1
|
Martí Y, Aponte Ribero V, Batson S, Mitchell S, Gorni K, Gusset N, Oskoui M, Servais L, Deconinck N, McGrattan KE, Mercuri E, Sutherland CS. A Systematic Literature Review of the Natural History of Respiratory, Swallowing, Feeding, and Speech Functions in Spinal Muscular Atrophy (SMA). J Neuromuscul Dis 2024:JND230248. [PMID: 38943396 DOI: 10.3233/jnd-230248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Background Respiratory and bulbar dysfunctions (including swallowing, feeding, and speech functions) are key symptoms of spinal muscular atrophy (SMA), especially in its most severe forms. Demonstrating the long-term efficacy of disease-modifying therapies (DMTs) necessitates an understanding of SMA natural history. Objective This study summarizes published natural history data on respiratory, swallowing, feeding, and speech functions in patients with SMA not receiving DMTs. Methods Electronic databases (Embase, MEDLINE, and Evidence-Based Medicine Reviews) were searched from database inception to June 27, 2022, for studies reporting data on respiratory and/or bulbar function outcomes in Types 1-3 SMA. Data were extracted into a predefined template and a descriptive summary of these data was provided. Results Ninety-one publications were included: 43 reported data on respiratory, swallowing, feeding, and/or speech function outcomes. Data highlighted early loss of respiratory function for patients with Type 1 SMA, with ventilatory support typically required by 12 months of age. Patients with Type 2 or 3 SMA were at risk of losing respiratory function over time, with ventilatory support initiated between the first and fifth decades of life. Swallowing and feeding difficulties, including choking, chewing problems, and aspiration, were reported in patients across the SMA spectrum. Swallowing and feeding difficulties, and a need for non-oral nutritional support, were reported before 1 year of age in Type 1 SMA, and before 10 years of age in Type 2 SMA. Limited data relating to other bulbar functions were collated. Conclusions Natural history data demonstrate that untreated patients with SMA experience respiratory and bulbar function deterioration, with a more rapid decline associated with greater disease severity. This study provides a comprehensive repository of natural history data on bulbar function in SMA, and it highlights that consistent assessment of outcomes in this area is necessary to benefit understanding and approval of new treatments.
Collapse
Affiliation(s)
| | | | | | | | | | - Nicole Gusset
- SMA Europe, Freiburg, Germany
- SMA Schweiz, Heimberg, Switzerland
| | - Maryam Oskoui
- Departments of Pediatrics and Neurology Neurosurgery, McGill University, Montreal, Canada
| | - Laurent Servais
- MDUK Oxford Neuromuscular Centre & NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Division of Child Neurology, Centre de Références des Maladies Neuromusculaires, Department of Pediatrics, University Hospital Liège & University of Liège, Liège, Belgium
| | - Nicolas Deconinck
- Neuromuscular Reference Center, UZ Gent, Ghent, Belgium
- Centre de Références des Maladies Neuromusculaires, Department Paediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Katlyn Elizabeth McGrattan
- Department of Speech-Language-Hearing Science, University of Minnesota, Minneapolis, MN, USA
- Department of Rehabilitation, Masonic Children's Hospital, Minneapolis, MN, USA
| | - Eugenio Mercuri
- Pediatric Neurology Institute, Catholic University and Nemo Pediatrico, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Gemelli, IRCCS, Rome, Italy
| | | |
Collapse
|
2
|
Kokaliaris C, Evans R, Hawkins N, Mahajan A, Scott DA, Sutherland CS, Nam J, Sajeev G. Long-Term Comparative Efficacy and Safety of Risdiplam and Nusinersen in Children with Type 1 Spinal Muscular Atrophy. Adv Ther 2024; 41:2414-2434. [PMID: 38705943 PMCID: PMC11133132 DOI: 10.1007/s12325-024-02845-6] [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] [Received: 12/18/2023] [Accepted: 03/13/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Spinal muscular atrophy (SMA) is a severe genetic neuromuscular disease characterized by a loss of motor neurons and progressive muscle weakness. Children with untreated type 1 SMA never sit independently and require increasing levels of ventilatory support as the disease progresses. Without intervention, and lacking ventilatory support, death typically occurs before the age of 2 years. There are currently no head-to-head trials comparing available treatments in SMA. Indirect treatment comparisons are therefore needed to provide information on the relative efficacy and safety of SMA treatments for healthcare decision-making. METHODS The long-term efficacy and safety of risdiplam versus nusinersen in children with type 1 SMA was evaluated using indirect treatment comparison methodology to adjust for differences between population baseline characteristics, to reduce any potential bias in the comparative analysis. An unanchored matching-adjusted indirect comparison was conducted using risdiplam data from 58 children in FIREFISH (NCT02913482) and published aggregate nusinersen data from 81 children obtained from the ENDEAR (NCT02193074) and SHINE (NCT02594124) clinical trials with at least 36 months of follow-up. RESULTS Children with type 1 SMA treated with risdiplam had a 78% reduction in the rate of death, an 81% reduction in the rate of death or permanent ventilation, and a 57% reduction in the rate of serious adverse events compared with children treated with nusinersen. Children treated with risdiplam also had a 45% higher rate of achieving a Hammersmith Infant Neurological Examination, Module 2 motor milestone response and a 186% higher rate of achieving a ≥ 4-point improvement in Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders compared with children treated with nusinersen. CONCLUSION Long-term data supported risdiplam as a superior alternative to nusinersen in children with type 1 SMA. Video abstract available for this article. Video abstract (MP4 184542 KB).
