, Akpinar TS, Erten SN, Saka B. Prognostic Value of Regular Nutritional Treatment in Patients With Amyotrophic Lateral Sclerosis. Neurologist 2023; 28:166-172. [PMID: 35981308 DOI: 10.1097/nrl.0000000000000460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Malnutrition adversely affects the prognosis of amyotrophic lateral sclerosis (ALS). The aim of this study was to evaluate the effect of regular nutrition treatment and follow-up in clinical nutrition outpatient clinic (CNOC) on survival in ALS patients. MATERIALS AND METHODS The study included 55 ALS patients who were admitted and followed up in CNOC. Malnutrition was diagnosed using ESPEN criteria and nutrition treatment was planned according to needs of each patient. Nutritional status was followed up by body mass index (BMI), bioelectrical impedence analysis, and serum albumin. During the follow-up, survivors and nonsurvivors were compared according to their nutrition treatment success and changes in the anthropometric and laboratory measurements. RESULTS Body weight, BMI, and fat free mass were decreased during the follow-up in both survivors and nonsurvivors ( P <0.01). The decrease in the serum albumin and BMI were significantly higher in nonsurvivors ( P <0.01). Mortality rate was lower in those with higher adherence to nutrition treatment ( P <0.01) and patients with lower adherence to nutrition treatment showed more significant decrease in serum albumin levels ( P <0.01). CONCLUSION A personalized nutrition treatment combined with increased nutritional adherence in CNOC can decrease mortality in ALS patients.
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Affiliation(s)
- Mustafa Altinkaynak
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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2
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Robison RD, DiBiase L, Anderson A, Wymer JP, Plowman EK. Maximum lingual pressure impacts both swallowing safety and efficiency in individuals with amyotrophic lateral sclerosis. Neurogastroenterol Motil 2023; 35:e14521. [PMID: 36573040 PMCID: PMC10033350 DOI: 10.1111/nmo.14521] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although reduced lingual strength is a confirmed early manifestation of amyotrophic lateral sclerosis (ALS), its functional impact on swallowing remains unclear. We therefore sought to examine relationships between maximum anterior isometric lingual pressure (MAIP) with swallowing safety, swallowing efficiency, and swallowing timing metrics in a large cohort of individuals with ALS. METHODS Ninety-seven participants with ALS completed a standardized videofluoroscopic swallowing examination (VF) and lingual pressure testing (Iowa Oral Performance Instrument). Duplicate and blinded ratings of the Penetration-Aspiration Scale (PAS) and Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) percent efficiency (%C2-C42 ) and timing (laryngeal vestibule closure (LVC) duration: amount of time (milliseconds, msec) between LVC onset and laryngeal vestibule opening; time-to-LVC: hyoid burst to onset of LVC (msec); and swallow reaction time: interval between bolus passing ramus of mandible and onset of LVC (msec)) were performed across bolus trials. Swallowing safety (safe PAS: 1, 2, 4; unsafe PAS: 3, 5, 6, 7, and 8) and efficiency (inefficient: ≥3% worst total residue) were derived. Statistical analyses including descriptives, binary logistic regressions, and Spearman's rho correlations were performed (α = 0.05). KEY RESULTS Mean MAIP was 36.3 kPa (SD: 18.7). Mean MAIP was higher in those with safe swallowing as compared to those who penetrated (mean difference: 12 kPa) or aspirated (mean difference: 18 kPa). Individuals with efficient swallowing demonstrated higher MAIP than those with inefficient swallowing (mean difference: 11 kPa). Binary logistic regression analyses revealed increasing MAIP was significantly associated with a 1.06 (95% CI: 1.03-1.09) and 1.04 (95% CI: 1.01-1.06) greater odds of safe and efficient swallowing, respectively. No relationships were observed between MAIP and swallow reaction time across all bolus trials. Longer time-to-LVC (5 ml thin liquid: rs = -0.35, p = 0.002; cup sip thin liquid: rs = -0.26, p = 0.02; moderately thick liquid: rs = -0.28, p = 0.01) and prolonged LVC duration (cup sip thin liquid, rs = -0.34, p = 0.003) were associated with lower MAIP. CONCLUSIONS AND INFERENCES Reduced lingual strength was confirmed in this group of 97 individuals with ALS that was associated with a diminished ability to effectively transport boluses and aide in laryngeal vestibule closure to prevent entry of material into the airway.
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Affiliation(s)
- Raele Donetha Robison
- Aerodigestive Research Core, University of Florida, Gainesville, Florida, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Center for Health Disparities Research, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lauren DiBiase
- Aerodigestive Research Core, University of Florida, Gainesville, Florida, USA
| | - Amber Anderson
- Aerodigestive Research Core, University of Florida, Gainesville, Florida, USA
| | - James P. Wymer
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Emily K. Plowman
- Aerodigestive Research Core, University of Florida, Gainesville, Florida, USA
- Department of Neurology, University of Florida, Gainesville, Florida, USA
- Speech, Language and Hearing Science Department, University of Florida, Gainesville, Florida, USA
- Department of Surgery, University of Florida, Gainesville, Florida, USA
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3
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Gandhi P, Plowman EK, Steele CM. Differences in pharyngeal swallow event timing: Healthy aging, Parkinson disease, and amyotrophic lateral sclerosis. Laryngoscope Investig Otolaryngol 2023; 8:466-477. [PMID: 37090868 PMCID: PMC10116960 DOI: 10.1002/lio2.1019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/01/2022] [Accepted: 12/29/2022] [Indexed: 02/05/2023] Open
Abstract
Objective The pharyngeal phase of swallowing involves a coordinated sequence of events. Event durations may be prolonged in people with Parkinson disease (PwPD), and amyotrophic lateral sclerosis (PwALS); however, the cumulative effect of these changes is unexplored. We compared event latencies relative to hyoid burst (HYB) (time zero) to understand differences in deglutatory event timing. We hypothesized PwPD and PwALS would display similarly prolonged cumulative pharyngeal phase durations compared to healthy controls, with greater prolongations with increasing bolus viscosity. Method We retrospectively evaluated videofluoroscopic data of healthy adults (n = 78), PwPD (n = 17), and PwALS (n = 20). Participants swallowed 15 boluses of 20% (w/v) barium across five liquid consistencies. Paired raters evaluated nine deglutitive events using the ASPEKT method. Latencies were plotted by consistency relative to HYB and compared across cohorts using Mann-Whitney U tests (p ≤ .05). Cohen's d was calculated for all statistically significant results to determine effect size. Results In PwPD, significantly prolonged latencies were observed on thin liquid boluses compared to healthy controls. Latencies to all post-HYB events were significantly prolonged except for maximum upper esophageal sphincter distension. In PwALS, significantly prolonged latencies for events preceding and following HYB were noted on all consistencies compared to healthy controls and PwPD. Conclusion In PwPD, event latencies for multiple components of the swallowing sequence were prolonged culminating in overall prolongation of the pharyngeal phase on thin liquid. A similar pattern, but with significantly greater prolongation, was seen in the PwALS, and extended to swallows of all liquid consistencies.
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Affiliation(s)
- Pooja Gandhi
- Swallowing Rehabilitation Research Laboratory KITE Research Institute—University Health Network Toronto Ontario Canada
- Rehabilitation Sciences Institute University of Toronto Toronto Ontario Canada
| | - Emily K. Plowman
- Aerodigestive Research Core—University of Florida Gainesville Florida United States
| | - Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory KITE Research Institute—University Health Network Toronto Ontario Canada
- Rehabilitation Sciences Institute University of Toronto Toronto Ontario Canada
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Balendra R, Jones AR, Al Khleifat A, Chiwera T, Wicks P, Young CA, Shaw PJ, Turner MR, Leigh PN, Al-Chalabi A. Comparison Of King's Clinical Staging In Multinational Amyotrophic Lateral Sclerosis Cohorts. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:71-81. [PMID: 35852375 DOI: 10.1080/21678421.2022.2090847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Amyotrophic lateral sclerosis (ALS) shows considerable clinical heterogeneity, which affects clinical trials. A clinical staging system has been proposed for ALS with potential applications in patient care, research, trial design and health economic analyses. The King's system consists of five stages. We have previously shown that progressive clinical stages were reached at predictable proportions through the disease course, but this needs to be validated in other independent samples. Objectives: We aimed to compare King's clinical staging in ALS in four patient groups, located in different regions and countries and using different health care systems from the original study population in South London. Methods: Clinical data were extracted from two European phase 3 randomized controlled trials (MitoTarget and LiCALS) and from two databases predominately from the United States: the PRO-ACT Consortium Database and a database of patients from the PatientsLikeMe website. Clinical stage was estimated using an algorithm, and standardized time to each clinical stage was calculated in deceased patients. Results: 8,796 patients were included, of whom 1,959 had died by the end of follow-up. Stages occurred in the same order as in the original study for all cohorts. Median standardized times to stages (interquartile range) were Stage 2: 0.61 (0.47-0.75), Stage 3: 0.68 (0.56-0.81), Stage 4A: 0.82 (0.71-0.91), Stage 4B: 0.82 (0.69-0.92) and Stage 4 0.80 (0.67-0.91). Discussion: Timings for all stages were similar to those reported in the original study, except Stage 2 which occurred later in the clinical trial databases due to recruitment occurring after diagnosis.
