Dysphagia In Multiple Sclerosis Research Articles

Dysphagia in neuromyelitis optica spectrum disorder and multiple sclerosis: A comparison of frequency, severity, and effects on quality of life

OverviewDysphagia has been previously discussed as a potential life-threatening condition secondary to chronic neurological diseases such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). However, its impact on the quality of life (QoL) of patients with NMOSD has never been studied before. This study aims to determine the frequency of dysphagia and its impact on QoL in NMOSD patients in comparison with MS people and healthy individuals. MethodsSeventy-five MS and sixty-five NMOSD patients with an expanded disability status scale (EDSS) score ≥ 3.5 in addition to 106 healthy controls were enrolled in this cross-sectional study. All the participants completed the self-report dysphagia in MS (DYMUS) and 36-item short-form health survey (SF-36) questionnaires. In case of positive answers to at least one of the questions in DYMUS, they were asked to fill out the dysphagia handicap index (DHI) questionnaire. ResultsThe frequency of dysphagia in NMOSD, MS, and control groups was 61.54 %, 72.97 %, and 27 %, respectively. Patients with swallowing problems had reduced scores across different swallowing-related QoL domains compared to non-dysphagic patients (p < 0.05). NMOSD (1, IQR [0–3.5]) and MS patients (2, IQR [0–4]) had a significantly higher median total DYMUS score than control (0, IQR [0–1]) (p < 0.01). However, there was no discernible difference between the two patient groups. NMOSD had the highest mean total DHI score (21.22 ± 21), followed by MS (15.25 ± 18.94) and control (7.08 ± 5.12). A significant correlation was seen in the NMOSD group between the DHI total score and the SF-36 total score (r = 0.62, p < 0.05). The DHI and SF-36 subscales showed a strong association as well. The overall SF-36 scores in both the control and MS groups was not significantly correlated with DHI. The generalized linear model analysis showed that the NMOSD group's age (p-value = 0.005), EDSS (p-value < 0.001), and total DYMUS score (p-value = 0.018) significantly affected overall health status. ConclusionThe presence of dysphagia significantly impacts the QoL in NMOSD patients, particularly in aspects related to swallowing. These findings underscore the critical need for diligent dysphagia screening and emphasize the importance of educating both caregivers and NMOSD patients about managing this challenging symptom.

Do proprioceptive neuromuscular facilitation techniques improve respiratory parameters and swallowing in people with multiple sclerosis: A randomized-controlled study

AimThis study aims to investigate the effects of Proprioceptive Neuromuscular Facilitation (PNF) techniques on respiratory parameters, swallowing, functional capacity, fatigue, and quality of life in people with Multiple Sclerosis (PwMS). MethodThirty-four PwMS were included and randomized into the PNF Group (mean age: 43.23±10.55/years) or Control Group (mean age:38.47±8.18/years). In the PNF group, head-neck, upper extremity, trunk, and breathing techniques were applied three days/eight weeks. The control group continued home-based breathing exercises. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow (PEF), forced expiratory flow 25–75 % (%FEF 25–75), peak cough flow (PCF), maximal inspiratory (MIP) and expiratory pressures (MEP) were and two minutes walking test (2MWT) were measured. Dysphagia in Multiple Sclerosis (DYMUS), Eating Assessment Tool (EAT-10), Fatigue Severity Scale (FSS) and Multiple Sclerosis Quality of Life (MusiQoL) were questioned. ResultsAfter treatment, MIP, MEP,%FEV1/FVCpred,%PEFpred,%FEF 25–75pred, PCF, DYMUS, EAT-10, FSS, and MUSIQoL were improved in the PNF group while MIP, MEP, PCF, DYMUS, EAT-10, MUSIQoL, and 2 MWT were improved in the control group (p < 0.05 for all). In the between-group analysis of the mean differences, the%FEV1pred was significantly different in favor of the PNF Group (p = 0.011), and MIP was significantly different in favor of the Control Group (p = 0.013). DiscussionThe PNF techniques can improve respiratory muscle strength, respiratory functions, cough efficiency, swallowing functions, and quality of life in mild to moderate PwMS. However, these improvements were not superior except for%FEV1pred compared to home-based breathing exercises.