Collapse
Affiliation(s)
| | | | - Neil Hawkins
- Visible Analytics, Oxford, UK
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | | | | | | | - Julian Nam
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
| | | |
Collapse
|
3
|
Bagga P, Singh S, Ram G, Kapil S, Singh A. Diving into progress: a review on current therapeutic advancements in spinal muscular atrophy. Front Neurol 2024; 15:1368658. [PMID: 38854961 PMCID: PMC11157111 DOI: 10.3389/fneur.2024.1368658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/29/2024] [Indexed: 06/11/2024] Open
Abstract
Spinal muscular atrophy (SMA) is an uncommon disorder associated with genes characterized by the gradual weakening and deterioration of muscles, often leading to substantial disability and premature mortality. Over the past decade, remarkable strides have been made in the field of SMA therapeutics, revolutionizing the landscape of patient care. One pivotal advancement is the development of gene-targeted therapies, such as nusinersen, onasemnogene abeparvovec and risdiplam which have demonstrated unprecedented efficacy in slowing disease progression. These therapies aim to address the root cause of SMA by targeting the survival motor neuron (SMN) gene, effectively restoring deficient SMN protein levels. The advent of these innovative approaches has transformed the prognosis for many SMA patients, offering a glimmer of hope where there was once limited therapeutic recourse. Furthermore, the emergence of small molecule compounds and RNA-targeting strategies has expanded the therapeutic arsenal against SMA. These novel interventions exhibit diverse mechanisms of action, including SMN protein stabilization and modulation of RNA splicing, showcasing the multifaceted nature of SMA treatment research. Collective efforts of pharmaceutical industries, research centers, and patient advocacy groups have played an important role in expediting the translation of scientific discoveries into visible clinical benefits. This review not only highlights the remarkable progress achieved in SMA therapeutics but also generates the ray of hope for the ongoing efforts required to enhance accessibility, optimize treatment strategies, rehabilitation (care and therapies) and ultimately pave the way for an improved quality of life for individuals affected by SMA.
Collapse
Affiliation(s)
- Pankaj Bagga
- School of Bioengineering & Biosciences, Lovely Professional University (LPU), Phagwara, India
| | - Sudhakar Singh
- School of Bioengineering & Biosciences, Lovely Professional University (LPU), Phagwara, India
| | - Gobind Ram
- PG Department of Biotechnology, Layalpur Khalsa College, Jalandhar, India
| | - Subham Kapil
- Department of Zoology, DAV College Jalandhar, Jalandhar, India
| | - Avtar Singh
- School of Electrical Engineering and Computing (SoEEC), Adama Science and Technology University (AS-TU), Adama, Ethiopia
| |
Collapse
|
4
|
Leon-Astudillo C, Brooks O, Salabarria SM, Coker M, Corti M, Lammers J, Plowman EK, Byrne BJ, Smith BK. Longitudinal changes of swallowing safety and efficiency in infants with spinal muscular atrophy who received disease modifying therapies. Pediatr Pulmonol 2024; 59:1364-1371. [PMID: 38358081 DOI: 10.1002/ppul.26919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Dysphagia is a common feature of the natural history of patients with spinal muscular atrophy (SMA). Literature regarding swallowing safety and efficiency is scarce in patients with SMA, particularly in the era of newborn screening programs and disease-modifying therapies. OBJECTIVE To describe the longitudinal changes of swallowing safety and efficiency in children with SMA who received one or more disease modifying therapies METHODS: Case series of patients with SMA followed at the University of Florida from 1 May 2019 to 31 December 2022 who had two or more videofluoroscopy swallowing studies (VFSS), with the first being within 30 days of their first treatment. Data extracted from the electronic health record included: neuromotor outcomes, VFSS penetration aspiration scores (PAS), presence of abrnormal oral or pharyngeal residue, clinical history, and timing of disease-modifying therapies administration. RESULTS Seven subjects were included (five male); three were diagnosed via newborn screen. Median age at diagnosis was 10 days (range: 4-250). Median age at initial VFSS was 29 days (range: 9-246), and age at the last VFSS was 26.1 months (range: 18.2-36.2). All subjects received onasemnogene-abeparvovec (OA); four received additional therapies. PAS at diagnosis was abnormal in four subjects. Six subjects required feeding modifications after VFSS results. Of these, three had silent aspiration (PAS 8) and three of them improved after treatment. CONCLUSIONS Swallowing safety and efficiency can be impaired in patients with SMA despite early treatment. Larger, prospective studies are needed to define optimal timiing of longitudinal instrumental evaluations.