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Affiliation(s)
- Rubika Balendra
- UK Dementia Research Institute, University College London, London, UK
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Ashley R Jones
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, UK
| | - Ahmad Al Khleifat
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, UK
| | - Theresa Chiwera
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, UK
| | - Paul Wicks
- Wicks Digital Health, Wicks Digital Health, Lichfield, UK
| | - Carolyn A Young
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience (SITraN), Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, OX3 9DU, UK
| | - P Nigel Leigh
- Department of Neuroscience, Brighton and Sussex Medical School, Trafford Centre for Biomedical Research, University of Sussex, Falmer, East Sussex, BN1 9RY, UK
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, UK
- Department of Neurology, King's College Hospital, London, UK
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Yokoi S, Nishio N, Maruo T, Hiramatsu M, Mukoyama N, Tsuzuki H, Wada A, Atsuta N, Ito D, Tsuboi T, Sobue G, Katsuno M, Fujimoto Y, Sone M. Safety and Clinical Benefits of Laryngeal Closure in Patients with Amyotrophic Lateral Sclerosis. Dysphagia 2023; 38:211-219. [PMID: 35507038 PMCID: PMC9873708 DOI: 10.1007/s00455-022-10454-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 04/11/2022] [Indexed: 01/28/2023]
Abstract
This study evaluated the safety of laryngeal closure and post-surgical changes in swallowing function of patients with amyotrophic lateral sclerosis (ALS) and proposed an appropriate surgical strategy for patients with ALS. Clinical and surgical data of 26 consecutive patients with ALS who underwent laryngeal closure at Nagoya University Hospital in Japan between 2003 and 2020 were retrospectively analyzed. Changes in swallowing functions were evaluated before and approximately 1 month post-surgery using Neuromuscular Disease Swallowing Status Scale (NdSSS), and Functional Oral Intake Scale (FOIS). The median operation time was 126 min (range, 51-163 min), and the median intraoperative blood loss was 20 mL (range, 0-88 mL). Among the 26 ALS patients who underwent laryngeal closure, grade 1 (mild) complications occurred in three patients (12%); however, no severe complications were observed. After surgery, 25 patients (96%) maintained the swallowing function and only one patient (4%) had deteriorating NdSSS and FOIS scores. No patients were referred to our hospital due to severe aspiration pneumonia after the surgery. Two patients did not require a feeding tube after the surgery and returned to oral intake. Laryngeal closure may be a safe surgical procedure for preventing chronic aspiration and may also maintain swallowing function of patients with ALS. Further multicenter prospective studies using the gold standard videofluoroscopic swallowing examination are required to support our findings.
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Affiliation(s)
- Sayaka Yokoi
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Takashi Maruo
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Mariko Hiramatsu
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Nobuaki Mukoyama
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hidenori Tsuzuki
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Akihisa Wada
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Naoki Atsuta
- Department of Neurology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Daisuke Ito
- Department of Neurology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Takashi Tsuboi
- Department of Neurology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Gen Sobue
- Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
- Department of Otorhinolaryngology, Head and Neck Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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Mueller M, Thompson R, Osman KL, Andel E, Dejonge C, Kington S, Stephenson Z, Hamad A, Bunyak F, Nichols NL, Lever TE. Impact of Limb Phenotype on Tongue Denervation Atrophy, Dysphagia Penetrance, and Survival Time in a Mouse Model of ALS. Dysphagia 2022; 37:1777-1795. [PMID: 35426522 PMCID: PMC9568622 DOI: 10.1007/s00455-022-10442-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
Current treatments for dysphagia in ALS do not target the underlying tongue weakness and denervation atrophy that is prevalent in spinal and bulbar ALS cases. To address this clinical gap, we studied the low copy number SOD1-G93A (LCN-SOD1) mouse model of ALS to quantify the impact of limb phenotype on tongue denervation atrophy, dysphagia penetrance, and survival time in preparation for future treatment-based studies. Two male LCN-SOD1 breeders and 125 offspring were followed for limb phenotype inheritance, of which 52 (30 LCN-SOD1 and 22 wild-type/WT, both sexes) underwent characterization of dysphagia penetrance (via videofluoroscopic swallow study; VFSS) and survival time at disease end-stage (15-20% body weight loss). From these, 16 mice (8/genotype) underwent postmortem histological analysis of the genioglossus for evidence of denervation atrophy. Results revealed that both breeders displayed a mixed (hindlimb and forelimb) ALS phenotype and sired equal proportions of hindlimb vs. mixed phenotype offspring. Dysphagia penetrance was complete for mixed (100%) versus incomplete for hindlimb (64%) phenotype mice; yet survival times were similar. Regardless of limb phenotype, LCN-SOD1 mice had significantly smaller genioglossus myofibers and more centralized myonuclei compared to WT mice (p < 0.05). These biomarkers of denervation atrophy were significantly correlated with VFSS metrics (lick and swallow rates, p < 0.05) but not survival time. In conclusion, both LCN-SOD1 phenotypes had significant tongue denervation atrophy, even hindlimb phenotype mice without dysphagia. This finding recapitulates human ALS, providing robust rationale for using this preclinical model to explore targeted treatments for tongue denervation atrophy and ensuing dysphagia.
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Affiliation(s)
| | | | - Kate L. Osman
- Department of Otolaryngology – Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Ellyn Andel
- University of Missouri Students, Columbia, MO, USA
| | | | | | | | - Ali Hamad
- University of Missouri Students, Columbia, MO, USA
| | - Filiz Bunyak
- Department of Electrical Engineering and Computer Science, University of Missouri College of Engineering, Columbia, MO, USA
| | - Nicole L. Nichols
- Department of Biomedical Sciences, University of Missouri College of Veterinary Medicine, Columbia, MO, USA
| | - Teresa E. Lever
- Department of Otolaryngology – Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA,Department of Biomedical Sciences, University of Missouri College of Veterinary Medicine, Columbia, MO, USA
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Characteristics of Dysphagia Based on the Type of ALS in Korean Patients Evaluated Using Videofluoroscopic Study: A Retrospective Analysis. Dysphagia 2022; 37:1748-1756. [PMID: 35304623 DOI: 10.1007/s00455-022-10430-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 02/25/2022] [Indexed: 12/16/2022]
Abstract
Dysphagia is one of the main serious issues for amyotrophic lateral sclerosis (ALS) patients because of causing malnutrition and aspiration pneumonia. Early detection and management of dysphagia are essential for the long-term survival. In this study, videofluoroscopic swallowing study (VFSS) results of bulbar and spinal onset ALS patients were compared. VFSS results and revised ALS Functional Rating Scale (ALSFRS-R) score were also analyzed to assess the correlation between dysphagia and functional status of patients. ALS patients with swallowing difficulties who underwent VFSS were recruited retrospectively. Two oral, seven pharyngeal, and two esophageal components of VFSS were evaluated. An ALSRFRS-R bulbar subtype score < 9 was used to divide the groups with severe bulbar symptoms. Total 109 Korean ALS patients (39 bulbar vs 70 spinal) were included. Bulbar ALS patients exhibited a significantly longer oral transit time (OTT) then spinal ALS patients, especially in severe bulbar patients with low ALSRFRS-R bulbar subscale. In bulbar ALS patients, penetration (thick liquid), aspiration, OTT, and Penetration-Aspiration Scale (PAS) were significantly correlated with ALSFRS-R bulbar subscale score. However, in spinal ALS patients, only OTT (thin liquid) and aspiration (thick liquid) were significantly correlated with ALSFRS-R bulbar subscale score. Bulbar ALS patients demonstrated significantly longer OTT than spinal ALS patients, and ALSFRS-R bulbar subscale score also correlated well with bulbar ALS patients. Therefore, high vigilance and aggressive treatment for dysphagia especially in bulbar ALS patients rather than spinal ALS patients are mandatory.
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Gandhi P, Plowman EK, Steele CM. Comparison of Lingual Pressure Generation Capacity in Parkinson Disease, Amyotrophic Lateral Sclerosis, and Healthy Aging. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1845-1853. [PMID: 35858265 PMCID: PMC9907496 DOI: 10.1044/2022_ajslp-21-00385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/01/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The tongue plays a key role in bolus propulsion during swallowing, with reduced lingual pressure generation representing a risk factor for impaired swallowing safety and efficiency. We compared lingual pressure generation capacity in people with Parkinson disease (PwPD), people with amyotrophic lateral sclerosis (PwALS), and healthy older adults. We hypothesized that both patient cohorts would demonstrate reduced maximum anterior isometric pressure (MAIP) and regular effort saliva swallow (RESS) pressures compared with healthy controls, with the greatest reductions expected in the ALS cohort. METHOD We enrolled 20 PwPD, 18 PwALS, and 20 healthy adults over 60 years of age. The Iowa Oral Performance Instrument was used to measure MAIP, RESS, and lingual functional reserve (LFR, i.e., MAIP - RESS). Descriptive statistics were calculated; between-groups differences were explored using univariate analyses of variance and post hoc Sidak tests with alpha set at .05. RESULTS Mean MAIPs for the PD, ALS, and heathy cohorts were 54.7, 33.5, and 47.4 kPa, respectively. Significantly lower MAIP was found in PwALS compared with PwPD and healthy controls. RESS values did not differ significantly across groups. LFR was significantly higher in PwPD versus PwALS and healthy controls. CONCLUSIONS Lingual pressure generation capacity and functional reserve were reduced in PwALS, but not in PwPD, beyond changes seen with healthy aging. Both patient cohorts displayed preserved lingual pressure during saliva swallows. Future studies exploring longitudinal changes in tongue pressure generation on isometric and saliva swallowing tasks will be needed to confirm whether tongue pressure measures serve as noninvasive clinical biomarkers of swallowing impairment.
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Affiliation(s)
- Pooja Gandhi
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | | | - Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
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Validation of the DYALS (dysphagia in amyotrophic lateral sclerosis) questionnaire for the evaluation of dysphagia in ALS patients. Neurol Sci 2021; 43:3195-3200. [PMID: 34853898 DOI: 10.1007/s10072-021-05775-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dysphagia is a common symptom during the trajectory of ALS, and it can significantly impact on the quality of life and prognosis of patients. Nowadays, no specific tool for the screening of dysphagia in ALS is validated, and the approach is heterogeneous across the Italian centres. OBJECTIVE To validate the DYALS (dysphagia in amyotrophic lateral sclerosis) questionnaire, adapting the DYMUS (dysphagia in multiple sclerosis) questionnaire, for the assessment of dysphagia in ALS patients, in order to uniform the evaluations across the Italian ALS network. METHODS We included 197 patients diagnosed with ALS following the El Escorial criteria, in sixteen Italian ALS centres between 1st December 2019 and 1st July 2020. For each patient, we collected clinical and demographic data and obtained ALSFRS-r score, ALSAQ-5 score, DYMUS score, and EAT-10 score. RESULTS Across the 197 patients, the ratio M/F was 113/84, and the median age was 64 years (IQR 56-72.5). Bulbar patients were 20%, and spinal patients 80%. The median ALSFRSr total score of patients was 35 (IQR 28-39). DYALS score was statistically higher in bulbar ALS than in spinal ALS (median = 6, IQR 4.5-9 vs median = 1, IQR 0-5, z = 6.253, p < 0.0001). DYALS questionnaire showed a high internal consistency (Cronbach's alpha = 0.88). There was a statistically significant correlation between DYALS and EAT-10 (rho = 0.90, p < 0.0001). CONCLUSIONS DYALS scale is reliable, manageable, and easily usable for the screening of dysphagia in ALS. It can be shared with all the Italian ALS centres in order to collect uniform data for therapeutic strategies and clinical trials.
