EVALUATION OF THE IMPACT OF FOOD LOAD ON SWALLOWING IN PATIENTS WITH MYASTHENIA GRAVIS: AN ASSESSMENT OF THE SWALLOWING FUNCTION BY THE NURSE

Abstract Introduction The current phase III EORTC 1420 Best-of trial (NCT02984410) compares the swallowing function after transoral surgery versus intensity modulated radiotherapy (RT) in patients with early-stage carcinoma of the oropharynx, supraglottis and hypopharynx. We report the analysis of the Benchmark Case (BC) procedures before patient recruitment with special attention to dysphagia/aspiration related structures (DARS). Materials and methods Submitted RT volumes and plans from participating centers were analyzed and compared against the gold-standard expert delineations and dose distributions. Descriptive analysis of protocol deviations was conducted. Mean Sorensen-Dice similarity index (mDSI) and Hausdorff distance (mHD) were applied to evaluate the inter-observer variability (IOV). Results 65% (23/35) of the institutions needed more than one submission to achieve Quality assurance (RTQA) clearance. OAR volume delineations were the cause for rejection in 53% (40/76) of cases. IOV could be improved in 5 out of 12 OARs by more than 10 mm after resubmission (mHD). Despite this, final IOV for critical OARs in delineation remained significant among DARS by choosing an aleatory threshold of 0.7 (mDSI) and 15 mm (mHD). Conclusions This is to our knowledge the largest BC analysis among Head and neck RTQA programs performed in the framework of a prospective trial. Benchmarking identified non-common OARs and target delineations errors as the main source of deviations and IOV could be reduced in a significant number of cases after this process. Due to the substantial resources involved with benchmarking, future benchmark analyses should assess fully the impact on patients’ clinical outcome.

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Absence of Association between Previous Mycoplasma pneumoniae Infection and Subsequent Myasthenia Gravis: A Nationwide Population-Based Matched Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147677 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7677

Author(s):

Kuan Chen ◽

James Cheng-Chung Wei ◽

Hei-Tung Yip ◽

Mei-Chia Chou ◽

Renin Chang

Keyword(s):

Cohort Study ◽

Myasthenia Gravis ◽

Mycoplasma Pneumoniae ◽

Pathogenic Bacteria ◽

Case Reports ◽

Statistical Significance ◽

Subsequent Development ◽

Population Based ◽

Cox Proportional Hazards ◽

The Impact

Mycoplasma pneumoniae (M. pneumoniae) is not only one of the most common pathogenic bacteria for respiratory infection but also a trigger for many autoimmune diseases. Its infection process shared many similarities with the pathogenesis of myasthenia gravis (MG) at cellular and cytokine levels. Recent case reports demonstrated patients present with MG after M. pneumoniae infection. However, no epidemiological studies ever looked into the association between the two. Our study aimed to investigate the relationship between M. pneumoniae infection and subsequent development of MG. In this population-based retrospective cohort study, the risk of MG was analyzed in patients who were newly diagnosed with M. pneumoniae infection between 2000 and 2013. A total of 2428 M. pneumoniae patients were included and matched with the non-M. pneumoniae control cohort at a 1:4 ratio by age, sex, and index date. Cox proportional hazards regression analysis was applied to analyze the risk of MG development after adjusting for sex, age, and comorbidities, with hazard ratios and 95% confidence intervals. The incidence rates of MG in the non-M. pneumoniae and M. pneumoniae cohorts were 0.96 and 1.97 per 10,000 person-years, respectively. Another case–control study of patients with MG (n = 515) was conducted to analyze the impact of M. pneumoniae on MG occurrence as a sensitivity analysis. The analysis yielded consistent absence of a link between M. pneumoniae and MG. Although previous studies have reported that M. pneumoniae infection and MG may share associated immunologic pathways, we found no statistical significance between M. pneumoniae infection and subsequent development of MG in this study.

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Dysphagia in Perry Syndrome: Pharyngeal Pressure in Two Cases

Case Reports in Neurology ◽

10.1159/000457900 ◽

2017 ◽

Vol 9 (2) ◽

pp. 161-167 ◽

Cited By ~ 1

Author(s):

George Umemoto ◽

Yoshio Tsuboi ◽

Hirokazu Furuya ◽

Takayasu Mishima ◽

Shinsuke Fujioka ◽

...