Collapse
Affiliation(s)
- Carmen Leon-Astudillo
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Olivia Brooks
- Department of Speech, Language, and Hearing Sciences, University of Florida College of Medicine, Gainesville, Florida, USA
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Florida, USA
| | - Stephanie M Salabarria
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Mackenzi Coker
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Manuela Corti
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jenna Lammers
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Emily K Plowman
- Department of Speech, Language, and Hearing Sciences, University of Florida College of Medicine, Gainesville, Florida, USA
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Florida, USA
| | - Barry J Byrne
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Barbara K Smith
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
5
|
Colot C, Benmechri S, Everaert E, Muys S, Van Himme L, Tahon V, Salmon M, Van Dyck D, De Vos E, Deconinck N. Assessing the Swallowing Function in Children with Spinal Muscular Atrophy: An Easily Accessible and Objective Multidimensional Approach. J Neuromuscul Dis 2024; 11:839-853. [PMID: 38701158 PMCID: PMC11307076 DOI: 10.3233/jnd-240017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/05/2024]
Abstract
Background Spinal muscular atrophy (SMA), a genetic neuromuscular disease caused by lack of survival of motor neuron (SMN) protein, is characterized by muscular atrophy and respiratory and bulbar dysfunction. While swallowing disorders are common, they remain poorly studied. Objectives Our study aimed to explore 1) intraoral pressure measurements with the Iowa Oral Performance Instrument system and the reliability of a Swallowing Function Assessment Questionnaire (SFAQ) in healthy controls, and 2) evaluate their use as swallowing function biomarkers and the evolution of swallowing function over time in children with SMA. Methods We recruited 53 healthy children and 27 SMA patients all treated with SMN gene modulator therapy. Participants completed the SFAQ and underwent at least one measurement of maximal oral pressures (lingual, labial, and masseter). Results Mean oral normalized pressure index were lower (all sites p < 0.001) and mean SFAQ scores were higher (p < 0.001) in patients compared with healthy controls. Pressure evolution over 1 year in SMA patients for all three oral sites did not show significant differences. SFAQ scores correlated negatively with oral pressures at all three sites in patients. Conclusions Both tools provided new insights on the oral and pharyngeal phase of swallowing in SMA patients. In SMA patients, muscle strength in certain crucial anatomical regions during swallowing is weaker than in healthy children.
Collapse
Affiliation(s)
- Charlotte Colot
- Paediatric Neurology Department and Neuromuscular Reference center; Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sarah Benmechri
- Paediatric Neurology Department and Neuromuscular Reference center; Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Elke Everaert
- Neuromuscular Reference Center (NMRC) Universitair Ziekenhuis (UZ Gent), Ghent, Belgium
| | - Sarah Muys
- Neuromuscular Reference Center (NMRC) Universitair Ziekenhuis (UZ Gent), Ghent, Belgium
| | - Linde Van Himme
- Neuromuscular Reference Center (NMRC) Universitair Ziekenhuis (UZ Gent), Ghent, Belgium
| | - Valentine Tahon
- Neuromuscular Reference Center (NMRC) Universitair Ziekenhuis (UZ Gent), Ghent, Belgium
| | - Maurine Salmon
- Department of Biomedical Research; Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Dorine Van Dyck
- Paediatric Neurology Department and Neuromuscular Reference center; Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Elke De Vos
- Neuromuscular Reference Center (NMRC) Universitair Ziekenhuis (UZ Gent), Ghent, Belgium
| | - Nicolas Deconinck
- Paediatric Neurology Department and Neuromuscular Reference center; Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Neuromuscular Reference Center (NMRC) Universitair Ziekenhuis (UZ Gent), Ghent, Belgium
| |
Collapse
|
6
|
Zang J, Witt S, Johannsen J, Weiss D, Denecke J, Dumitrascu C, Nießen A, Quitmann JH, Pflug C, Flügel T. DySMA - an Instrument to Monitor Swallowing Function in Children with Spinal Muscular Atrophy ages 0 to 24 Months: Development, Consensus, and Pilot Testing. J Neuromuscul Dis 2024; 11:473-483. [PMID: 38457144 PMCID: PMC10977442 DOI: 10.3233/jnd-230177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 03/09/2024]
Abstract
Background The manifestation of bulbar symptoms, especially swallowing, is important for evaluating disease-modifying therapies for spinal muscular atrophy (SMA). Due to the lack of instruments, the topic is still underrepresented in research. Objective This study aimed to develop a tool to monitor swallowing development in children aged 0 to 24 months with SMA. Methods The method was guided by the COSMIN guidelines and followed a multi-stage Delphi process. The first step was a rapid review of swallowing outcomes in children with SMA younger than 24 months. In the second step, online group interviews with experts (n = 7) on dysphagia in infants were conducted, followed by an anonymous online survey among experts in infants with SMA (n = 19). A predefined consensus threshold for nominal scaled voting was set at≥75 % and for 5-point Likert scale voting at 1.25 of the interquartile range. The third step was the pilot test of the instrument, performed with three groups (healthy controls n = 8; pre-symptomatic n = 6, symptomatic n = 6). Results Based on the multi-level interprofessional consensus, the DySMA comprises two parts (history and examination), ten categories, with 36 items. Implementation and scoring are clearly articulated and easy to implement. The pilot test showed that swallowing development could be recorded in all groups. Conclusion The DySMA is well suited for monitoring swallowing development in pre-symptomatic and symptomatic treated infants with SMA. It can be performed in a time-efficient and interprofessional manner. The resulting score is comparable to results from other instruments measuring other domains, e.g., motor function.