Screening for dysphagia in patients with relapsing-remitting multiple sclerosis

BackgroundIn multiple sclerosis (MS), dysphagia is an important and common clinical symptom. Although often overlooked and underdiagnosed, it can have a significant impact on a patient's life, including social integration, and it can lead to malnutrition, aspiration pneumonia, and suffocation, i.e., life-threatening complications. Early detection of dysphagia is essential to prevent these risks. However, the optimal screening method and the inter-relationship between different methods used for dysphagia screening are not clear. The aim of this study was to compare the diagnostic performance of a simple question about swallowing problems, the DYsphagia in MUltiple Sclerosis (DYMUS) swallowing questionnaire, and the Timed Water Swallowing Test (TWST) to detect dysphagia in people with relapsing-remitting MS (RRMS). MethodsPatients with MS were asked about subjective swallowing difficulties and, regardless of their response, completed the DYMUS questionnaire and underwent the TWST at their routine follow-up visit. Patients with at least one positive screening method were offered an objective assessment of swallowing function using the Fiberoptic Endoscopic Evaluation of Swallowing (FEES). The results were statistically analyzed and correlated with demographic and MS-related parameters. ResultsOf the 304 people with RRMS enrolled in the study, 46 (15.1 %) reported having subjective difficulty swallowing when asked a simple question. The DYMUS questionnaire was positive in 59 (19.4 %) of the 304 patients; 51 (16.8 %) had an abnormality on the TWST. A clear correlation (r = 0.351, p < 0.01) was found between the DYMUS and TWST results, but a significant proportion of patients (about half) had an abnormality on only one of these tests. The positivity of at least one of the screening methods used (DYMUS or TWST) had a better chance of identifying a patient with dysphagia than a simple question (p < 0.001). Of the patients with a positive result for difficulty swallowing, 37 underwent FEES, which confirmed dysphagia in 94.6% of this subgroup. Patients with higher Expanded Disability Status Scale (EDSS) scores, female gender, and older age were at higher risk of developing dysphagia. ConclusionThe DYMUS questionnaire and TWST had a confirmed potential to identify more patients with dysphagia than a simple question about swallowing problems. However, our study found only a partial overlap between DYMUS and TWST; a combination of these two methods was more sensitive in identifying patients with MS at risk of dysphagia. Furthermore, the screening showed excellent specificity: almost 95 % of the positively screened patients had dysphagia confirmed by objective methods. Age, female gender, and a higher EDSS score appear to be potential risk factors for dysphagia in patients with MS.

Validation of the swallowing disturbance questionnaire in people with multiple sclerosis

BackgroundThe DYSPHAGIA IN MULTIPLE SCLEROSIS (DYMUS) questionnaire is the only specific tool developed to screen for dysphagia in people with Multiple Sclerosis (pwMS). However, some limitations of DYMUS could potentially be addressed by the SWALLOWING DISTURBANCE QUESTIONNAIRE (SDQ), which has not yet been validated in pwMS. The objective of this study was to translate and validate the SDQ into the Italian language for use in pwMS to detect swallowing disturbances. MethodsWe translated the SDQ into Italian and adapted it for use in Italian pwMS. PwMS aged > 18 years, assessed for disability using the Expanded Disability Status Scale (EDSS), completed the SDQ and DYMUS questionnaires and performed the 3-OUNCE WATER SWALLOW TEST (WST). Clinical and demographic data were collected for each patient. The Italian version of the SDQ was retested after 30 days. ResultsA total of 84 pwMS were recruited for the study, consisting of 73.8 % women and 48.8 % with a relapsing-remitting form of MS. The mean age of participants was 44.5 years (SD: ±12.46), with a mean disease duration of 17 years (SD: ±10.27), and a median EDSS of 4 (range 1.5–7.5). The Cronbach's alpha for SDQ (to assess internal consistency) was 0.902, which increased to 0.908 after the elimination of item 15, resulting in the SDQ composed of 14 items. ROC analysis demonstrated good accuracy of the 14-item SDQ in pwMS (AUC: 0.811). By dividing the 14-item SDQ score into quartiles, three risk levels for dysphagia were identified: low (score 1–3), intermediate (score 4–8), and high (score ≥9). 14-item SDQ scores significantly correlated with DYMUS (r = 0.820; p<0.0001) and with EDSS (r = 0.541; p<0.0001). PwMS who reported dysphagia had a significantly higher mean 14-item SDQ score (8.27 ± SD 8.15) compared to those without swallowing problems (2.77 ± SD 4.25; p = 0.003). Additionally, pwMS with a positive WST had a significantly higher mean 14-item SDQ score (10.17 ± SD 8.96) than those with a negative WST (2.96 ± SD 3.93; p = 0.02). The Intraclass Correlation Coefficient for the retest, calculated on 48 pwMS in a stable phase of the disease, was 0.91 (95 % CI 0.84–0.95). ConclusionThe 14-item SDQ has demonstrated high internal consistency, good accuracy, and reliability in pwMS, making it a readily applicable tool for investigating dysphagia in MS.