Keyword(s):

Tube Feeding ◽

Oral Intake ◽

Normal Diet ◽

Oral Feeding ◽

Tongue Pressure ◽

Normal Range ◽

Swallowing Function ◽

Pharyngeal Pressure ◽

Swallowing Dysfunction ◽

The Impact

Background: To investigate the impact of dysphagia in Perry syndrome (PS), an autosomal dominant parkinsonism caused by mutation of DCTN1, which is associated with hypoventilation, depression, and weight loss. Case Presentation: We used tongue pressure measurements and manofluorography to investigate swallowing function in 2 patients with PS. Case 1, a 60-year-old male showing parkinsonism, and case 2, a 49-year-old male admitted with pneumonia, were diagnosed as having PS based on the DCTN1 gene analysis. Case 1 showed a pharyngeal retention of the bolus on videofluorography (VF) and a few swallows were required for its passage into the esophagus. However, tongue pressure and manometry were within the normal range. This patient could eat a normal diet under supervision. Case 2 required artificial ventilation and tube feeding on admission. The VF image showed a slow transfer of the bolus, delayed swallow reflex, and pharyngeal retention of the bolus that required several swallows for its passage into the esophagus. The tongue pressure was within the normal range, but manometry showed a significant decrease in pressure at the hypopharynx and upper esophageal sphincter. The oral intake of the patients was limited to 2 cups of jelly per day. Conclusions: The investigation of swallowing dysfunction of 2 cases of PS showed that maintaining pharyngeal pressure within the normal range was very important for oral feeding success and prognosis.

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Detecting myasthenia gravis as a cause of unclear dysphagia with an endoscopic tensilon test

Therapeutic Advances in Neurological Disorders ◽

10.1177/17562864211035544 ◽

2021 ◽

Vol 14 ◽

pp. 175628642110355

Author(s):

Tobias Warnecke ◽

Sun Im ◽

Bendix Labeit ◽

Olga Zwolinskaya ◽

Sonja Suntrup-Krüger ◽

...

Keyword(s):

Myasthenia Gravis ◽

Sensitivity And Specificity ◽

Nerve Stimulation ◽

Serum Antibody ◽

Significant Heterogeneity ◽

Swallowing Function ◽

Repetitive Nerve Stimulation ◽

Muscle Involvement ◽

Pharyngeal Dysphagia ◽

Tensilon Test

Aims: The flexible endoscopic evaluation of swallowing-tensilon test (FTT) was developed to diagnose myasthenia gravis (MG) in patients with unclear pharyngeal dysphagia. The purpose of this study was to determine sensitivity and specificity of the FTT and compare its diagnostic validity with that of other diagnostic markers. Methods: In this single-centre pragmatic clinical cohort study, a total of 100 patients with unclear pharyngeal dysphagia were eligible to undergo FTT. All patients were subjected to FTT and subsequently followed up clinically. FTT was considered positive if a significant improvement of pharyngeal swallowing function could be objectified endoscopically upon administration of edrophonium chloride. In addition, repetitive nerve stimulation test and serum MG antibody analysis were conducted. Results: All subjects (mean age 62.5 ± 14.1 years, female 33) underwent FTT without any complications. According to the results of the diagnostic procedures and based on long-term clinical follow-up for at least 3 years, 51 patients were finally diagnosed with MG. The sensitivity and specificity for the FTT was 88.2% and 95.9%, respectively. Application of the Cochran’s Q test showed statistically significant heterogeneity among the diagnostic tests, with results indicating FTT performance to be more accurate than the repetitive nerve stimulation results ( p < 0.001) and comparable with serum antibody tests ( p > 0.99). Conclusion: FTT has excellent clinical properties to be used routinely in the assessment of dysphagia with isolated or predominant pharyngeal muscle involvement allowing rapid and accurate diagnosis of MG.

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The impact of physical exercise on neuromuscular function in Myasthenia gravis patients

Medicine ◽

10.1097/md.0000000000011510 ◽

2018 ◽

Vol 97 (31) ◽

pp. e11510 ◽

Cited By ~ 5

Author(s):

Elisabet Westerberg ◽

Carl Johan Molin ◽

Sören Spörndly Nees ◽

Johan Widenfalk ◽

Anna Rostedt Punga

Keyword(s):

Physical Exercise ◽

Myasthenia Gravis ◽

Neuromuscular Function ◽

The Impact

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Early Tracheostomy Is Associated With Shorter Ventilation Time and Duration of ICU Stay in Patients With Myasthenic Crisis—A Multicenter Analysis

Journal of Intensive Care Medicine ◽

10.1177/0885066620967646 ◽

2020 ◽

pp. 088506662096764

Author(s):

Klemens Angstwurm ◽

Amelie Vidal ◽

Henning Stetefeld ◽

Christian Dohmen ◽

Philipp Mergenthaler ◽

...

