scholarly journals Dysphagia Associated with Neurological Disorders

2021 ◽  
Author(s):  
Vadim I. Ershov
Keyword(s):  
Oral Cavity ◽  
Neural Control ◽  
Neurological Diseases ◽  
Neuromuscular Diseases ◽  
Pseudobulbar Palsy ◽  
Neurogenic Dysphagia ◽  
Endoscopic Gastrostomy ◽  
Efficient Recovery ◽  
Correct Technique ◽  
Upper Gastrointestinal Tract Endoscopy

Neurogenic dysphagia is characterized by problems with neural control of swallowing caused by various neurological diseases: vascular diseases, traumatic diseases, neoplasms, infections, neuromuscular diseases, and others. In patients of intensive care units after long-term intubation and extubation may evolve “postextubation dysphagia”, characterized by the “learned non-use” phenomenon. Neurogenic dysphagia is a component of bulbar or pseudobulbar palsy, depending on the level of the neurological lesion. Diagnoses of neurogenic dysphagia include clinical examination (water swallow test), videofluoroscopy, upper gastrointestinal tract endoscopy and manometry, fiberoptic endoscopic evaluation of swallowing, a grade of Penetration-Aspiration Scale, and Fiberoptic Endoscopic Dysphagia Severity Scale. Dysphagia complications (malnutrition, dehydration, weight loss, aspiration, and respiratory tract obstruction) associated with bad functional recovery and life prognosis, so neurogenic dysphagia need a complex treatment: correct feeding pattern of caloric value and consistency, methods of oral cavity mucosa sensitivity stimulation, swallowing process stimulation, physiotherapeutic treatment methods (electrical stimulation of the larynx and tongue root), logopedic exercises therapy, surgical correction, lifestyle correction, and others. Sometimes it is a need for replacement therapy method by nasogastric tube and percutaneous endoscopic gastrostomy, parenteral feeding in several cases. Neurogenic dysphagia patient rehabilitation includes the “swallowing enhancement” method with optimal food consistency and training method after correct preparation of the oral cavity for swallowing. Neurogenic dysphagia patient oral feeding requires correct technique and contact with the patient for safety and efficient recovery.

scholarly journals Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Rainer Dziewas ◽  
Hans-Dieter Allescher ◽  
Ilia Aroyo ◽  
Gudrun Bartolome ◽  
Ulrike Beilenhoff ◽  
...  
Keyword(s):  
Neurological Diseases ◽  
Treatment Options ◽  
German Society ◽  
Diagnosis And Treatment ◽  
Dietary Interventions ◽  
Neurogenic Dysphagia ◽  
Treatment Interventions ◽  
Term Care ◽  
High Resolution Manometry ◽  
Clinical Scenarios

Abstract Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).

scholarly journals Attitude and experience of neurologists towards percutaneous endoscopic gastrostomy: an Egyptian study

2020 ◽  
Vol 56 (1) ◽  
Author(s):  
Sherien Farag ◽  
Shady S. Georgy ◽  
Mai Fathy ◽  
Ahmed elSadek ◽  
Khaled O. Abdulghani
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Neurological Diseases ◽  
Public Awareness ◽  
Cerebrovascular Disorders ◽  
Common Symptom ◽  
Nasogastric Feeding ◽  
Endoscopic Gastrostomy ◽  
Intervention Failure ◽  
Self Administered Questionnaire ◽  
Nasogastric Tube Insertion

Abstract Background Dysphagia is a common symptom among various neurological diseases. Guidelines recommend gastrostomy insertion for prolonged dysphagia with lower rate of intervention failure encountered with percutaneous endoscopic gastrostomy (PEG) as compared to nasogastric tube insertion. Methods Neurology consultants only were included and completed a self-administered questionnaire concerning their practice backgrounds and previous experience with PEG feeding during their practice. Results Ninety-eight percent stated that they would recommend PEG for patients with prolonged need of nasogastric feeding. However, only 88% actually referred patients to perform PEG, with the cerebrovascular disorders being the most common cases to be referred. The main barriers the surveyed neurologists faced were family resistance and financial reasons (53.5%). Interestingly, younger neurologists practicing for less than 15 years referred patient to perform PEG significantly more frequent than older ones (p = 0.01). About 18% of our sample confirmed the lack of sufficient knowledge about the benefits of PEG feeding, and only 22% previously attended scientific sessions about the benefits and indications of PEG. Conclusion Based on our study, we recommend that PEG should be more encouraged in indicated neurological cases. Scientific sessions targeting neurologists and public awareness about the benefits of PEG and its relatively infrequent complications are highly demanded.