Collapse
Affiliation(s)
- Jana Zang
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie Witt
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jessika Johannsen
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Deike Weiss
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Denecke
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Charlotte Dumitrascu
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Almut Nießen
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Hannah Quitmann
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Flügel
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
7
|
Allen J, Stone-Ghariani A, Quezada G, Banks D, Rose F, Knight W, Newman J, Newman W, Anderson P, Smith C. Living with Dysphagia: A Survey Exploring the Experiences of Adults Living with Neuromuscular Disease and their Caregivers in the United Kingdom. J Neuromuscul Dis 2024; 11:389-410. [PMID: 38250781 DOI: 10.3233/jnd-230002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Background Dysphagia is common in adults living with neuromuscular disease (NMD). Increased life expectancy, secondary to improvements in standards of care, requires the recognition and treatment of dysphagia with an increased priority. Evidence to support the establishment of healthcare pathways is, however, lacking. The experiences of people living with NMD (pplwNMD) and their caregivers are valuable to guide targeted, value-based healthcare. Objective To generate preliminary considerations for neuromuscular dysphagia care and future research in the United Kingdom, based on the experiences of those living with, or caring for, people with NMD. Methods Two surveys (one for adults living with NMD and dysphagia, and a second for caregivers) were co-designed with an advisory group of people living with NMD. Surveys were electronically distributed to adults living with NMD and their caregivers between 18th May and 26th July 2020. Distribution was through UK disease registries, charity websites, newsletters, and social media. Results Adults living with NMD receive little information or education that they are likely to develop swallowing difficulties. Most respondents report wanting this information prior to developing these difficulties. Difficulties with swallowing food and medication are common in this group, and instrumental assessment is considered a helpful assessment tool. Both adults living with NMD and caregivers want earlier access to neuromuscular swallowing specialists and training in how best to manage their difficulties. Conclusions Improvement is needed in the dysphagia healthcare pathway for adults living with NMD to help mitigate any profound physical and psychological consequences that may be caused by dysphagia. Education about swallowing difficulties and early referral to a neuromuscular swallowing specialist are important to pplwNMD and their caregivers. Further research is required to better understand the experiences of pplwNMD and their caregivers to inform the development of dysphagia healthcare pathways.
Collapse
Affiliation(s)
- Jodi Allen
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
- Department of Language and Cognition, Division of Psychology and Language Sciences, University College London, London, UK
| | - Aoife Stone-Ghariani
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
| | - Gabriella Quezada
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
| | - Donna Banks
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
| | - Frank Rose
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
| | - William Knight
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
| | - Jill Newman
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
| | - William Newman
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
| | - Philip Anderson
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
| | - Christina Smith
- Department of Language and Cognition, Division of Psychology and Language Sciences, University College London, London, UK
| |
Collapse
|
8
|
Young SD, McGrattan K, Johnson E, van der Heul M, Duong T, Bakke M, Werlauff U, Pasternak A, Cattaneo C, Hoffman K, Fanelli L, Breaks A, Allison K, Baranello G, Finkel R, Coratti G, Lofra RM. Development of an International SMA Bulbar Assessment for Inter-professional Administration. J Neuromuscul Dis 2023:JND221672. [PMID: 37212069 DOI: 10.3233/jnd-221672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Progressive weakness can affect bulbar muscles in individuals with moderate to severe forms of spinal muscular atrophy (SMA). The paucity of standardized, valid bulbar assessments capturing clinically significant deficits in SMA impedes the ability to monitor function, facilitate intervention, or detect treatment response. OBJECTIVE To fill this void, an international multidisciplinary team gathered to develop an agreed upon consensus-derived assessment of bulbar function in SMA for inter-professional administration to enhance our ability to monitor disease progression, support clinical management, and evaluate treatment effects. METHODS Fifty-six international clinicians experienced in SMA were invited and engaged using the Delphi method over multiple rounds of web-based surveys to establish consensus. RESULTS Serial virtual meetings occurred with 42 clinicians (21 speech and language therapists, 11 physical therapists, 5 neurologists, 4 occupational therapists, and 1 dentist). Seventy-two validated assessments of bulbar function were identified for potential relevance to individuals with SMA (32 accessible objective, 11 inaccessible objective, 29 patient-reported outcomes). Delphi survey rounds (n = 11, 15, 15) achieved consensus on individual items with relevance and wording discussed. Key aspects of bulbar function identified included: oral intake status, oral facial structure and motor strength, swallowing physiology, voice & speech, and fatigability. CONCLUSIONS Multidisciplinary clinicians with expertise in bulbar function and SMA used Delphi methodology to reach consensus on assessments/items considered relevant for SMA across all age groups. Future steps include piloting the new scale moving towards validation/reliability. This work supports the advancement of assessing bulbar function in children and adults with SMA by a variety of professionals.