Keyword(s):

Myasthenia Gravis ◽

Late Onset ◽

Retrospective Chart Review ◽

Health Condition ◽

Myasthenic Crisis ◽

Early Tracheostomy ◽

Ventilation Time ◽

Data Rates ◽

Multicenter Analysis ◽

The Impact

Background: Myasthenic crisis (MC) requiring mechanical ventilation (MV) is a rare and serious complication of myasthenia gravis. Here we analyzed the frequency of performed tracheostomies, risk factors correlating with a tracheostomy, as well as the impact of an early tracheostomy on ventilation time and ICU length of stay (LOS) in MC. Methods: Retrospective chart review on patients treated for MC in 12 German neurological departments between 2006 and 2015 to assess demographic/diagnostic data, rates and timing of tracheostomy and outcome. Results: In 107 out of 215 MC (49.8%), a tracheostomy was performed. Patients without tracheostomy were more likely to have an early-onset myasthenia gravis (27 [25.2%] vs 12 [11.5%], p = 0.01). Patients receiving a tracheostomy, however, were more frequently suffering from multiple comorbidities (20 [18.7%] vs 9 [8.3%], p = 0.03) and also the ventilation time (34.4 days ± 27.7 versus 7.9 ± 7.8, p < 0.0001) and ICU-LOS (34.8 days ± 25.5 versus 12.1 ± 8.0, p < 0.0001) was significantly longer than in non-tracheostomized patients. Demographics and characteristics of the course of the disease up to the crisis were not significantly different between patients with an early (within 10 days) compared to a late tracheostomy. However, an early tracheostomy correlated with a shorter duration of MV at ICU (26.2 days ± 18.1 versus 42.0 ± 33.1, p = 0.006), and ICU-LOS (26.2 days ± 14.6 versus 42.3 ± 33.0, p = 0.003). Conclusion: Half of the ventilated patients with MC required a tracheostomy. Poorer health condition before the crisis and late-onset MG were associated with a tracheostomy. An early tracheostomy (≤ day 10), however, was associated with a shorter duration of MV and ICU-LOS by 2 weeks.

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Changes in Swallowing After Anterior Cervical Discectomy and Fusion With Instrumentation: A Presurgical Versus Postsurgical Videofluoroscopic Comparison

Journal of Speech Language and Hearing Research ◽

10.1044/2016_jslhr-s-16-0091 ◽

2017 ◽

Vol 60 (4) ◽

pp. 785-793 ◽

Cited By ~ 6

Author(s):

Lydia Muss ◽

Janina Wilmskoetter ◽

Kerstin Richter ◽

Constanze Fix ◽

Soenke Stanschus ◽

...

Keyword(s):

Wall Thickness ◽

Posterior Pharyngeal Wall ◽

Anterior Cervical Discectomy ◽

Future Research ◽

Swallowing Function ◽

Pharyngeal Wall ◽

Cervical Discectomy ◽

Functional Measures ◽

Posterior Pharyngeal Wall Thickness ◽

The Impact

Purpose The purpose of this study was to explore the impact of anterior cervical discectomy and fusion (ACDF) with anterior instrumentation on swallowing function and physiology as measured on videofluoroscopic swallowing studies. Method We retrospectively analyzed both functional measures (penetration-aspiration, residue) and physiological/anatomical measures (hyoid excursion, posterior pharyngeal wall thickness) in a series of 17 patients (8 men, 9 women, mean age 54 years). These measures were extracted from calibrated 5-ml boluses of thin radio-opaque liquids on both pre-ACDF and post-ACDF videofluoroscopies, thus controlling for individual variation and protocol variation. Results After ACDF surgery, we found significant within-subject worsening of Penetration-Aspiration Scale (Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996) scores, vallecular (but not piriform sinus) residue, superior (but not anterior) hyoid excursion, and posterior pharyngeal wall thickness. Results are discussed in the context of previous literature. Conclusions ACDF surgery can affect both physiological/anatomical and functional measures of swallowing. Future research should expand to other biomechanical and temporal variables, as well as greater bolus volumes and a wider array of viscosities and textures.

