Oropharyngeal dysphagia in patients with multiple sclerosis: do the disease classification scales reflect dysphagia severity?

Alessandro Murano Ferré Fernandes,André De Campos Duprat,Cláudia Alessandra Eckley,Leonardo Da Silva,Roberta Busch Ferreira,Charles Peter Tilbery

doi:10.5935/1808-8694.20130082

Abstract

Multiple sclerosis is a neurological disease that involves swallowing disorders. Many studies have shown an association between neurological and swallowing performance, but results have been conflicting. ObjectiveTo identify the frequency of dysphagia in patients with multiple sclerosis and neurological indicators that can represent the performance of swallowing. MethodIn this study (cross-sectional) 120 Multiple Sclerosis patients underwent Functional Assessment of Swallowing by flexible nasal-pharyngo-laryngoscopy and the results were compared with the scores of the rating scales: (Clinical Evolving Forms of Disease, Functional Disability Scale for and Scale Systems Extended Functional Disability [Kurtzke Expanded Disability Status Scale]). ResultsDysphagia was found in 90% of patients. Among the clinical forms of the disease, the progressive forms (primary progressive and secondary progressive) were more frequently associated with severe dysphagia, while the relapsing-remitting form presented more often mild and moderate dysphagia. Regarding the Disability Scale for Functional Systems, cerebellar function, brainstem function and mental health were associated with dysphagia, especially in the severe form. Regarding the Extended Functional Disability Scale, higher scores were associated with severe dysphagia. ConclusionDysphagia is common in MS patients, especially in those with greater impairment of neurological functions.

Highlights

Multiple sclerosis (MS) is a disease of probable autoimmune origin, characterized by inflammation of the central nervous system, demyelination and gliosis formation
Regarding the Disability Scale for Functional Systems, cerebellar function, brainstem function and mental health were associated with dysphagia, especially in the severe form
Regarding the Extended Functional Disability Scale, higher scores were associated with severe dysphagia

Summary

Introduction

Multiple sclerosis (MS) is a disease of probable autoimmune origin, characterized by inflammation of the central nervous system, demyelination and gliosis formation. The combination of genetic, immunological and infectious factors seems to explain its appearance It most often affects young individuals, especially Caucasian women between 20 and 40 years of age, being rare in Asians and blacks, and unusual in individuals older than these age limits[1]. The distribution of this disease in the globe is not uniform. Countries like England, New Zealand, the northern United States, southern Canada and Australia are highly prevalent, with more than 30 patients per 100,000 inhabitants. Brazil and the other countries of South America have low prevalence rates; the mixing of races with European influence caused an increased prevalence in the states of São Paulo and Minas Gerais, with rates of around 18 patients per 100,000 inhabitants[1]

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