Abstract
Dysphagia is defined as an impairment of this complex and integrated sensorimotor system. It is estimated that 400,000 to 800,000 individuals worldwide develop neurogenic dysphagia per year. Neurogenic dysphagia is typically occurring in patients with neurological disease of different etiologies. A correct and early diagnosis and an appropriate management of dysphagia could be useful for improving patient’s quality of life and may help to prevent or delay death. In the present review, we discuss thoroughly the anatomy and physiology of swallowing and also the pathophysiological mechanisms involved in impaired swallowing, as well as the diagnosis, management, and potential treatments of neurogenic dysphagia. Assessment of neurogenic dysphagia includes medical history, physical exam, and instrumental examinations (fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, electromyography). Pharmacological treatment of these problems includes oral anticholinergic drugs. Surgical myotomy of the cricopharyngeal muscle showed an important improvement of oropharyngeal dysphagia associated to upper esophageal sphincter hyperactivity. Chemical myotomy of the upper esophageal sphincter by local injections of botulinum toxin type A into the cricopharyngeal muscle has been proposed as an alternative less invasive and less unsafe than surgical myotomy.
Highlights
The names in italic are the groups of diseases, but it is deductible for the readers pathophysiological mechanisms involved in impaired swallowing, as well as the diagnosis, management, and potential treatments of neurogenic dysphagia
Dysphagia is reported to be prevalent in 30–100% of individuals depending on type of motor neuron disease (MND) and the stage of disease affecting all individuals in the later stages of the disease
Several assessment tools [22] are used to evaluate and quantify the dysphagia: (1) Swallowing Disturbance Questionnaire, a self-reported 15item questionnaire on swallowing disturbances; (2) Eating Assessment Tool (EAT-10), a self-administered, symptomspecific outcome instrument for dysphagia; (3) Dysphagia Outcome and Severity Scale (DOSS), a 7-point scale developed to systematically rate the functional severity of dysphagia based on objective assessment; and (4) PenetrationAspiration Scale (PAS), an 8-point scale based on VFS, to describe penetration and aspiration events
Summary
Swallowing is defined as the semiautomatic motor action of the muscles of respiratory, oropharyngeal, and. Neurol Sci (2020) 41:3067–3073 incidence of dysphagia in specific neurologic diseases is variable, owing in part to patient selection methods and evaluation methods (e.g., questionnaires, clinical evaluation, diagnostic evaluation). It is estimated that dysphagia occurs in approximately 65% of acute stroke patients. In Parkinson’s disease (PD), dysphagia occurs approximately in 50%. Dysphagia is common in dementia with prevalence rates varying from 13 to 57%. Dysphagia is reported to be prevalent in 30–100% of individuals depending on type of motor neuron disease (MND) and the stage of disease affecting all individuals in the later stages of the disease. Malnutrition and aspiration pneumonia are the most common and troublesome consequences of dysphagia, with increased risk of death in elderly and debilitated patients. Aspiration pneumonia is the most common cause of mortality in patients with neurological disease associated to dysphagia [18]
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