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10
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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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11
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Lee J, Madhavan A, Krajewski E, Lingenfelter S. Assessment of dysarthria and dysphagia in patients with amyotrophic lateral sclerosis: Review of the current evidence. Muscle Nerve 2021; 64:520-531. [PMID: 34296769 DOI: 10.1002/mus.27361] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/21/2021] [Accepted: 06/27/2021] [Indexed: 11/11/2022]
Abstract
Bulbar dysfunction is a common presentation of amyotrophic lateral sclerosis (ALS) and significantly impacts quality of life of people with ALS (PALS). The current paper reviews measurements of dysarthria and dysphagia specific to ALS to identify efficient and valid assessment measures. Using such assessment measures will lead to improved management of bulbar dysfunction in ALS. Measures reviewed for dysarthria in PALS are organized into three categories: acoustic, kinematic, and strength. A set of criteria are used to evaluate the effectiveness of the measures' identification of speech impairments, measurement of functional verbal communication, and clinical applicability. Assessments reviewed for dysphagia in PALS are organized into six categories: patient reported outcomes, dietary intake, pulmonary function and airway defense capacity, bulbar function, dysphagia/aspiration screens, and instrumental evaluations. Measurements that have good potential for clinical use are highlighted in both topic areas. Additionally, areas of improvement for clinical practice and research are identified and discussed. In general, no single speech measure fulfilled all the criteria, although a few measures were identified as potential diagnostic tools. Similarly, few objective measures that were validated and replicated with large sample sizes were found for diagnosis of dysphagia in PALS. Importantly, clinical applicability was found to be limited; thus, a collaborative team focused on implementation science would be helpful to improve the clinical uptake of assessments. Overall, the review highlights the need for further development of clinically viable and efficient measurements that use a multidisciplinary approach.
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Affiliation(s)
- Jimin Lee
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Aarthi Madhavan
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Elizabeth Krajewski
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Sydney Lingenfelter
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, Pennsylvania, USA
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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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13
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Robison R, DiBiase L, Ashley A, McElheny K, Anderson A, Wymer JP, Plowman EK. Swallowing Safety and Efficiency Impairment Profiles in Individuals with Amyotrophic Lateral Sclerosis. Dysphagia 2021; 37:644-654. [PMID: 34037850 DOI: 10.1007/s00455-021-10315-2] [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: 12/10/2020] [Accepted: 05/13/2021] [Indexed: 12/01/2022]
Abstract
Dysphagia is common in individuals with amyotrophic lateral sclerosis (ALS) and associated with reductions in quality of life and health-related outcomes. Despite the high prevalence of dysphagia in ALS, functional impairment profiles of swallowing safety and efficiency have not been comprehensively examined. We therefore aimed to determine the relative prevalence of unsafe and inefficient swallowing in a large cohort of individuals with ALS. We further sought to examine the impact of global and bulbar disease progression (Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised "ALSFRS-R" total and bulbar scores, respectively), disease duration, and onset type on swallowing impairment profiles. One hundred individuals with ALS completed a standardized videofluoroscopic swallowing examination Two independent and blinded raters performed validated ratings of safety (Penetration-Aspiration Scale, PAS) and efficiency (Analysis of Swallowing Physiology: Events, Kinematics, and Timing, ASPEKT % residue). Binary classifications of safety (unsafe: PAS ≥ 3), efficiency (inefficient: total residue ≥ 3% of C2-42) and global swallowing status were derived. The ALSFRS-R was completed to derive ALSFRS-R total and bulbar subscale scores. Demographic data (disease duration and onset type) for each participant was also recorded. Descriptives, 2 × 2 contingency tables with Fishers exact test, and independent samples t-tests were performed (α = 0.05). Prevalence of unsafe and inefficient swallowing was 48% and 73%, respectively. Global swallowing profiles were, in rank order: unsafe and inefficient (39%), inefficient but safe (34%), safe and efficient (18%), and unsafe but efficient (9%). There were no differences in global disease progression or disease duration across swallowing impairment profiles. ALSFRS-R bulbar subscale scores were significantly lower in unsafe versus safe swallowers, p < 0.05. Spinal onset patients had a greater proportion of safe swallowers as compared to bulbar onset patients (p = 0.000, Fisher's exact test). Both spinal and bulbar onset patients demonstrated a higher prevalence of inefficient swallowers as compared to efficient swallowers (p = 0.04, Fisher's exact test). Dysphagia was prevalent in this group of individuals with ALS. Approximately half demonstrated safety impairments and two-thirds had impairments in swallowing efficiency. Inefficient swallowing was approximately four times more likely to be the initial functional impairment in patients with one pathophysiologic functional impairment. A longitudinal study is needed to examine the temporal evolution of dysphagia in ALS.
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Affiliation(s)
- Raele Robison
- Aerodigestive Research Core, University of Florida, Gainesville, FL, USA. .,Speech, Language and Hearing Science Department, University of Florida, Gainesville, FL, USA. .,William S. Middleton Memorial Veteran's Hospital, Madison, WI, USA.
| | - Lauren DiBiase
- Aerodigestive Research Core, University of Florida, Gainesville, FL, USA
| | - Amy Ashley
- Aerodigestive Research Core, University of Florida, Gainesville, FL, USA.,Speech, Language and Hearing Science Department, University of Florida, Gainesville, FL, USA
| | - Kasey McElheny
- Aerodigestive Research Core, University of Florida, Gainesville, FL, USA.,Speech, Language and Hearing Science Department, University of Florida, Gainesville, FL, USA
| | - Amber Anderson
- Aerodigestive Research Core, University of Florida, Gainesville, FL, USA
| | - James P Wymer
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Emily K Plowman
- Aerodigestive Research Core, University of Florida, Gainesville, FL, USA.,Speech, Language and Hearing Science Department, University of Florida, Gainesville, FL, USA.,Department of Neurology, University of Florida, Gainesville, FL, USA.,Department of Surgery, University of Florida, Gainesville, FL, USA
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14
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Xu C, Yang ZQ, Liu S, Yang W, Shi HB, Zhou WZ. Percutaneous radiologic gastrostomy in patients with amyotrophic lateral sclerosis: A safe and effective technique. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2021. [DOI: 10.18528/ijgii210004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Chen Xu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zheng-Qiang Yang
- Department of Interventional Therapy, National Cancer Center, National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Yang
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei-Zhong Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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15
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Sarmet M, Mangilli LD, Costa GP, Paes JPRS, Codeço VM, Million JL, Maldaner V. The relationship between pulmonary and swallowing functions in patients with neuromuscular diseases followed up by a tertiary referral center: a cross-sectional study. LOGOP PHONIATR VOCO 2021; 47:117-124. [PMID: 33586591 DOI: 10.1080/14015439.2021.1879254] [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: 10/22/2022]
Abstract
INTRODUCTION Respiratory muscle weakness is common in patients with neuromuscular diseases (NMD). This puts them at risk for dysphagia and other pulmonary complications. OBJECTIVES To investigate the relationship between pulmonary function and swallowing in NMD. MATERIALS AND METHODS In this cross-sectional study, medical records of patients undergoing treatment at the Tertiary Referral Center for Neuromuscular Diseases of Hospital de Apoio de Brasília, Brazil, were reviewed. Respiratory function was assessed through spirometry (FVC and FEV1 measured) and swallowing assessed by the Dysphagia Risk Evaluation Protocol and the Functional Oral Intake Scale. RESULTS Two hundred and twenty-two patients were included. Dysphagia was present in 46.8% of patients and impairment of pulmonary function in 64.0%. The mean FVC observed was 66.9% and FEV1 was 66.0%, indicating restrictive lung disease. A correlation between the decline of pulmonary and swallowing functions was observed in patients with NMDs (FVC vs. DREP, R = 0.46; FVC vs. FOIS, R = 0.42; FEV1 vs. DREP, R = 0.42; FEV1 vs. FOIS, R = 0.40, p<.01). FVC and FEV1 values tend to be lower in patients with dysphagia in the context of NMD. CONCLUSIONS A positive correlation between pulmonary function and swallowing outcomes was observed in patients with NMD. Despite respiratory and swallowing impairment being widely present in the population with NMD, they require different treatments according to the disease's pathophysiology. Future studies should be conducted to explore the disease-specific relationship between pulmonary function and swallowing in patients with NMD.