Neuromuscular Electrical Stimulation in Conjunction with Conventional Swallowing Therapy in the Treatment of Dysphagia Caused by Multiple Sclerosis: A Single-Case Experimental Design

Introduction: Dysphagia as a consequence of multiple sclerosis (MS) puts individuals at higher risk of dehydration, malnutrition, and aspiration pneumonia. This study intended to investigate the effects of a combined program of neuromuscular electrical stimulation (NMES) and conventional swallowing therapy to improve swallow safety and efficiency, oral intake, and physical, emotional, and functional impacts of dysphagia in people with dysphagia and MS. Methods: In this single-case experimental study with ABA design, two participants with dysphagia caused by MS underwent 12 sessions therapy during 6 weeks following a baseline of 4 evaluation sessions. They were evaluated 4 more times in the follow-up phase after therapy sessions. Scores of Mann Assessment of Swallowing Ability (MASA), DYsphagia in MUltiple Sclerosis (DYMUS), and timed test of swallowing capacity were obtained at baseline, during treatment, and in the follow-up phases. The Dysphagia Outcome and Severity Scale (DOSS) based on videofluoroscopic swallow studies, Persian-Dysphagia Handicap Index (Persian-DHI), and Functional Oral Intake Scale (FOIS) were also completed before and after treatment. Visual analysis and percentage of nonoverlapping data were calculated. Results: MASA, DYMUS, FOIS, and DHI scores indicated significant improvement in both participants. Although the scores of the timed test of swallowing capacity in participant 1 (B.N.) and DOSS in participant 2 (M.A.) showed no changes, considerable improvements including reducing the amount of residue and the number of swallows required to clear bolus were seen in the posttreatment videofluoroscopic records of both participants. Conclusion: NMES in conjunction with conventional dysphagia therapy based on motor learning principles could improve the swallowing function and decrease disabling effects of dysphagia on different aspects of life in participants with dysphagia caused by MS.

Validation of the Czech Version of the Dysphagia in Multiple Sclerosis Questionnaire (DYMUS).

Dysphagia is a common symptom of neurological disease, including multiple sclerosis (MS). The DYsphagia in MUltiple Sclerosis (DYMUS) questionnaire was developed as a screening tool for swallowing problems. The purpose of the present study was to validate the Czech version of the DYMUS questionnaire. We validated the questionnaire on a sample of 435 patients with MS and 135 healthy controls (HC) chosen by accidental sampling from larger, long-term studies conducted by the Prague MS Center. For the purposes of this study, we used both electronic (primary method of distribution) and paper-based (backup) versions of the questionnaire. The internal consistency of the whole scale was satisfactory (Cronbach’s α =0.833). The DYMUS mean score in HC was 0.215 (standard deviation [SD] = 0.776). Normative data suggested a cut-off value for dysphagia between 1 and 2 points. Principal component analysis (PCA) showed a two-factor structure of the adapted scale. However, the structure did not completely correspond to the originally proposed dimensions of dysphagia for solids and liquids; our data supported dropout of item Q10. Criterion validity was proved by the difference in dysphagia between HC and patients MS (U = 25,546, p < 0.001) and by a positive correlation with the EDSS (Kendall’s tau-b = 0.169, p < 0.001) and other patient-reported outcomes. The Czech version of the DYMUS questionnaire is a valid and reliable tool for evaluating swallowing impairment in Czech-speaking patients with MS. Moreover, the questionnaire can be administered electronically, with a paper-based backup.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00455-022-10530-5.