scholarly journals DYSPHAGIA IN NEUROLOGICAL DISORDERS

2020 ◽  
Vol 73 (9) ◽  
pp. 1848-1852
Author(s):  
Amelia Śledzik ◽  
Paweł Szlendak
Keyword(s):  
Neurological Diseases ◽  
Swallowing Disorders ◽  
Screening Tests ◽  
Neurological Deficits ◽  
Diagnostic Process ◽  
Neurogenic Dysphagia ◽  
Standard Procedures ◽  
Volume Viscosity ◽  
Speech Pathologist ◽  
Clinical Conditions

Introduction: Neurogenic dysphagia is a frequent disorder affecting people with neurological diseases. Many experts work together to diagnose and treat dysphagia. The aim: The article focuses on the specificity of neurogenic dysphagia, its symptoms and treatment possibilities. The speech pathologist can be included in the diagnostic process and can evaluate the intake of liquids and foods based on a variety of consistency tests. In clinical conditions, screening tests such as water swallowing test, multiple consistency tests: GUSS (Gugging Swallowing Screen), V-VST (Volume-Viscosity Swallow Test) and EAT-10 questionnaire can be used successfully. If you have limited ability to perform instrumental tests, they can help you to expand your diagnosis. Review and Discussion:Treatment of swallowing disorders is based on a daily modification of the patient’s posture and consistency of the eaten meals. Nursing staff are involved in this adaptation activity, which plays an invaluable role in the diagnosis and treatment of patients in neurological and rehabilitation departments. Conclusions: Despite the knowledge of the problem, difficulty swallowing is still unnoticed. The effects of this neglect are felt both for patients and from the perspective of management within treatment units For people suffering from neurological diseases, swallowing disorders should be diagnosed on a compulsory basis and their assessment should be a permanent part of the standard procedures for assessing patients with neurological deficits.

scholarly journals Management of Dysphagia in Acquired and Progressive Neurologic Conditions

2019 ◽  
Vol 40 (03) ◽  
pp. 203-212
Author(s):  
Michelle Ciucci ◽  
Jesse Hoffmeister ◽  
Karen Wheeler-Hegland
Keyword(s):  
Neural Control ◽  
Ethical Decision Making ◽  
Discussion Boards ◽  
Neurogenic Dysphagia ◽  
Transdisciplinary Approach ◽  
Life Issues ◽  
Solid Foundation ◽  
End Of Life Issues ◽  
High Level ◽  
Management Of Dysphagia

AbstractAs the act of deglutition involves much of the central and peripheral nervous systems, neurologic disease can affect swallowing behaviors ranging from mild to profound in severity. The key in working with neurogenic dysphagia is to have a solid foundation in normal swallowing processes, including neural control. Within this framework, then, understanding how the neurologic condition affects neural control will guide hypothesis-based assessment and evidence-based treatment. The purpose of this article is to provide an overview of evaluation and treatment of neurogenic dysphagia in adult populations as well to propose assessment of co-occurring speech, language, and airway compromise. Furthermore, it is vital to be familiar with ethical decision making and end-of-life issues. Continuing education in the form of research articles, conferences, and professional discussion boards is useful in maintaining a high level of service delivery. Whenever possible, an inter- or transdisciplinary approach is recommended.

Paroxysmal dystonia and pathological laughter as a first manifestation of multiple sclerosis

2007 ◽  
Vol 14 (2) ◽  
pp. 262-265 ◽  
Author(s):  
M. Aguirregomozcorta ◽  
LI Ramió-Torrentà ◽  
J. Gich ◽  
A. Quiles ◽  
D. Genís
Keyword(s):  
Multiple Sclerosis ◽  
Neurological Diseases ◽  
Pseudobulbar Palsy ◽  
Initial Symptom ◽  
Pathological Laughter ◽  
Variable Duration ◽  
Ectopic Activation ◽  
Paroxysmal Dystonia