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Affiliation(s)
- Max Sarmet
- Departments of Speech Therapy and Physical Therapy, Hospital de Apoio de Brasília, Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil.,Graduate Department of Health Sciences and Technologies, University of Brasília (UnB), Brasília, Brazil
| | | | - Geovanna Pereira Costa
- Undergraduate Program, College of Medicine, Escola Superior de Ciências da Saúde, Brasília, Brazil
| | | | - Vitor Martins Codeço
- Department of Thoracic Diseases, Hospital Regional da Asa Norte, Brasília, Brazil
| | - Janae Lyon Million
- Department of Human Biology, University of California, Santa Cruz, CA, USA
| | - Vinicius Maldaner
- Departments of Speech Therapy and Physical Therapy, Hospital de Apoio de Brasília, Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil.,Undergraduate Program, College of Medicine, Escola Superior de Ciências da Saúde, Brasília, Brazil
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Crary MA. Adult Neurologic Disorders. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Humoral Influence of Repeated Lineage-Negative Stem/Progenitor Cell Administration on Articulatory Functions in ALS Patients. Stem Cells Int 2020; 2020:8888271. [PMID: 33381192 PMCID: PMC7755492 DOI: 10.1155/2020/8888271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/13/2020] [Accepted: 12/08/2020] [Indexed: 01/13/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) remains a fatal, neurodegenerative disease frequently leading to dysarthria and impaired swallowing. Better understanding of ALS pathophysiology is prompting the use of humoral cell therapies. Hence, a repeated cellular therapy was applied to ALS patients as an attempt to prevent speech deterioration. Autologous bone marrow-derived lineage-negative (Lin−) cells were intrathecally administered three times at six-week intervals to 42 sporadic ALS patients. Patients were examined for articulatory functions using subjective (VHI) and objective (FDA) scales. Selected trophic, proinflammatory factors and expression profiles of miRNA were measured in cerebrospinal fluid (CSF) and plasma by multiplex Luminex and q-PCR in different timepoints. Of the 42 patients who received the Lin− cells, 6 showed improvement in articulatory functions, 27 remained stable, and 9 deteriorated after 18 weeks of therapy according to FDA scale. Clinical improvement was particularly evident by the 7th day of each cell application and concerned better cough and swallow reflex, soft palate, laryngeal time, pitch, and volume. These results correlated with significant changes in the concentration of various trophic and proinflammatory factors and miRNA expression profiles. A multiple application of Lin− cells proved to be safe and feasible. The repeated procedure can potentate a humoral effect and prevent speech deterioration. A short-lasting trophic effect of each Lin− cells administration was observed on local and systemic level. However, further in-depth studies are necessary to sustain the beneficial effect.
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Evaluation and Management of Dysphagia in Amyotrophic Lateral Sclerosis: A Survey of Speech-Language Pathologists' Clinical Practice. J Clin Neuromuscul Dis 2020; 21:135-143. [PMID: 32073459 PMCID: PMC7034365 DOI: 10.1097/cnd.0000000000000281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Objectives: The aim of this study was to determine the evaluation and management of dysphagia in amyotrophic lateral sclerosis (ALS) patients by speech-language pathologists (SLPs). Methods: A 15-question web-based survey sent to SLPs in general clinical practice. Results: Forty-nine SLPs responded. Although only 8 (17.0%) of the SLPs worked in ALS clinics, 46 (93.9%) had worked with ALS patients. A variety of dysphagia evaluation protocols were used by 43 (97.7%) SLPs. Most SLPs, 40 (88.9%), recommended instrumental assessments, but timing and indication varied greatly: 19 (42.2%) SLPs recommended this at baseline even without bulbar symptoms, whereas others recommended this based on symptoms and/or clinical assessments. Conclusions: There is currently no uniform approach as to the indication, timing, and specific methods to use in the evaluation of dysphagia in ALS patients among SLPs. There is need for further research to assist in the development of definitive guideline recommendations for this population.
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Esophageal Peristalsis Disorders in ALS Patients with Dysphagia. Brain Sci 2020; 10:brainsci10110820. [PMID: 33171941 PMCID: PMC7694681 DOI: 10.3390/brainsci10110820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022] Open
Abstract
To detect the variations of esophageal peristalsis in amyotrophic lateral sclerosis (ALS) patients with predominantly bulbar or predominantly pseudobulbar clinical presentation by using esophageal manometry (EM). Fifteen ALS patients with pseudobulbar clinical presentation (PBP) and 13 patients with bulbar presentation (BP), fulfilling WFN Criteria, were studied. EM was performed in all subjects using a flexible catheter with solid-state transducers. Swallowing was initiated with 5 to 10 mL of water (wet swallows) and saliva (dry swallows) and repeated at 30 s intervals. The manometric parameters were measured automatically and visualized by the computer system. The tracings were analyzed using Synectics software. In PBP patients, an increase of resting pressure value in the upper esophageal sphincter (UES) >45 mmHg, a wave-like course of resting pressure, and toothed peristaltic waves were observed. In BP patients, a low amplitude of peristaltic waves <30 mmHg (mean: 17 ± 5) was recorded, without signs of esophageal motility disturbance at onset or during progression. EM procedure allows objectively distinguishing dysphagia in ALS patients due to bulbar syndrome from the dysphagia due to pseudobulbar syndrome. It is important to identify PBP patients because of their high risk of aspiration.
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Romero-Gangonells E, Virgili-Casas MN, Dominguez-Rubio R, Povedano M, Pérez-Saborit N, Calvo-Malvar N, Barceló MA. Evaluation of Dysphagia in Motor Neuron Disease. Review of Available Diagnostic Tools and New Perspectives. Dysphagia 2020; 36:558-573. [PMID: 32797289 DOI: 10.1007/s00455-020-10170-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 08/06/2020] [Indexed: 11/26/2022]
Abstract
Oropharyngeal dysphagia (OD) is highly prevalent (up to 80%) in patients with motor neuron disease (MND), influencing the prognosis of the disease. The clinical assessment of dysphagia is complex. There are assessment scales and screening questionnaires, but they have not been tested in patients with MND. In a sample of 46 patients with MND, the sensitivity and specificity of the EAT-10 and SwalQoL questionnaires, as well as the ALS-SS and FOIS scales, were tested and compared to the gold standard technique (videofluoroscopy, VFS). The patients were stratified using the DOSSc variable according to the video fluoroscopic examination with (n = 37) or without (n = 8) signs of dysphagia, and the results were compared with the scores obtained in the dysphagia questionnaires. None of the studied questionnaires was more sensitive than the others, but one stood out for its high specificity (= 1): the SwalQoL revised FS. The symptom frequency section of the SwalQoL questionnaire with some modifications, (SwalQoL revised FS) may be a useful tool in the clinical assessment of dysphagia because it's capable to detect the patients that really don't have dysphagia. The ALS-SS showed the greatest validity as a severity scale of dysphagia among the sample studied. A specific questionnaire for screening for dysphagia in MND needs to be developed. Until that time, the proposal is to use a combination of the existing questionnaires for other pathologies (EAT-10 and SwalQoL) and the specific scale for MND, the ALS-SS, to make an accurately clinical assessment of OD in MND patients before to perform a videofluoroscopy.
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Affiliation(s)
- Elisabet Romero-Gangonells
- Functional Motor Neuron Unit (UFMN), Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), L'Hospitalet de Llobregat, Spain
- Department of Endocrinology and Clinical Nutrition, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - M Núria Virgili-Casas
- Functional Motor Neuron Unit (UFMN), Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), L'Hospitalet de Llobregat, Spain
- Department of Endocrinology and Clinical Nutrition, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Raúl Dominguez-Rubio
- Functional Motor Neuron Unit (UFMN), Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), L'Hospitalet de Llobregat, Spain
| | - Mònica Povedano
- Functional Motor Neuron Unit (UFMN), Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), L'Hospitalet de Llobregat, Spain
| | - Núria Pérez-Saborit
- Department of Image Diagnosis and Nuclear Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Nahum Calvo-Malvar
- Department of Image Diagnosis and Nuclear Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Maria A Barceló
- Functional Motor Neuron Unit (UFMN), Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain.
- Research Group On Statistics, Econometrics and Health (GRECS), University of Girona, Carrer de la Universitat de Girona 10, Campus de Montilivi, 17003, Girona, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
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Chapin JL, Gray LT, Vasilopoulos T, Anderson A, DiBiase L, York JD, Robison R, Wymer J, Plowman EK. Diagnostic utility of the amyotrophic lateral sclerosis Functional Rating Scale-Revised to detect pharyngeal dysphagia in individuals with amyotrophic lateral sclerosis. PLoS One 2020; 15:e0236804. [PMID: 32790801 PMCID: PMC7425890 DOI: 10.1371/journal.pone.0236804] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/13/2020] [Indexed: 12/18/2022] Open
Abstract
Objective The ALS Functional Rating Scale–Revised (ALSFRS-R) is the most commonly utilized instrument to index bulbar function in both clinical and research settings. We therefore aimed to evaluate the diagnostic utility of the ALSFRS-R bulbar subscale and swallowing item to detect radiographically confirmed impairments in swallowing safety (penetration or aspiration) and global pharyngeal swallowing function in individuals with ALS. Methods Two-hundred and one individuals with ALS completed the ALSFRS-R and the gold standard videofluoroscopic swallowing exam (VFSE). Validated outcomes including the Penetration-Aspiration Scale (PAS) and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) were assessed in duplicate by independent and blinded raters. Receiver operator characteristic curve analyses were performed to assess accuracy of the ALSFRS-R bulbar subscale and swallowing item to detect radiographically confirmed unsafe swallowing (PAS > 3) and global pharyngeal dysphagia (DIGEST >1). Results Although below acceptable screening tool criterion, a score of ≤ 3 on the ALSFRS-R swallowing item optimized classification accuracy to detect global pharyngeal dysphagia (sensitivity: 68%, specificity: 64%, AUC: 0.68) and penetration/aspiration (sensitivity: 79%, specificity: 60%, AUC: 0.72). Depending on score selection, sensitivity and specificity of the ALSFRS-R bulbar subscale ranged between 34–94%. A score of < 9 optimized classification accuracy to detect global pharyngeal dysphagia (sensitivity: 68%, specificity: 68%, AUC: 0.76) and unsafe swallowing (sensitivity:78%, specificity:62%, AUC: 0.73). Conclusions The ALSFRS-R bulbar subscale or swallowing item did not demonstrate adequate diagnostic accuracy to detect radiographically confirmed swallowing impairment. These results suggest the need for alternate screens for dysphagia in ALS.