Collapse
Affiliation(s)
- Sally Dunaway Young
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA, USA
| | - Katlyn McGrattan
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Emily Johnson
- Department of Speech and Language Therapy, Great Ormond Street Hospital, London, UK
| | - Marise van der Heul
- Department of Neurology, University Medical Center Utrecht, Brain Center UMC Utrecht, Department of Neurology & Neurosurgery, Spieren voor Spieren Kindercentrum, Utrecht, the Netherlands
| | - Tina Duong
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA, USA
| | - Merete Bakke
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Werlauff
- National Rehabilitation Centre for Neuromuscular Diseases, Aarhus, Denmark
| | - Amy Pasternak
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Therapyand Occupational Therapy, Boston Children's Hospital, Boston, MA, USA
| | | | - Katie Hoffman
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Lavinia Fanelli
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Anne Breaks
- Acute Speech and Language Therapy Service, Evelina London Children's Hospital, London, UK
| | - Kristen Allison
- Department of Communication Sciences & Disorders, Northeastern University, Boston, MA, USA
| | - Giovanni Baranello
- Dubowitz Neuromuscular Centre, National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College London, and Great Ormond Street Hospital Foundation Trust, London
| | - Richard Finkel
- Center for Experimental Neurotherapeutics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Giorgia Coratti
- Pediatric Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Robert Muni Lofra
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|
9
|
Zang J, Johannsen J, Denecke J, Weiss D, Koseki JC, Nießen A, Müller F, Nienstedt JC, Flügel T, Pflug C. Flexible endoscopic evaluation of swallowing in children with type 1 spinal muscular atrophy. Eur Arch Otorhinolaryngol 2023; 280:1329-1338. [PMID: 36209319 PMCID: PMC9547642 DOI: 10.1007/s00405-022-07685-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/28/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed to report on implementing flexible endoscopic evaluation of swallowing (FEES) in infants and toddlers with type 1 spinal muscular atrophy (SMA). In addition, a comparison of FEES results and clinical scores was carried out. METHODS A prospective pilot study was conducted including ten symptomatic children with SMA type 1 (two SMN2 copies). They started treatment with one of the three currently approved therapies for SMA at a median age of 3.8 months (range 0.7-8.9). FEES was performed according to a standard protocol using Penetration-Aspiration Scale (PAS) and Murray Secretion Scale as a primary outcome. The Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) for motor function, Neuromuscular Disease Swallowing Status Scale (NdSSS), Oral and Swallowing Abilities Tool (OrSAT), and single clinical swallowing-related parameters were also assessed. RESULTS Distinct swallowing disorders were already evident in eight children at inclusion. The most common findings from FEES were pharyngeal secretion pooling, penetration, and aspiration of saliva and food as well as delayed initiation of swallowing. Despite an average increase in motor function, no comparable improvement was found in swallowing function. None of the surveyed clinical scores showed a significant dependence on PAS in a mixed linear model. CONCLUSIONS Valuable information regarding the status of dysphagia can be gathered endoscopically, particularly concerning secretion management and when oral intake is limited. Currently available clinical tools for children with type 1 may represent a change in nutritional status but are not yet mature enough to conclude swallowing ability. Further development is still required.
Collapse
Affiliation(s)
- Jana Zang
- grid.13648.380000 0001 2180 3484Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jessika Johannsen
- grid.13648.380000 0001 2180 3484Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Denecke
- grid.13648.380000 0001 2180 3484Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Deike Weiss
- grid.13648.380000 0001 2180 3484Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana-Christiane Koseki
- grid.13648.380000 0001 2180 3484Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Almut Nießen
- grid.13648.380000 0001 2180 3484Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Frank Müller
- grid.13648.380000 0001 2180 3484Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Julie Cläre Nienstedt
- grid.13648.380000 0001 2180 3484Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Till Flügel
- grid.13648.380000 0001 2180 3484Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christina Pflug
- grid.13648.380000 0001 2180 3484Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| |
Collapse
|
10
|
Dunaway Young S, Pasternak A, Duong T, McGrattan KE, Stranberg S, Maczek E, Dias C, Tang W, Parker D, Levine A, Rohan A, Wolford C, Martens W, McDermott MP, Darras BT, Day JW. Assessing Bulbar Function in Spinal Muscular Atrophy Using Patient-Reported Outcomes. J Neuromuscul Dis 2023; 10:199-209. [PMID: 36776075 DOI: 10.3233/jnd-221573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Novel Spinal Muscular Atrophy (SMA) treatments have demonstrated improvements on motor measures that are clearly distinct from the natural history of progressive decline. Comparable measures are needed to monitor bulbar function, which is affected in severe SMA. OBJECTIVE To assess bulbar function with patient-reported outcome measures (PROs) and determine their relationships with clinical characteristics. METHODS We recruited 47 non-ambulatory participants (mean (SD) age = 29.8 (13.7) years, range = 10.3-73.2) with SMA. PROs including Voice Handicap Index (VHI) and Eating Assessment Tool-10 (EAT-10) were collected alongside clinical characteristics and standardized motor assessments. Associations were assessed using Spearman correlation coefficients and group comparisons were performed using Wilcoxon rank sum tests. RESULTS A majority of the 47 participants were SMA type 2 (70.2%), non-sitters (78.7%), 3 copies of SMN2 (77.5%), and using respiratory support (66.0%). A majority (94%) reported voice issues primarily in 8/30 VHI questions. Problems included: difficulty understanding me in a noisy room (87.2%); difficult for people to hear me (74.5%); and people ask me to repeat when speaking face-to-face (72.3%). A majority (85.1%) reported swallowing issues primarily in 3/10 EAT-10 questions: swallowing pills (68.1%); food sticks to my throat (66.0%); and swallowing solids (61.7%). The two PROs were moderately associated (rs = 0.66). CONCLUSIONS Weaker individuals with SMA experience bulbar problems including difficulties with voice and swallowing. Further refinement and assessment of functional bulbar scales will help determine their relevance and responsiveness to changes in SMA. Additional study is needed to quantify bulbar changes caused by SMA and their response to disease-modifying treatments.