Paroxysmal dystonia is an uncommon but well-established feature of multiple sclerosis (MS). Attacks can occur in established MS and may even occasionally be the initial symptom of this disorder. Pathological laughter is usually seen as a pseudobulbar palsy in some diffuse neurological diseases, but cases have been described, mostly in ischaemic attacks or tumours, where it is presented as bursts of laughter of variable duration. The pathogenesis of neither of the two phenomena has been fully established but both have been reported as being positive phenomena resulting from ectopic activation with ephaptic spread. We describe the first reported case of a paroxysmal hemidystonia together with bursts of pathological laughter as the first manifestation of MS. Multiple Sclerosis 2008; 14: 262—265. http://msj.sagepub.com

scholarly journals Single Cell Deconstruction of Muscle Stem Cell Heterogeneity During Aging Reveals Sensitivity to the Neuromuscular Junction

2020 ◽  
Author(s):  
Peter J. Ulintz ◽  
Jacqueline Larouche ◽  
Mahir Mohiuddin ◽  
Jesus Castor Macias ◽  
Sarah J. Kurpiers ◽  
...  
Keyword(s):  
Neuromuscular Junction ◽  
Single Cell ◽  
Motor Neurons ◽  
Satellite Cells ◽  
Neural Control ◽  
Neuromuscular Diseases ◽  
Neuromuscular Synapse ◽  
List Type ◽  
Genetic Rescue ◽  
Before And After

AbstractDuring aging and neuromuscular diseases, there is a progressive loss of skeletal muscle volume and function in that impacts mobility and quality of life. Muscle loss is often associated with denervation and a loss of resident muscle stem cells (satellite cells or MuSCs), but the relationship between MuSCs and neural control has not been established. Herein, using a combination of single-cell transcriptomic analysis, high-resolution immunofluorescence imaging and transgenic young and aged mice as well as from mice with neuromuscular degeneration (Sod1-/-), a compensatory neuro-responsive function for a subset of MuSCs was identified. Genetic rescue of motor neurons in Sod1-/- mice reduced this subset of MuSCs and restored integrity of the neuromuscular junction (NMJ) in a manner akin to young muscle. Administration of severe neuromuscular trauma induced young MuSCs to specifically engraft in a position proximal to the NMJ but in aging, this behavior was abolished. Contrasting the expression programs of young and aged MuSCs after muscle injury at the single cell level, we observed distinctive gene expression programs between responses to neuro-muscular degeneration and muscle trauma. Collectively, these data reveal MuSCs sense synaptic perturbations during aging and neuro-muscular deterioration, and can exert support for the NMJ, particularly in young muscle.HighlightsTranscriptional landscapes of single satellite cells from different ages before and after injury as well as neurodegenerative models before and after nervous rescueA population of satellite cells reside in close proximity to neuromuscular synapse, which are lost with ageDenervation promotes satellite cell engraftment into post-synaptic regions of young as opposed to aged muscle

scholarly journals Specialized medical care for patients with malignant neoplasms of the maxillofacial area in the Penza region of Russia

2021 ◽  
Vol 10 (3) ◽  
pp. 23-31
Author(s):  
M. V. Lebedev ◽  
Yu. A. Abdullina ◽  
I. Yu. Zakharova
Keyword(s):  
Oral Cavity ◽  
Clinical Manifestations ◽  
Interdisciplinary Approach ◽  
Diagnostic Methods ◽  
Malignant Neoplasms ◽  
Maxillofacial Region ◽  
Lower Lip ◽  
Endoscopic Gastrostomy ◽  
Results Of Treatment ◽  
Psychological Assistance

This article analyzes domestic and foreign sources, regulatory documents of the Russian Federation, in order to determine the etiological factors of oral cancer, assess the statistical data on morbidity and mortality from malignant neoplasms of the maxillofacial region in the Penza region. The results of changing the routing, an interdisciplinary approach to treating patients with malignant neoplasms of the maxillofacial region in the Penza region are presented. The epidemiology, clinical manifestations, main diagnostic methods, routing, treatment and rehabilitation of patients with head and neck oncology are considered. The results of treatment of patients with oral cavity and lower lip cancer using photodynamic therapy (PDT), both alone and in combination with radiation and chemotherapy, are analyzed. The study showed that PDT of tumors of the lower lip and buccal mucosa in mono-mode made allowed achieving 100% efficiency. After the completed treatment, all participants in the experiment were provided with a complex of rehabilitation, including nutritional support, psychological assistance, exercise therapy, training in correct swallowing tactics, percutaneous endoscopic gastrostomy, and a course of oral cavity massage. An interdisciplinary approach to treating malignant neoplasms of the maxillofacial region is the most correct in modern practice.