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Affiliation(s)
- Jennifer L. Chapin
- Aerodigestive Research Core, University of Florida, Gainesville, FL, United States of America
| | - Lauren Tabor Gray
- Aerodigestive Research Core, University of Florida, Gainesville, FL, United States of America
- Department of Neurology, Phil Smith Neuroscience Institute, Holy Cross Hospital, Fort Lauderdale, FL, United States of America
| | - Terrie Vasilopoulos
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Amber Anderson
- Aerodigestive Research Core, University of Florida, Gainesville, FL, United States of America
- Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, United States of America
| | - Lauren DiBiase
- Aerodigestive Research Core, University of Florida, Gainesville, FL, United States of America
- Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, United States of America
| | - Justine Dallal York
- Aerodigestive Research Core, University of Florida, Gainesville, FL, United States of America
- Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, United States of America
| | - Raele Robison
- Aerodigestive Research Core, University of Florida, Gainesville, FL, United States of America
- Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, United States of America
| | - James Wymer
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Emily K. Plowman
- Aerodigestive Research Core, University of Florida, Gainesville, FL, United States of America
- Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, United States of America
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States of America
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, United States of America
- * E-mail:
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22
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Waito AA, Plowman EK, Barbon CEA, Peladeau-Pigeon M, Tabor-Gray L, Magennis K, Robison R, Steele CM. A Cross-Sectional, Quantitative Videofluoroscopic Analysis of Swallowing Physiology and Function in Individuals With Amyotrophic Lateral Sclerosis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:948-962. [PMID: 32310713 PMCID: PMC7242989 DOI: 10.1044/2020_jslhr-19-00051] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/17/2019] [Accepted: 12/11/2019] [Indexed: 05/04/2023]
Abstract
Purpose To date, research characterizing swallowing changes in individuals with amyotrophic lateral sclerosis (ALS) has primarily relied on subjective descriptions. Thus, the degree to which swallowing physiology is altered in ALS, and relationships between such alterations and swallow safety and/or efficiency are not well characterized. This study provides a quantitative representation of swallow physiology, safety, and efficiency in a sample of individuals with ALS, to estimate the degree of difference in comparison to published healthy reference data and identify parameters that pose risk to swallow safety and efficiency. Secondary analyses explored the therapeutic effect of thickened liquids on swallowing safety and efficiency. Method Nineteen adults with a diagnosis of probable-definite ALS (El-Escorial Criteria-Revised) underwent a videofluoroscopic swallowing study, involving up to 15 sips of barium liquid (20% w/v), ranging in thickness from thin to extremely thick. Blinded frame-by-frame videofluoroscopy analysis yielded the following measures: Penetration-Aspiration Scale, number of swallows per bolus, amount of pharyngeal residue, degree of laryngeal vestibule closure (LVC), time-to-LVC, duration of LVC (LVCdur), pharyngeal area at maximum constriction, diameter of upper esophageal sphincter opening, and duration of UES opening (UESOdur). Measures of swallow physiology obtained from thin liquid trials were compared against published healthy reference data using unpaired t tests, chi-squared tests, and Cohen's d effect sizes (adjusted p < .008). Preliminary relationships between parameters of swallowing physiology, safety, and efficiency were explored using nonparametric Cochrane's Q, Friedman's test, and generalized estimating equations (p < .05). Results Compared to healthy reference data, this sample of individuals with ALS displayed a higher proportion of swallows with partial or incomplete LVC (24% vs. < 1%), increased time-to-LVC (d = 1.09), reduced UESwidth (d = 0.59), enlarged pharyngeal area at maximum constriction, prolonged LVCdur (d = 0.64), and prolonged UESOdur (d = 1.34). Unsafe swallowing (i.e., PAS ≥ 3) occurred more frequently when LVC was partial/incomplete or time-to-LVC was prolonged. Pharyngeal residue was associated with larger pharyngeal areas at maximum constriction. Unsafe swallowing occurred less frequently with extremely thick liquids, compared to thin liquids. No significant differences in pharyngeal residue were observed based on liquid thickness. Conclusions Quantitative videofluoroscopic measurements revealed moderate-to-large differences in swallow physiology between this sample of individuals with ALS and healthy reference data. Increased time-to-LVC, noncomplete LVC, and enlarged pharyngeal area at maximum constriction were associated with impaired swallow safety or efficiency. Thickened liquids may mitigate the risk of acute episodes of aspiration in individuals with ALS. Further work is needed to corroborate these preliminary findings and explore how swallowing profiles evolve throughout disease progression.
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Affiliation(s)
- Ashley A. Waito
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
| | | | - Carly E. A. Barbon
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
| | - Melanie Peladeau-Pigeon
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
| | - Lauren Tabor-Gray
- Department of Neurology, Holy Cross Hospital, Phil Smith Neuroscience Institute, Fort Lauderdale, FL
| | - Kelby Magennis
- Swallowing Systems Core, University of Florida, Gainesville
| | - Raele Robison
- Swallowing Systems Core, University of Florida, Gainesville
| | - Catriona M. Steele
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
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Yuan TW, He Y, Wang SB, Kong P, Cao J. Technical success rate and safety of radiologically inserted gastrostomy versus percutaneous endoscopic gastrostomy in motor neuron disease patients undergoing: A systematic review and meta-analysis. J Neurol Sci 2020; 410:116622. [DOI: 10.1016/j.jns.2019.116622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/22/2019] [Accepted: 12/06/2019] [Indexed: 12/13/2022]
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24
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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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25
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Keage M, Delatycki MB, Dyer J, Corben LA, Vogel AP. Changes detected in swallowing function in Friedreich ataxia over 12 months. Neuromuscul Disord 2019; 29:786-793. [DOI: 10.1016/j.nmd.2019.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/08/2019] [Accepted: 08/23/2019] [Indexed: 12/20/2022]
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26
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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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27
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Osman KL, Kohlberg S, Mok A, Brooks R, Lind LA, McCormack K, Ferreira A, Kadosh M, Fagan MK, Bearce E, Nichols NL, Coates JR, Lever TE. Optimizing the Translational Value of Mouse Models of ALS for Dysphagia Therapeutic Discovery. Dysphagia 2019; 35:343-359. [PMID: 31300881 DOI: 10.1007/s00455-019-10034-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/10/2019] [Accepted: 07/02/2019] [Indexed: 01/03/2023]
Abstract
The goal of this study was to compare dysphagia phenotypes in low and high copy number (LCN and HCN) transgenic superoxide dismutase 1 (SOD1) mouse models of ALS to accelerate the discovery of novel and effective treatments for dysphagia and early amyotrophic lateral sclerosis (ALS) diagnosis. Clinicopathological features of dysphagia were characterized in individual transgenic mice and age-matched controls utilizing videofluoroscopy in conjunction with postmortem assays of the tongue and hypoglossal nucleus. Quantitative PCR accurately differentiated HCN-SOD1 and LCN-SOD1 mice and nontransgenic controls. All HCN-SOD1 mice developed stereotypical paralysis in both hindlimbs. In contrast, LCN-SOD1 mice displayed wide variability in fore- and hindlimb involvement. Lick rate, swallow rate, inter-swallow interval, and pharyngeal transit time were significantly altered in both HCN-SOD1 and LCN-SOD1 mice compared to controls. Tongue weight, tongue dorsum surface area, total tongue length, and caudal tongue length were significantly reduced only in the LCN-SOD1 mice compared to age-matched controls. LCN-SOD1 mice with lower body weights had smaller/lighter weight tongues, and those with forelimb paralysis and slower lick rates died at a younger age. LCN-SOD1 mice had a 32% loss of hypoglossal neurons, which differed significantly when compared to age-matched control mice. These novel findings for LCN-SOD1 mice are congruent with reported dysphagia and associated tongue atrophy and hypoglossal nucleus pathology in human ALS patients, thus highlighting the translational potential of this mouse model in ALS research.
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Affiliation(s)
- Kate L Osman
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
| | - Sabrina Kohlberg
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
| | - Alexis Mok
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
| | - Ryan Brooks
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
| | - Lori A Lind
- Department of Biomedical Sciences, University of Missouri College of Veterinary Medicine, Columbia, MO, USA
| | - Katelyn McCormack
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
| | - Andries Ferreira
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
| | - Matan Kadosh
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
| | - Mary K Fagan
- Department of Communication Science and Disorders, University of Missouri School of Health Professions, Columbia, MO, USA
| | - Elizabeth Bearce
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
| | - Nicole L Nichols
- Department of Biomedical Sciences, University of Missouri College of Veterinary Medicine, Columbia, MO, USA
| | - Joan R Coates
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, MO, USA
| | - Teresa E Lever
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA. .,Department of Biomedical Sciences, University of Missouri College of Veterinary Medicine, Columbia, MO, USA. .,Department of Communication Science and Disorders, University of Missouri School of Health Professions, Columbia, MO, USA.
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Yunusova Y, Plowman EK, Green JR, Barnett C, Bede P. Clinical Measures of Bulbar Dysfunction in ALS. Front Neurol 2019; 10:106. [PMID: 30837936 PMCID: PMC6389633 DOI: 10.3389/fneur.2019.00106] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/28/2019] [Indexed: 12/31/2022] Open
Abstract
Bulbar impairment represents a hallmark feature of Amyotrophic Lateral Sclerosis (ALS) that significantly impacts survival and quality of life. Speech and swallowing dysfunction are key contributors to the clinical heterogeneity of ALS and require well-timed and carefully coordinated interventions. The accurate clinical, radiological and electrophysiological assessment of bulbar dysfunction in ALS is one of the most multidisciplinary aspects of ALS care, requiring expert input from speech-language pathologists (SLPs), neurologists, otolaryngologists, augmentative alternative communication (AAC) specialists, dieticians, and electrophysiologists—each with their own evaluation strategies and assessment tools. The need to systematically evaluate the comparative advantages and drawbacks of various bulbar assessment instruments and to develop integrated assessment protocols is increasingly recognized. In this review, we provide a comprehensive appraisal of the most commonly utilized clinical tools for assessing and monitoring bulbar dysfunction in ALS based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) evaluation framework. Despite a plethora of assessment tools, considerable geographical differences exist in bulbar assessment practices and individual instruments exhibit considerable limitations. The gaps identified in the literature offer unique opportunities for the optimization of existing and development of new tools both for clinical and research applications. The multicenter validation and standardization of these instruments will be essential for guideline development and best practice recommendations.