Collapse
Affiliation(s)
- Sally Dunaway Young
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA, USA
| | - Amy Pasternak
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Physical Therapy and Occupational Therapy, Boston Children's Hospital, Boston, MA, USA
| | - Tina Duong
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA, USA
| | - Katlyn E McGrattan
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Sarah Stranberg
- Outpatient Neurologic Rehabilitation Program, Stanford Health Care, Palo Alto, CA, USA
| | - Elizabeth Maczek
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Physical Therapy and Occupational Therapy, Boston Children's Hospital, Boston, MA, USA
| | - Courtney Dias
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Physical Therapy and Occupational Therapy, Boston Children's Hospital, Boston, MA, USA
| | - Whitney Tang
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA, USA
| | - Dana Parker
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA, USA
| | - Alexis Levine
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alyssa Rohan
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Connie Wolford
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA, USA
| | - William Martens
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Michael P McDermott
- Department of Neurology, University of Rochester, Rochester, NY, USA.,Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Basil T Darras
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - John W Day
- Department of Neurology and Clinical Neurosciences, Stanford University, Palo Alto, CA, USA
| |
Collapse
|
11
|
Lotta S, Lisa B. Congenital or Early Developing Neuromuscular Diseases Affecting Feeding, Swallowing and Speech – A Review of the Literature from January 1998 to August 2021. J Neuromuscul Dis 2022; 9:581-596. [PMID: 35848032 PMCID: PMC9535595 DOI: 10.3233/jnd-210772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The knowledge about the impact of oral motor impairment in neuromuscular diseases (NMDs) is limited but increasing. Objective: The aim of this review was to collect and compile knowledge on how muscle weakness in congenital or early developing NMDs directly or indirectly affects feeding, swallowing, speech and saliva control. Methods: A literature search was performed in PubMed from January 1, 1998, to August 31, 2021. The keywords “feeding”, “dysphagia”, “swallowing”, “dysarthria”, “speech”, “drooling” and “sialorrhea” were used in combination with “paediatric neuromuscular disease” or specific diagnoses. Results: Sixty-five studies were selected for the review, 33 focused on feeding and swallowing, 11 on speech, four on a combination of feeding, swallowing, saliva control or speech and 17 general descriptions. Most of the studies reported on patients with a disorder affecting muscles. These studies show that muscle weakness and impaired motility affecting the muscles innervated by the cranial nerves may influence feeding, swallowing, and speech, and that respiratory function, general health and neurodevelopmental delay also influence these functions. Feeding impairment and breathing difficulties are common in NMDs. Lifesaving interventions such as tube feeding and ventilatory support are common in severe cases. Conclusions: Feeding impairment, dysphagia and dysarthria are prevalent in NMDs with congenital or early age of onset. Feeding and swallowing has been studied more than speech and saliva control. More children with NMD survive thanks to new treatment options and it is therefore urgent to follow up how these therapies may impact the development of feeding, swallowing, and speech.
Collapse
Affiliation(s)
- Sjögreen Lotta
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Medicinaregatan, Gothenburg, Sweden
| | - Bengtsson Lisa
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Medicinaregatan, Gothenburg, Sweden
| |
Collapse
|
12
|
Lavie M, Rochman M, Sagi L, Yerushalmy Feler A, Ovadia D, Cahal M, Be'er M, Sadot E, Fattal-Valevski A, Amirav I. Nonrespiratory complications of nusinersen-treated spinal muscular atrophy type 1 patients. Pediatr Pulmonol 2022; 57:686-694. [PMID: 34921596 DOI: 10.1002/ppul.25795] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/23/2021] [Accepted: 12/16/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Emergence of new treatments for spinal muscular atrophy type 1 (SMA1) has led to dramatic improvements in respiratory failure and survival. However, these "treated" patients sustain major problems in other organ systems, which may directly or indirectly affect their respiratory function. We observed three main nonrespiratory manifestations in these patients comprised of facial deformities, feeding problems, and spinal deformities. OBJECTIVE To investigate these three main sequelae in nusinersen-treated SMA1 patients. METHODS Data on nusinersen-treated SMA1 patients were prospectively collected throughout a 3-year period, with special focus upon nonrespiratory features of the disease. RESULTS Twenty nusinersen-treated SMA1 patients were included (eight males, median age 13.5 months, interquartile range: 4-56.2 months), among whom 17 survived after 3 years of follow-up. At follow-up, 15 (88%) patients were diagnosed with facial weakness, hypoplasia, or deformity. All but one patient (94%) were fed invasively by percutaneous endoscopic gastrostomy or nasogastric tube feeding. Four patients (25%) had maintained oral feeding in parallel to gastrostomy feeding and had clinical and radiologic evidence of aspirations. Fifteen (88%) patients were diagnosed with scoliosis, of whom seven had undergone or were scheduled to undergo corrective surgery. CONCLUSIONS Nusinersen-treated SMA1 patients may sustain facial deformities, feeding problems, and severe scoliosis, all of which affect their respiratory system. Strict surveillance of these complications is essential to avoid further respiratory morbidity.