Myotonometric comparison of sternocleidomastoideus and masseter muscles in multiple sclerosis patients with swallowing problem and healthy individuals

BackgroundDysphagia occurring in the oral and pharyngeal phases of swallowing in MS patients may be caused by changes in muscles' viscoelasticity. The aim of this study was to compare the muscles' (sternocloideomastoideus and masseter) viscoelasticity properties by myotonometer between MS patients and healthy individuals. MethodsThis study design was a cross-sectional, non-interventional study. Ten healthy individuals were allocated to the control group, eleven MS patients without swallowing problems were allocated to the without swallowing group, ten MS patients with swallowing problems were allocated to the swallowing group. Disability was evaluated using the Expanded Disability Status Scale (EDSS), swallowing problem was assessed with Dysphagia in Multiple Sclerosis (DYMUS) scale, and to measure the viscoelastic parameters (tone, stiffness, elasticity) of sternocloideomastoideus (SCM) and masseter muscles bilaterally, MyotonPro® was used. The comparison between the groups was performed using the Kruskal-Wallis H test. ResultsIt was observed that there was no difference in terms of viscoelastic properties of the masseter muscle in groups (p > 0.05). There was no difference between the groups in terms of the elasticity of the SCM muscle (p > 0.05). However, the tonus and stiffness of the SCM on the left side of the MS patients were higher than in other groups (p = 0.050, p = 0.005). ConclusionThe increment level of tone and stiffness of SCM muscle is related to swallowing problems in patients with MS. Due to swallowing problems in MS, the orofacial and neck region's muscles' viscoelastic properties may change in time and may be affected by phases of swallowing problems.

Screening of dysphagia in relapsing-remitting multiple sclerosis patients in Montenegro.

Objectives:To perform screening of dysphagia in Montenegrin multiple sclerosis (MS) patients. Dysphagia is often neglected problem in patients with MS.Methods:We included 104 patients with relapsing-remitting MS who completed 3 questionnaires: dysphagia in multiple sclerosis (DYMUS), eating assessment tool-10 (EAT-10) and swallowing disturbance questionnaire (SDQ). Our study was performed in the clinic for neurology of the Clinical Center of Montenegro (Podgorica, Montenegro) and Polyclinic Neuron (Bijelo Polje, Montenegro) between November 2020 and December 2020.Results:Self-reported prevalence of this symptom in our group was simmilar to previously reported results. We did not find correlation between DYMUS and expanded disability status scale (EDSS), as it was reported before. Time spent from disease onset to diagnosis is strongly correlated with reported SDQ results. The population of dysphagia-patients is statistically significantly older compared to the non-dysphagia patients, and statistically higher mean values in this population of our subjects were proven on all 3 questionnaires used.Conclusion:The importance of this issue is not just because it warns of potientially malnutrion in MS patients, but also important factor in therapy choosing algorithm in the era of orally used immunomodulatory drugs.