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Affiliation(s)
- Yana Yunusova
- Department of Speech Language Pathology, University of Toronto, Toronto, ON, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Volcal Tract Visualization Lab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Emily K Plowman
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, United States
| | - Jordan R Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, United States.,Speech and Hearing Biosciences and Technology Program, Harvard University, Cambridge, MA, United States
| | - Carolina Barnett
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Peter Bede
- Computational Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
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29
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Chiaramonte R, Di Luciano C, Chiaramonte I, Serra A, Bonfiglio M. Multi-disciplinary clinical protocol for the diagnosis of bulbar amyotrophic lateral sclerosis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2017.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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30
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Waito AA, Tabor-Gray LC, Steele CM, Plowman EK. Reduced pharyngeal constriction is associated with impaired swallowing efficiency in Amyotrophic Lateral Sclerosis (ALS). Neurogastroenterol Motil 2018; 30:e13450. [PMID: 30129164 PMCID: PMC6249041 DOI: 10.1111/nmo.13450] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Swallowing inefficiency is a prevalent but understudied problem in individuals with Amyotrophic Lateral Sclerosis (ALS). Although reduced pharyngeal constriction has been identified as a mechanism contributing to swallowing inefficiency following stroke, this relationship has not been empirically tested in the ALS population. This study sought to characterize profiles of swallowing efficiency in a sample of ALS patients and investigate relationships between pharyngeal constriction and swallowing efficiency. METHODS Twenty-six adults with ALS underwent videofluoroscopic swallowing studies, involving 3 mL-thin, 20 mL-thin, and 3 mL-pudding boluses. Full-length recordings were segmented into bolus clips and randomized for analysis. We recorded the total number of swallows per bolus and obtained normalized pixel-based measures of pharyngeal constriction area and post-swallow residue in the vallecular and pyriform sinuses. Linear mixed models with Spearman's correlations were used to determine relationships between pharyngeal constriction and swallowing efficiency, with added factors of bolus volume and thickness. KEY RESULTS Individuals with ALS demonstrated reduced pharyngeal constriction and increased vallecular and pyriform sinus residue, compared to norms. Reduced pharyngeal constriction had a significant effect on the presence of vallecular and pyriform sinus residue as well as the number of swallows per bolus. Increased bolus thickness was associated with increased vallecular residue, while increased bolus volume was associated with reduced pharyngeal constriction. Results were significant at P < 0.05. CONCLUSIONS & INFERENCES Our results suggest that reduced pharyngeal constriction is a significant physiological parameter related to swallow inefficiency in ALS. Future work is needed to corroborate these preliminary results and investigate factors to mitigate such impairments.
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Affiliation(s)
- A. A. Waito
- Toronto Rehabilitation Institute – University Health Network,University of Toronto – Rehabilitation Sciences Institute
| | - L. C. Tabor-Gray
- Swallowing Systems Core – University of Florida,Phil Smith Neuroscience Institute – Holy Cross Hospital
| | - C. M Steele
- Toronto Rehabilitation Institute – University Health Network,University of Toronto – Rehabilitation Sciences Institute
| | - E. K. Plowman
- Swallowing Systems Core – University of Florida,Department of Speech - Language and Hearing Sciences – University of Florida,Department of Neurology – University of Florida
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Perry BJ, Martino R, Yunusova Y, Plowman EK, Green JR. Lingual and Jaw Kinematic Abnormalities Precede Speech and Swallowing Impairments in ALS. Dysphagia 2018; 33:840-847. [PMID: 29774424 PMCID: PMC6244810 DOI: 10.1007/s00455-018-9909-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 05/10/2018] [Indexed: 11/18/2022]
Abstract
Early identification of bulbar involvement in persons with ALS is critical for improving diagnosis and prognosis; however, efficacious diagnostic markers have not yet been identified. The purpose of this study was to determine whether kinematic changes of the tongue and jaw during swallowing, measured using 3D electromagnetic articulography (EMA), predate clinically identifiable symptoms of speech and swallowing impairment in persons diagnosed with ALS. Data were collected from 16 adults diagnosed with ALS and 18 neurotypical controls. Groups were aged matched. Eligible participants with ALS were tolerating an unrestricted diet (FOIS = 7), produced intelligible speech (> 97%), and had a speaking rate greater than 150 words per minute. Participants completed a 3-mL water swallow task, during which EMA recorded kinematic measures of the anterior and posterior regions of tongue including lingual speed, range of motion, duration, coordination, and efficiency. Jaw speed and range of motion were also recorded. Persons diagnosed with ALS demonstrated reduced posterior lingual range of motion (11.40 mm ± 4.01 vs. 16.07 mm ± 5.27), slower posterior lingual speeds (83.67 mm/s ± 47.96 vs. 141.35 mm/s ± 66.54), increased lingual movement duration (13.46 s ± 6.75 vs. 9.21 s ± 3.28), and reduced lingual coordination (0.04 s ± 0.11 vs. 17 s ± 0.19) during the 3-oz water swallow task compared to controls. Persons diagnosed with ALS demonstrated increased range of motion (9.86 mm ± 5.38 vs. 6 mm ± 3.78) and increased jaw speed (68.62 mm/s ± 50.13 vs. 34.72 mm/s ± 17.75) during swallowing compared to controls. The current findings suggest that changes in lingual and jaw motor performance during a simple water swallow task are present in persons with ALS who are pre-symptomatic of clinically detectable bulbar impairment.
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Affiliation(s)
- Bridget J Perry
- MGH Institute of Health Professions, 79/96 13th Street, Charlestown, MA, 02109, USA
| | - Rosemary Martino
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- University Health Network - Toronto Rehabilitation Institute, Toronto, Canada
- Biological Sciences, Sunnybrook Research Institute, 160-500 University Ave, Toronto, ON, M5G1V7, Canada
| | - Emily K Plowman
- Swallowing Systems Core, University of Florida, Gainesville, FL, USA
- Department of Speech-Language Hearing Sciences and Neurology, University of Florida, Gainesville, FL, 32610, USA
| | - Jordan R Green
- MGH Institute of Health Professions, 79/96 13th Street, Charlestown, MA, 02109, USA.
- Program in Speech and Hearing Bioscience and Technology, Harvard University, 260 Longwood Avenue, Boston, MA, 02115, USA.
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32
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Lind LA, Murphy ER, Lever TE, Nichols NL. Hypoglossal Motor Neuron Death Via Intralingual CTB-saporin (CTB-SAP) Injections Mimic Aspects of Amyotrophic Lateral Sclerosis (ALS) Related to Dysphagia. Neuroscience 2018; 390:303-316. [PMID: 30179644 DOI: 10.1016/j.neuroscience.2018.08.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/20/2018] [Accepted: 08/24/2018] [Indexed: 12/13/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating disease leading to degeneration of motor neurons and skeletal muscles, including those required for swallowing. Tongue weakness is one of the earliest signs of bulbar dysfunction in ALS, which is attributed to degeneration of motor neurons in the hypoglossal nucleus in the brainstem, the axons of which directly innervate the tongue. Despite its fundamental importance, dysphagia (difficulty swallowing) and strategies to preserve swallowing function have seldom been studied in ALS models. It is difficult to study dysphagia in ALS models since the amount and rate at which hypoglossal motor neuron death occurs cannot be controlled, and degeneration is not limited to the hypoglossal nucleus. Here, we report a novel experimental model using intralingual injections of cholera toxin B conjugated to saporin (CTB-SAP) to study the impact of only hypoglossal motor neuron death without the many complications that are present in ALS models. Hypoglossal motor neuron survival, swallowing function, and hypoglossal motor output were assessed in Sprague-Dawley rats after intralingual injection of either CTB-SAP (25 g) or unconjugated CTB and SAP (controls) into the genioglossus muscle. CTB-SAP treated rats exhibited significant (p ≤ 0.05) deficits vs. controls in: (1) lick rate (6.0 ± 0.1 vs. 6.6 ± 0.1 Hz; (2) hypoglossal motor output (0.3 ± 0.05 vs. 0.6 ± 0.10 mV); and (3) hypoglossal motor neuron survival (398 ± 34 vs. 1018 ± 41 neurons). Thus, this novel, inducible model of hypoglossal motor neuron death mimics the dysphagia phenotype that is observed in ALS rodent models, and will allow us to study strategies to preserve swallowing function.
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Affiliation(s)
- Lori A Lind
- Department of Biomedical Sciences, University of Missouri, Columbia, MO 65211, United States
| | - Erika R Murphy
- Department of Communication Science and Disorders, University of Missouri, Columbia, MO 65211, United States
| | - Teresa E Lever
- Department of Biomedical Sciences, University of Missouri, Columbia, MO 65211, United States; Department of Communication Science and Disorders, University of Missouri, Columbia, MO 65211, United States; Department of Otolaryngology-Head and Neck Surgery, University of Missouri, Columbia, MO 65211, United States
| | - Nicole L Nichols
- Department of Biomedical Sciences, University of Missouri, Columbia, MO 65211, United States; Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO 65211, United States.
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33
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Watanabe M, Shiraishi W, Yamasaki R, Isobe N, Sawatsubashi M, Yasumatsu R, Nakagawa T, Kira JI. Oral phase dysphagia in facial onset sensory and motor neuronopathy. Brain Behav 2018; 8:e00999. [PMID: 29781209 PMCID: PMC5991595 DOI: 10.1002/brb3.999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/11/2018] [Accepted: 04/15/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Facial onset motor and sensory neuronopathy (FOSMN) is a rare disease whose cardinal features are initial asymmetrical facial sensory deficits followed by bulbar symptoms and spreading of sensory and motor deficits from face to scalp, neck, upper trunk, and upper extremities in a rostral-caudal direction. Although bulbar involvement is frequently observed in FOSMN, dysphagia in these patients has not been fully described. In this study, we aimed to characterize dysphagia as a prognostic factor in FOSMN by investigating our institutional case series. METHODS We retrospectively reviewed the medical records, including swallowing function tests, of six patients with FOSMN (three men and three women) who were thoroughly examined at Kyushu University Hospital between 1 January 2005 and 30 November 2017. RESULTS Average age at onset was 58.5 years; average disease duration was 5.7 years. All patients developed bulbar dysfunction and dysphagia (at an average of 1.8 and 2.6 years from onset, respectively), resulting in choking episodes in three patients, percutaneous endoscopic gastrostomy placement in three, and recurrent aspiration pneumonia in one. Four of five patients evaluated with videofluoroscopic swallowing studies had poor oral retention, leading to bolus flowing into the pharynx before swallowing; the fifth patient showed poor lingual transfer. Fiberoptic endoscopic evaluation of swallowing revealed leakage of blue-dyed water from the mouth to the pharynx in three patients because of poor oral retention, but only mild pharyngeal phase dysphagia in all four cases evaluated. CONCLUSIONS Oral phase dysphagia predominates in the early stage of FOSMN.