Collapse
Affiliation(s)
- Moran Lavie
- Pediatric Pulmonology Unit, Tel-Aviv Sourasky Medical Center, Dana-Dwek Children's Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mika Rochman
- Pediatric Pulmonology Unit, Tel-Aviv Sourasky Medical Center, Dana-Dwek Children's Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liora Sagi
- Pediatric Neurology Institute, Tel-Aviv Sourasky Medical Center, Dana-Dwek Children's Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Yerushalmy Feler
- Pediatric Gastroenterology Unit, Tel-Aviv Sourasky Medical Center, Dana-Dwek Children's Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Ovadia
- Pediatric Orthopedic Department, Tel-Aviv Sourasky Medical Center, Dana-Dwek Children's Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Cahal
- Pediatric Pulmonology Unit, Tel-Aviv Sourasky Medical Center, Dana-Dwek Children's Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moria Be'er
- Pediatric Pulmonology Unit, Tel-Aviv Sourasky Medical Center, Dana-Dwek Children's Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efraim Sadot
- Pediatric Pulmonology Unit, Tel-Aviv Sourasky Medical Center, Dana-Dwek Children's Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Intensive Care Unit, Tel-Aviv Sourasky Medical Center, Dana-Dwek Children's Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviva Fattal-Valevski
- Pediatric Neurology Institute, Tel-Aviv Sourasky Medical Center, Dana-Dwek Children's Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Amirav
- Pediatric Pulmonology Unit, Tel-Aviv Sourasky Medical Center, Dana-Dwek Children's Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
13
|
Validation and psychometric properties of the Turkish version of Neuromuscular disease Swallowing Status Scale (NdSSS) in patients with oro-pharygo-esophageal dysphagia in neuromuscular disorders. Acta Gastroenterol Belg 2022; 85:21-27. [PMID: 35304990 DOI: 10.51821/85.1.8929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective Dysphagia is one of the most disabling conditions arising from neuromuscular disorders(NMD). There is no specific methods to use in the evaluation of dysphagia in NMD patients. We aimed both to evaluate the applicability of the Neuromuscular Disease Swallowing Status Scale (NdSSS) for dysphagia in all phases of swallowing in various NMD patients and to investigate psychometric properties of this scale. Methods Patients with NMD were enrolled. Functional Oral Intake Scale (FOIS), Fiberoptic Endoscopic Evaluation of Swallowing (FEES), NdSSS and High-Resolution Esophageal Manometry (HRM) were performed on all subjects within 72 hours. While the convergent and concurrent validities were used as validation method, Cohen's kappa and Cronbach's alpha coefficient were calculated for inter-rater reliability. The correlation between FOIS, PAS and HRM diagnosis according to Chicago version 3.0 (CCv3) were analyzed. Results 115 NMD patients were included. There was good correlation between NdSSS and FOIS and PAS scores (Spearman's rank correlation coefficient (r):0.927, r:0.927 and r:-0.836, r:0.841, respectively). Also, there was a positive good correlation between NdSSS and CCv3 evaluating disorders of esophageal peristalsis (r:0.677-0.679, p=0.001). When evaluated separately, there were good correlation between NdSSS levels; and PAS (r:-0.648-0.656); and CCv3 (r:0.514-0.573) levels for ALS. For Myasthenia gravis there was a good correlation between NdSSS levels; and CCv3 (r:0.577-0.622); FOIS (r:0.508-0.521); and PAS (r:-0.504-0.519) scores. Also, for myopathy; a very good(CCv3(0.976-0.982)) and good(FOIS (0.511-0.581) and (PAS (-0.516-0.550)) correlations were defined for myopathy. Conclusion The NdSSS was found applicable to detect both oropharyngeal and esophageal dysphagia risk in patients with NMD and is a valid and reliable swallowing screening tool that can evaluate oro-pharyngo-esophageal dysphagia in NMD patients.
Collapse
|
14
|
Berti B, Fanelli L, de Sanctis R, Onesimo R, Palermo C, Leone D, Carnicella S, Norcia G, Forcina N, Coratti G, Giorgio V, Cerchiari A, Lucibello S, Finkel R, Pane M, Mercuri E. Oral and Swallowing Abilities Tool (OrSAT) for Type 1 SMA Patients: Development of a New Module. J Neuromuscul Dis 2021; 8:589-601. [PMID: 34024771 PMCID: PMC8385514 DOI: 10.3233/jnd-200614] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe the development of a new tool specifically designed to record oral abilities, swallowing and, more generally, feeding in young type 1 SMA patients, to be used during the first 24 months of life.The tool is composed by a checklist and a separate section summarizing the functional abilities into levels of feeding/swallowing impairment. The checklist includes 12 questions assessing aspects thought to be clinically meaningful for a type 1 SMA population and developmentally appropriate for infants during the first months of life. Each item is graded with a score of 0 or 1, depending on the child's ability to perform the activity. As some items are age-dependent, the number of items to be used, and therefore the maximum score, changes with increasing age. The levels of feeding/swallowing impairment include four levels that can be identified using easily identifiable clinical criteria.In an attempt to validate the tool in an untreated population we applied it to 24 type 1 SMA patients (age range: 2.3-24.1 months, mean: 10.8) in whom the same information collected by the new tool had been previously recorded using a less-structured format.When patients were classified in three groups according to the Dubowitz decimal classification, there was a significant difference both at baseline and at follow-up (p < 0.001). The items assessing fatigue during the nursing sessions were the most frequently impaired even in infants who did not have any other obvious clinical sign of swallowing difficulties.