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The Effect of Lingual Resistance Training Interventions on Adult Swallow Function: A Systematic Review

Dysphagia ◽

10.1007/s00455-019-10066-1 ◽

2019 ◽

Vol 35 (5) ◽

pp. 745-761 ◽

Cited By ~ 4

Author(s):

Sana Smaoui ◽

Amy Langridge ◽

Catriona M. Steele

Keyword(s):

Systematic Review ◽

Resistance Training ◽

Data Extraction ◽

Meta Analysis ◽

Quality Data ◽

Tongue Pressure ◽

Swallowing Function ◽

Temporal Measures ◽

The Impact ◽

Training Protocols

Abstract Lingual resistance training has been proposed as an intervention to improve decreased tongue pressure strength and endurance in patients with dysphagia. However, little is known about the impact of lingual resistance training on swallow physiology. This systematic review scrutinizes the available evidence regarding the effects of lingual resistance training on swallowing function in studies using Videofluoroscopic Swallowing Studies (VFSS) with adults. Seven articles met the inclusion criteria and underwent detailed review for study quality, data extraction, and planned meta-analysis. Included studies applied this intervention to a stroke and brain injury patient populations or to healthy participants, applied different training protocols, and used a number of outcome measures, making it difficult to generalize results. Lingual resistance training protocols included anterior and posterior tongue strengthening, accuracy training, and effortful press against hard palate with varying treatment durations. VFSS protocols typically included a thin barium stimulus along with one other consistency to evaluate the effects of the intervention. Swallowing measures included swallow safety, efficiency, and temporal measures. Temporal measures significantly improved in one study, while safety improvements showed mixed results across studies. Reported improvements in swallowing efficiency were limited to reductions in thin liquid barium residue in two studies. Overall, the evidence regarding the impact of lingual resistance training for dysphagia is mixed. Meta-analysis was not possible due to differences in methods and outcome measurements across studies. Reporting all aspects of training and details regarding VFSS protocols is crucial for the reproducibility of these interventions. Future investigations should focus on completing robust analyses of swallowing kinematics and function following tongue pressure training to determine efficacy for swallowing function.

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The Impact of Upper Airway Stimulation on Swallowing Function

Ear Nose & Throat Journal ◽

10.1177/0145561319853519 ◽

2019 ◽

Vol 98 (8) ◽

pp. 496-499 ◽

Cited By ~ 1

Author(s):

Colin Huntley ◽

Adam Vasconcellos ◽

Michael Mullen ◽

David W. Chou ◽

Haley Geosits ◽

...

Keyword(s):

Assessment Tool ◽

Medical Center ◽

Academic Medical Center ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Swallowing Function ◽

Upper Airway Stimulation ◽

Obstructive Sleep ◽

The Mean ◽

The Impact

Objective: To evaluate the impact of upper airway stimulation therapy (UAS) on swallowing function in patients with obstructive sleep apnea. Study Design: Prospective cohort study. Setting: Academic medical center. Participants and Outcome Measures: We recorded demographic, preoperative polysomnogram (PSG), operative, and postoperative PSG data. We assessed the patients swallowing function using the Eating Assessment Tool (EAT-10) dysphagia questionnaire. This was administered both pre- and postoperatively. The postoperative EAT-10 survey was administered at least 3 months after UAS implantation. Results: During the study period, 27 patients underwent UAS implantation, completed the pre- and postoperative EAT-10 questionnaire, met inclusion/exclusion criteria, and were included in the study. The cohort consisted of 16 men and 11 women with a mean age of 63.63 years. The mean preoperative BMI, Epworth Sleepiness Scale (ESS), and Apnea Hypopnea Index (AHI) were 29.37, 10.33, and 34.90, respectively. The mean postoperative ESS and AHI were 5.25 and 7.59, respectively. These were both significantly lower than the preoperative values ( P = .026 and P < .001). The mean pre- and postoperative EAT-10 scores were 0.37 and 0.22, respectively ( P = .461). Conclusion: Our data suggest that UAS likely does not lead to postoperative dysphagia.

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Videofluoroscopic assessment of swallowing function in patients with myasthenia gravis

Journal of the Neurological Sciences ◽

10.1016/j.jns.2004.12.007 ◽

2005 ◽

Vol 231 (1-2) ◽

pp. 45-48 ◽

Cited By ~ 18

Author(s):

Ryuzaburo Higo ◽

Takaharu Nito ◽

Niro Tayama

Keyword(s):

Myasthenia Gravis ◽

Swallowing Function

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