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Affiliation(s)
- Mitsuru Watanabe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Wataru Shiraishi
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryo Yamasaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriko Isobe
- Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Motohiro Sawatsubashi
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryuji Yasumatsu
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Chiaramonte R, Di Luciano C, Chiaramonte I, Serra A, Bonfiglio M. Multi-disciplinary clinical protocol for the diagnosis of bulbar amyotrophic lateral sclerosis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 70:25-31. [PMID: 29699694 DOI: 10.1016/j.otorri.2017.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/21/2017] [Accepted: 12/08/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND OBJECTIVES The objective of this study was to examine the role of different specialists in the diagnosis of amyotrophic lateral sclerosis (ALS), to understand changes in verbal expression and phonation, respiratory dynamics and swallowing that occurred rapidly over a short period of time. MATERIALS AND METHODS 22 patients with bulbar ALS were submitted for voice assessment, ENT evaluation, Multi-Dimensional Voice Program (MDVP), spectrogram, electroglottography, fiberoptic endoscopic evaluation of swallowing. RESULTS In the early stage of the disease, the oral tract and velopharyngeal port were involved. Three months after the initial symptoms, most of the patients presented hoarseness, breathy voice, dysarthria, pitch modulation problems and difficulties in pronunciation of explosive, velar and lingual consonants. Values of MDVP were altered. Spectrogram showed an additional formant, due to nasal resonance. Electroglottography showed periodic oscillation of the vocal folds only during short vocal cycle. Swallowing was characterized by weakness and incoordination of oro-pharyngeal muscles with penetration or aspiration. CONCLUSIONS A specific multidisciplinary clinical protocol was designed to report vocal parameters and swallowing disorders that changed more quickly in bulbar ALS patients. Furthermore, the patients were stratified according to involvement of pharyngeal structures, and severity index.
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Affiliation(s)
- Rita Chiaramonte
- Department of Physical Medicine and Rehabilitation, University of Catania, 95125 Catania, Italy.
| | - Carmela Di Luciano
- Department for Health activities and Epidemiologic Observatory, Sicily Region, Italy
| | | | - Agostino Serra
- Departments of Otolaryngology, University of Catania, 95125 Catania, Italy
| | - Marco Bonfiglio
- Department for Health activities and Epidemiologic Observatory, Sicily Region, Italy
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Brandão BC, Galdino ADS, Lourenção LG, Trindade GS, Silva MAOMD, Silva RGD. Correlation between bulbar functionality and laryngeal penetration and/or laryngotracheal aspiration on motor neuron disease. Codas 2018. [PMID: 29513871 DOI: 10.1590/2317-1782/20182017056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Describe and correlate bulbar functionality with laryngeal penetration and/or laryngotracheal aspiration for different food consistencies in Motor Neuron Disease (MND). METHODS Study participants were 18 individuals diagnosed with MND regardless of the type and time of onset of disease. The Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised/BR (ALSFRS-R/BR) was applied, and only the bulbar parameter, which includes speech, salivation and swallowing, was analyzed, with scores raging from 0 (disability) to 12 (normal functionality). Swallowing videofluoroscopy was performed using the Penetration-Aspiration Scale (PAS) described by Rosenbek et al. (1996). The Pearson correlation test was used for data analysis. RESULTS According to food consistency, the PAS level ranged from 1 to 5 for puree consistency, 1 to 4 for thickened liquid, and 1 to 3 for liquid, and no laryngotracheal aspiration was observed. Negative correlation between bulbar functionality and laryngeal penetration was observed for all food consistencies (pasty: r=-0.487, p=0.041; thickened liquid: r=-0.442, p=0.076; liquid r=0.460, p=0.073), but statistically significant difference was found only for the puree consistency, that is, individuals with poor bulbar functionality presented higher levels of laryngeal penetration. CONCLUSION Negative correlation was observed between bulbar functionality and laryngeal penetration in MND. The bulbar parameters of the ALSFRS-R/BR are significant for predicting risk of laryngotracheal aspiration for pasty consistency in MND.
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Affiliation(s)
| | - Alline de Sousa Galdino
- Faculdade de Medicina de São José do Rio Preto - FAMERP - São José do Rio Preto (SP), Brasil
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ESPEN guideline clinical nutrition in neurology. Clin Nutr 2018; 37:354-396. [DOI: 10.1016/j.clnu.2017.09.003] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 12/12/2022]
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Computational Analysis of Pharyngeal Swallowing Mechanics in Patients with Motor Neuron Disease: A Pilot Investigation. Dysphagia 2017; 33:243-250. [DOI: 10.1007/s00455-017-9853-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/03/2017] [Indexed: 12/13/2022]
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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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Clinical assessment of dysphagia in neurodegeneration (CADN): development, validity and reliability of a bedside tool for dysphagia assessment. J Neurol 2017; 264:1107-1117. [DOI: 10.1007/s00415-017-8499-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 04/24/2017] [Accepted: 04/26/2017] [Indexed: 12/12/2022]
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Tomik J, Tomik B, Gajec S, Ceranowicz P, Pihut M, Olszanecki R, Stręk P, Składzień J. The Balloon-Based Manometry Evaluation of Swallowing in Patients with Amyotrophic Lateral Sclerosis. Int J Mol Sci 2017; 18:ijms18040707. [PMID: 28346382 PMCID: PMC5412293 DOI: 10.3390/ijms18040707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/10/2017] [Accepted: 03/22/2017] [Indexed: 11/25/2022] Open
Abstract
The aim of the study was to analyse the disturbances of the oro-pharyngeal swallowing phase of dysphagia in amyotrophic lateral sclerosis (ALS) patients with the use of specific manometric measurements and to evaluate their plausible association with the duration of the disease. Seventeen patients with ALS were evaluated with manometric examinations of the oral and pharyngeal part of the gastrointestinal tract. Tests were carried out by using the oesophageal balloon-based method with four balloon transducers located 5 cm away from each other. The following manometric parameters were analysed: the base of tongue contraction (BTC) and the upper oesophageal sphincter pressure (UESP), and the hypopharyngeal suction pump (HSP) as well as the oro-pharyngeal, pharyngeal and hypopharyngeal transit time and average pharyngeal bolus velocity (oropharyngeal transit time (OTT), pharyngeal transit time (PTT), hypopharyngeal transit time (HTT) and average pharyngeal bolus velocity (APBV), respectively). Manomatric examinations during swallowing in patients with ALS showed significant weakness of BTC, a decrease of HSP and a decrease of the velocity of bolus transit inside the pharynx which were particularly marked between the first and the third examination. Manometric examinations of the oro-pharyngeal part of the gastrointestinal tract are useful and supportive methods in the analysis of swallowing disturbances in ALS patients.
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Affiliation(s)
- Jerzy Tomik
- Ear, Nose & Throat (ENT) Department, Faculty of Medicine, Jagiellonian University Medical College, Kraków 31-531, Poland.
| | - Barbara Tomik
- Department of Neurology, Faculty of Medicine, Jagiellonian University Medical College, Kraków 31-503, Poland.
| | - Sebastian Gajec
- Ear, Nose & Throat (ENT) Department, Faculty of Medicine, Jagiellonian University Medical College, Kraków 31-531, Poland.
| | - Piotr Ceranowicz
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków 31-531, Poland.
| | - Małgorzata Pihut
- Department of Prosthetic Dentistry, Faculty of Medicine, Jagiellonian University Medical College, Kraków 31-155, Poland.
| | - Rafał Olszanecki
- Department of Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, Kraków 31-531, Poland.
| | - Paweł Stręk
- Ear, Nose & Throat (ENT) Department, Faculty of Medicine, Jagiellonian University Medical College, Kraków 31-531, Poland.
| | - Jacek Składzień
- Ear, Nose & Throat (ENT) Department, Faculty of Medicine, Jagiellonian University Medical College, Kraków 31-531, Poland.
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Yamada Y, Kawakami M, Wada A, Otsuka T, Muraoka K, Liu M. A comparison of swallowing dysfunction in Becker muscular dystrophy and Duchenne muscular dystrophy. Disabil Rehabil 2017; 40:1421-1425. [PMID: 28288529 DOI: 10.1080/09638288.2017.1298680] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Swallowing dysfunction has been reported in Duchenne muscular dystrophy (DMD), but has not been studied in Becker muscular dystrophy (BMD). The aims of this study were to report the characteristics of swallowing dysfunction in BMD compared with DMD. MATERIALS AND METHODS The study participants were 18 patients with BMD and 18 patients with DMD. All the patients were examined using videofluorography during swallowing of 5 mL of fluid. The penetration-aspiration scale (P-A scale) and the videofluorographic dysphagia scale (VDS) were used to evaluate dysphagia. RESULTS Swinyard functional ability stage was not significantly different between the BMD and DMD groups. Rate of aspiration, P-A scale score, and total VDS score did not differ across groups, but the VDS item score for laryngeal elevation was lower in the BMD group than in the DMD group (median scores 4.5 and 9, respectively; p < 0.001). In the BMD group, total VDS score significantly correlated with Swinyard stage (r = 0.78, p < 0.001), but not with age or lung function. CONCLUSION Patients with BMD have swallowing problems similar to those observed in patients with DMD when matched according to physical functional status. These patients should be evaluated and followed-up for the duration of their disease. Implications for rehabiliation Dysphagia is one of the most critical problems in patients with progressive neuromuscular disease but dysphagia in patients with Becker muscular dystrophy (BMD) was not well known. Eighteen patients with BMD and 18 patients with Duchenne muscular dystrophy were examined with videofluorography. Patients with BMD have swallowing problems similar to those observed in patients with DMD.