Collapse
Affiliation(s)
- Beatrice Berti
- Centro Clinico Nemo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lavinia Fanelli
- Centro Clinico Nemo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberto de Sanctis
- Centro Clinico Nemo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberta Onesimo
- Pediatric Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Concetta Palermo
- Centro Clinico Nemo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniela Leone
- Centro Clinico Nemo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sara Carnicella
- Centro Clinico Nemo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulia Norcia
- Centro Clinico Nemo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicola Forcina
- Centro Clinico Nemo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgia Coratti
- Centro Clinico Nemo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valentina Giorgio
- Pediatric Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonella Cerchiari
- Speech Language Pathology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Simona Lucibello
- Centro Clinico Nemo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Richard Finkel
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Marika Pane
- Centro Clinico Nemo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Child Neurology and Psychiatry, Catholic University of Rome, Italy
| | - Eugenio Mercuri
- Centro Clinico Nemo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Child Neurology and Psychiatry, Catholic University of Rome, Italy
| |
Collapse
|
15
|
Nutritional, Gastrointestinal and Endo-Metabolic Challenges in the Management of Children with Spinal Muscular Atrophy Type 1. Nutrients 2021; 13:nu13072400. [PMID: 34371910 PMCID: PMC8308588 DOI: 10.3390/nu13072400] [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: 06/04/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 12/18/2022] Open
Abstract
The management of patients with spinal muscular atrophy type 1 (SMA1) is constantly evolving. In just a few decades, the medical approach has switched from an exclusively palliative therapy to a targeted therapy, transforming the natural history of the disease, improving survival time and quality of life and creating new challenges and goals. Many nutritional problems, gastrointestinal disorders and metabolic and endocrine alterations are commonly identified in patients affected by SMA1 during childhood and adolescence. For this reason, a proper pediatric multidisciplinary approach is then required in the clinical care of these patients, with a specific focus on the prevention of most common complications. The purpose of this narrative review is to provide the clinician with a practical and usable tool about SMA1 patients care, through a comprehensive insight into the nutritional, gastroenterological, metabolic and endocrine management of SMA1. Considering the possible horizons opened thanks to new therapeutic frontiers, a nutritional and endo-metabolic surveillance is a crucial element to be considered for a proper clinical care of these patients.
Collapse
|
16
|
Relationship between Oral Hypofunction and Sarcopenia in Community-Dwelling Older Adults: The Otassha Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126666. [PMID: 34205795 PMCID: PMC8296410 DOI: 10.3390/ijerph18126666] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/31/2022]
Abstract
Oral hypofunction, resulting from a combined decrease in multiple oral functions, may affect systemic-condition deterioration; however, few studies have examined the association between oral hypofunction and general health among older adults. In this cross-sectional study, we examined the relationship between oral hypofunction and sarcopenia in community-dwelling older adults. We included 878 adults (268 men and 610 women, mean age 76.5 ± 8.3 years). Tongue coating index, oral moisture, occlusal force, oral diadochokinesis (/pa/,/ta/,/ka/), tongue pressure, mas-ticatory function, and swallowing function were evaluated as indicators of oral hypofunction. Grip strength, gait speed, and skeletal muscle mass index were measured as diagnostic sarcopenia parameters. The association between oral hypofunction and sarcopenia was examined via logistic regression using sarcopenia as the dependent variable. Oral hypofunction prevalence was 50.5% overall, 40.3% in men, and 54.9% in women. The prevalence of sarcopenia was 18.6% overall, 9.7% in men, and 22.5% in women. A logistic regression showed oral hypofunction, age, body mass index, higher-level functional capacity, and serum albumin level were significantly associated with sarcopenia. Sarcopenia occurred at an increased frequency in patients diagnosed with oral hypofunction (odds ratio: 1.59, 95% confidence interval: 1.02–2.47); accordingly, oral hypofunction appears to be significantly associated with sarcopenia.
Collapse
|
17
|
McGrattan KE, Graham RJ, DiDonato CJ, Darras BT. Dysphagia Phenotypes in Spinal Muscular Atrophy: The Past, Present, and Promise for the Future. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1008-1022. [PMID: 33822657 PMCID: PMC8702868 DOI: 10.1044/2021_ajslp-20-00217] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/06/2020] [Accepted: 01/15/2021] [Indexed: 05/09/2023]
Abstract
Purpose The aim of this study was to provide clinicians with an overview of literature relating to dysphagia in spinal muscular atrophy (SMA) to guide assessment and treatment. Method In this clinical focus article, we review literature published in Scopus and PubMed between 1990 and 2020 pertaining to dysphagia in SMA across the life span. Original research articles that were published in English were included. Searches were conducted within four themes of inquiry: (a) etiology and phenotypes, (b) respiratory systemic deficits and management, (c) characteristics of natural history dysphagia and its treatment, and (d) dysphagia outcomes with disease-modifying therapies. Articles for the first two themes were selected by content experts who identified the most salient articles that would provide clinicians foundational background knowledge about SMA. Articles for the third theme were identified using search terms, including spinal muscular atrophy, swallow, dysphagia, bulbar, nutrition, g-tube, alternative nutrition, jaw, mouth, palate, OR mandible. Search terms for the fourth theme included spinal muscular atrophy AND nusinersen OR AVXS-101/onasemnogene abeparvovec-xioi. Review of Pertinent Literature Twenty-nine articles were identified. Findings across identified articles support the fact that patients with SMA who do not receive disease-modifying therapy exhibit clinically significant deficits in oropharyngeal swallow function. Few investigations provided systematic information regarding the underlying physiological deficits responsible for this loss in function, the timing of the degradation, or how disease-modifying therapies change these outcomes. Conclusion Future research outlining the physiological and functional oropharyngeal swallowing deficits among patients with SMA who receive disease-modifying therapy is critical in developing standards of dysphagia care to guide clinicians.
Collapse
Affiliation(s)
- Katlyn Elizabeth McGrattan
- Department of Speech-Language-Hearing Science, University of Minnesota, Minneapolis
- Department of Rehabilitation, Masonic Children's Hospital, Minneapolis, MN
| | - Robert J. Graham
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, MA
| | - Christine J. DiDonato
- Department of Pediatrics, Northwestern University, Chicago, IL
- Human Molecular Genetics and Physiology Program, Anne & Robert H. Lurie Children's Hospital, Chicago, IL
| | | |
Collapse
|