scholarly journals CSF Diagnostics: A Potentially Valuable Tool in Neurodegenerative and Inflammatory Disorders Involving Motor Neurons: A Review

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1522
Author(s):  
Karsten Krause ◽  
Maximilian Wulf ◽  
Paula Sommer ◽  
Katalin Barkovits ◽  
Matthias Vorgerd ◽  
...  
Keyword(s):  
Motor Neurons ◽  
Muscular Atrophy ◽  
Neurological Diseases ◽  
Neuromuscular Disorders ◽  
Disease Onset ◽  
Neuromuscular Diseases ◽  
Promising Alternative ◽  
Alternative Techniques ◽  
Subordinate Role ◽  
Lateral Sclerosis

Cerebrospinal fluid (CSF) diagnostics has emerged as a valid tool for a variety of neurological diseases. However, CSF diagnostics has been playing a subordinate role in the diagnosis of many neurological conditions. Thus, in the multitude of neuromuscular diseases in which motor neurons are affected, a CSF sample is rarely taken routinely. However, CSF diagnostics has the potential to specify the diagnosis and monitor the treatment of neuromuscular disorders. In this review, we therefore focused on a variety of neuromuscular diseases, among them amyotrophic lateral sclerosis (ALS), peripheral neuropathies, and spinal muscular atrophy (SMA), for which CSF diagnostics has emerged as a promising option for determining the disease itself and its progression. We focus on potentially valuable biomarkers among different disorders, such as neurofilaments, cytokines, other proteins, and lipids to determine their suitability, differentiating between different neurological disorders and their potential to determine early disease onset, disease progression, and treatment outcome. We further recommend novel approaches, e.g., the use of mass spectrometry as a promising alternative techniques to standard ELISA assays, potentially enhancing biomarker significance in clinical applications.

scholarly journals Neurogenic Dysphagia: A Systematic Review and Proposal of a Classification System

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011350
Author(s):  
Tobias Warnecke ◽  
Bendix Labeit ◽  
Jens Schroeder ◽  
Alexander Reckels ◽  
Sigrid Ahring ◽  
...  
Keyword(s):  
Neurological Disorders ◽  
Neurological Diseases ◽  
Underlying Disease ◽  
Qualitative Synthesis ◽  
Neurogenic Dysphagia ◽  
Stroke Patients ◽  
Chi Square ◽  
Brainstem Stroke ◽  
Unclear Etiology

Objective:Introduction and validation of a phenotypic classification of neurogenic dysphagia based on flexible endoscopic evaluation of swallowing (FEES).Methods:A systematic literature review was conducted, searching MEDLINE from inception to 05/2020 for FEES findings in neurological diseases of interest. Based on a retrospective analysis of FEES-videos in neurological diseases and considering the results from the review, a classification of neurogenic dysphagia was developed distinguishing different phenotypes. The classification was validated using 1012 randomly selected FEES-videos of patients with various neurological disorders. Chi-square-tests were used to compare the distribution of dysphagia phenotypes between the underlying neurological disorders.Results:159 articles were identified of which 59 were included in the qualitative synthesis. Seven dysphagia phenotypes were identified: (1) “Premature bolus spillage” and (2) “delayed swallowing reflex” occurred mainly in stroke patients, (3) “predominance of residue in the valleculae” was most common in Parkinson's disease, (4) “predominance of residue in the piriform sinus” occurred only in myositis, motoneuron disease and brainstem stroke patients, (5) “pharyngolaryngeal movement disorder” was found in atypical Parkinsonian syndromes and stroke patients, (6) “fatigable swallowing weakness” was common in patients with myasthenia gravis, and (7) “complex disorder” with a heterogeneous dysphagia pattern was the leading mechanism in amyotrophic later sclerosis. The interrater reliability showed a strong agreement (kappa = 0.84).Conclusion:Neurogenic dysphagia is not a mere symptom, but a multi-etiological syndrome with different phenotypic patterns depending on the underlying disease. Dysphagia phenotypes can facilitate differential diagnosis in patients with dysphagia of unclear etiology.

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