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Affiliation(s)
- Yuka Yamada
- a Department of Rehabilitation Medicine , National Higashisaitama Hospital , Saitama , Japan.,b Department of Rehabilitation Medicine , Keio University School of Medicine , Tokyo , Japan
| | - Michiyuki Kawakami
- b Department of Rehabilitation Medicine , Keio University School of Medicine , Tokyo , Japan
| | - Ayako Wada
- a Department of Rehabilitation Medicine , National Higashisaitama Hospital , Saitama , Japan.,b Department of Rehabilitation Medicine , Keio University School of Medicine , Tokyo , Japan
| | - Tomoyoshi Otsuka
- a Department of Rehabilitation Medicine , National Higashisaitama Hospital , Saitama , Japan.,b Department of Rehabilitation Medicine , Keio University School of Medicine , Tokyo , Japan
| | - Kaori Muraoka
- b Department of Rehabilitation Medicine , Keio University School of Medicine , Tokyo , Japan
| | - Meigen Liu
- b Department of Rehabilitation Medicine , Keio University School of Medicine , Tokyo , Japan
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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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Keating GM. Riluzole oral suspension in amyotrophic lateral sclerosis: a guide to its use. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0312-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Nakamori M, Hosomi N, Takaki S, Oda M, Hiraoka A, Yoshikawa M, Matsushima H, Ochi K, Tsuga K, Maruyama H, Izumi Y, Matsumoto M. Tongue thickness evaluation using ultrasonography can predict swallowing function in amyotrophic lateral sclerosis patients. Clin Neurophysiol 2016; 127:1669-1674. [DOI: 10.1016/j.clinph.2015.07.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/22/2015] [Accepted: 07/29/2015] [Indexed: 12/12/2022]
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Crary MA. Adult Neurologic Disorders. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00003-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wada A, Kawakami M, Liu M, Otaka E, Nishimura A, Liu F, Otsuka T. Development of a new scale for dysphagia in patients with progressive neuromuscular diseases: the Neuromuscular Disease Swallowing Status Scale (NdSSS). J Neurol 2015; 262:2225-31. [PMID: 26142025 DOI: 10.1007/s00415-015-7836-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 06/24/2015] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
Abstract
Dysphagia is one of the most critical problems in patients with progressive neuromuscular diseases. However, clinically useful and practical scales to evaluate dysphagia are limited. Therefore, the aim of this study was to develop such a scale. An 8-stage Neuromuscular Disease Swallowing Status Scale (NdSSS) was developed and tested for its inter- and intrarater reliabilities, concurrent validity, and responsiveness. The NdSSS was used to evaluate 134 patients with Duchenne muscular dystrophy (DMD) and 84 patients with amyotrophic lateral sclerosis (ALS). Inter- and intrarater reliabilities were examined with weighted kappa statistics. Concurrent validity was assessed by correlating the NdSSS with the existing scales [Functional Oral Intake Scale (FOIS), Functional Intake LEVEL Scales (FILS), and ALS Functional Rating Scale-Revised Swallow (ALSFRS-R Sw)], using Spearman's correlation coefficients. Responsiveness was determined with the standardized response mean (SRM). For inter- and intrarater reliabilities, the weighted kappas were 0.95 and 1.00, respectively, for DMD; and 0.98 and 0.98, respectively, for ALS. The NdSSS showed strong correlations with the FOIS (rs = 0.87 for DMD, rs = 0.93 for ALS, p < 0.001), FILS (rs = 0.89 for DMD, rs = 0.92 for ALS, p < 0.001), and ALSFRS-R SW (rs = 0.93, p < 0.001). SRMs were 0.65 for DMD and 1.21 for ALS. The SRM was higher in DMD patients for the NdSSS than for the other scales, while it was similar in ALS patients and the other scales. Our originally developed NdSSS demonstrated sufficient reliability, validity, and responsiveness in patients with DMD and ALS. It is also useful in evaluating dysphagia in patients with progressive neuromuscular diseases.
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Affiliation(s)
- Ayako Wada
- Department of Rehabilitation Medicine, National Higashisaitama Hospital, Saitama, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Eri Otaka
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Atsuko Nishimura
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Fumio Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomoyoshi Otsuka
- Department of Rehabilitation Medicine, National Higashisaitama Hospital, Saitama, Japan
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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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Omari TI, Wiklendt L, Dinning P, Costa M, Rommel N, Cock C. Upper esophageal sphincter mechanical states analysis: a novel methodology to describe UES relaxation and opening. Front Syst Neurosci 2015; 8:241. [PMID: 25610376 PMCID: PMC4285690 DOI: 10.3389/fnsys.2014.00241] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/04/2014] [Indexed: 12/14/2022] Open
Abstract
The swallowing muscles that influence upper esophageal sphincter (UES) opening are centrally controlled and modulated by sensory information. Activation of neural inputs to these muscles, the intrinsic cricopharyngeus muscle and extrinsic suprahyoid muscles, results in their contraction or relaxation, which changes the diameter of the lumen, alters the intraluminal pressure and ultimately inhibits or promotes flow of content. This relationship that exists between the changes in diameter and concurrent changes in intraluminal pressure has been used previously to calculate the “mechanical states” of the muscle; that is when the muscles are passively or actively, relaxing or contracting. Diseases that alter the neural pathways to these muscles can result in weakening the muscle contractility and/or decreasing the muscle compliance, all of which can cause dysphagia. Detecting these changes in the mechanical state of the muscle is difficult and as the current interpretation of UES motility is based largely upon pressure measurement (manometry), subtle changes in the muscle function during swallow can be missed. We hypothesized that quantification of mechanical states of the UES and the pressure-diameter properties that define them, would allow objective characterization of the mechanisms that govern the timing and extent of UES opening during swallowing. To achieve this we initially analyzed swallows captured by simultaneous videofluoroscopy and UES pressure with impedance recording. From these data we demonstrated that intraluminal impedance measurements could be used to determine changes in the internal diameter of the lumen when compared to videofluoroscopy. Then using a database of pressure-impedance studies, recorded from young and aged healthy controls and patients with motor neuron disease, we calculated the UES mechanical states in relation to a standardized swallowed bolus volume, normal aging and dysphagia pathology. Our results indicated that eight different mechanical states were almost always seen during healthy swallowing and some of these calculated changes in muscle function were consistent with the known neurally dependent phasic discharge patterns of cricopharyngeus muscle activity during swallowing. Clearly defined changes in the mechanical states were observed in motor neuron disease when compared to age matched healthy controls. Our data indicate that mechanical state predictions were simple to apply and revealed patterns consistent with the known neural inputs activating the different muscles during swallowing.
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Affiliation(s)
- Taher I Omari
- Department of Human Physiology, School of Medicine, Flinders University Adelaide, SA, Australia ; Department of Gastroenterology and Hepatology, Flinders Medical Centre and School of Medicine, Flinders University Adelaide, SA, Australia
| | - Lukasz Wiklendt
- Department of Human Physiology, School of Medicine, Flinders University Adelaide, SA, Australia
| | - Philip Dinning
- Department of Human Physiology, School of Medicine, Flinders University Adelaide, SA, Australia ; Department of Gastroenterology and Hepatology, Flinders Medical Centre and School of Medicine, Flinders University Adelaide, SA, Australia
| | - Marcello Costa
- Department of Human Physiology, School of Medicine, Flinders University Adelaide, SA, Australia
| | - Nathalie Rommel
- Translational Research Center for Gastrointestinal Diseases, University of Leuven Leuven, Belgium
| | - Charles Cock
- Department of Gastroenterology and Hepatology, Flinders Medical Centre and School of Medicine, Flinders University Adelaide, SA, Australia
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Balendra R, Jones A, Jivraj N, Steen IN, Young CA, Shaw PJ, Turner MR, Leigh PN, Al-Chalabi A. Use of clinical staging in amyotrophic lateral sclerosis for phase 3 clinical trials. J Neurol Neurosurg Psychiatry 2015; 86:45-9. [PMID: 24463480 DOI: 10.1136/jnnp-2013-306865] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The use of clinical staging in the fatal neurodegenerative disease amyotrophic lateral sclerosis would have value in optimising future therapeutic trials. We aimed to use previous clinical trial data to determine the length of time patients spend in each of four proposed stages, its range and transition patterns to subsequent stages. METHODS Using databases from two multicentre clinical trials, patients were retrospectively staged through the trial course. At each stage we assessed whether patients then progressed to an earlier, consecutive or later stage or death. Duration spent in each stage before progression to a later stage was calculated. RESULTS There were 725 patients. No patients moved to an earlier stage. More patients at stages 1, 2 and 3 progressed to the consecutive stage rather than skipping a stage. 59.3% of patients at Stage 1 progressed to Stage 2, 54.0% of patients at Stage 2 progressed to Stage 3, 42.3% of patients at Stage 3 progressed to Stage 4 and 47.0% of Stage 4 patients progressed to death. Transition times between stages had a median duration of 3 to 7 months for stages 2 to 4. DISCUSSION We have shown using trial data that transition times between stages are short. Use of stage duration as an endpoint might allow a shorter trial duration. We have shown face validity in this system as most patients progress through consecutive stages, and none revert to earlier stages. Furthermore, we have shown the system is reliable across populations and therefore has content validity.
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Affiliation(s)
- Rubika Balendra
- King's College London, Institute of Psychiatry, Department of Clinical Neuroscience, London, UK
| | - Ashley Jones
- King's College London, Institute of Psychiatry, Department of Clinical Neuroscience, London, UK
| | - Naheed Jivraj
- Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK
| | - I Nick Steen
- Institute of Health and Safety, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Pamela J Shaw
- Academic Neurology Unit, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - P Nigel Leigh
- Brighton and Sussex Medical School, Trafford Centre for Biomedical Research, University of Sussex, Falmer, East Sussex, UK
| | - Ammar Al-Chalabi
- King's College London, Institute of Psychiatry, Department of Clinical Neuroscience, London, UK
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