From DYMUS to DYPARK: Validation of a Screening Questionnaire for Dysphagia in Parkinson’s Disease

Dysphagia is a common debilitating symptom in people with Parkinson’s Disease (PD), adequate screening of swallowing disorders is fundamental. The DYMUS questionnaire has shown very good characteristics for the screening of dysphagia in Multiple Sclerosis, and it might also prove useful for screening dysphagia in PD. The primary aim was to test and validate the DYMUS questionnaire in PD patients. This is an observational multicentric study involving 103 patients affected by PD. All subjects filled in the DYMUS and the Eating Assessment Tool (EAT-10) questionnaires. A subgroup of patients (n = 53) underwent a fiber-optic endoscopic evaluation of swallowing (FEES) and their dysphagia was scored by means of the Dysphagia Outcome Severity Scale (DOSS). DYMUS showed a relatively high level of internal consistency (Cronbach’s alpha 0.79). A significant positive correlation was found between the DYMUS and the EAT-10 scores (p < 0.001), while a negative correlation was found between the DYMUS and the DOSS scores (p < 0.001). DYMUS showed a good sensitivity and specificity compared to FEES for detecting dysphagia (area under the curve: 0.82, p < 0.001). The ROC curve analysis showed that a DYMUS score ≥ 6 represents a reliable cut-off for the risk of dysphagia. The DYMUS questionnaire proved to be a reliable screening tool to detect dysphagia in patients suffering from PD. It is easy to understand, it can be self-administered and therefore adequate for adoption in the clinical practice with the more convenient name of DYPARK.

Accuracy of the Brazilian version of the DYMUS questionnaire for the screening of oropharyngeal dysphagia in multiple sclerosis

BackgroundOropharyngeal dysphagia is a common symptom of many neurological diseases, including Multiple Sclerosis (MS). Early identification of the risk of dysphagia in neurological patients is very important for early referral for specialized evaluations of oropharyngeal swallowing and treatments. The Dysphagia in Multiple Sclerosis (DYMUS) questionnaire has been translated and validated in different countries over the last 10 years. We aimed to analyze the accuracy of the Brazilian Portuguese version of the DYMUS (DYMUS-BR) questionnaire in identifying dysphagia in patients with MS. MethodsThe DYMUS questionnaire and a videofluorographic swallowing study (VFSS) were conducted in 30 patients with MS. Dysphagia was identified by at least one abnormal response and was considered alarming when the DYMUS scores were equal to or higher than 3. Patients were considered to have dysphagia in the VFSS when one or more signs of impairment in the efficiency and/or safety of swallowing were detected. ResultsAccording to the initial self-assessment, 37% (N = 11) of patients with MS self-reported with dysphagia. According to the DYMUS-BR scores, 53% (N = 16) of the patients with MS were classified as having dysphagia. The sensitivity, specificity, and positive and negative predictive values of the DYMUS-BR questionnaire for the detection of dysphagia as measured by the VFSS were 50% [95% confidence interval (CI) 29–71], 78% (95% CI 61–90), 60% (95% CI 42–76), and 70% (95% CI 60–78), respectively. The area under the receiver-operating characteristic curve for detecting dysphagia was 64% (95% CI 49–79). ConclusionThe accuracy of the DYMUS-BR questionnaire is poor to detect mild swallowing impairment in patients with MS. However, we suggest longitudinal follow-up in patients with low DYMUS-BR scores for early detection of oropharyngeal dysphagia.

Dysphagia in Multiple Sclerosis - an underestimated symptom?

It is estimated that 240,000 people suffer from multiple sclerosis in Germany. In addition to sensory, motor, vegetative, and neuropsychological functional deficits, dysphagia is a highly relevant and disabling, although not well studied symptom of MS. The purpose of this article is to provide an overview of the scientific background, increase awareness of the symptoms of dysphagia, and to introduce diagnostic tools for its management, overall aiming at alleviating symptoms of dysphagia in persons with MS, and improving their quality of life. A structured literature review was conducted of what is currently known on the development, manifestation, diagnosis and treatment options for MS-related dysphagia. Due to the lack of class 1 evidence, in particular for diagnosis and treatment options of dysphagia, also smaller studies or pilot projects were included and discussed in this review. Data from imaging methods such as Flexible Endoscopic Evaluation of Swallowing and Videofluoroscopic Swallowing Evaluation enabled the diagnosis. There was a high variablity in the reported frequency of dysphagia in published studies, largely related to differences in methodology to evaluate the swallowing (from 38 % up to 81 %). Overall, dysphagia as a symptom of multiple sclerosis was underestimated at the patient and the physician level. According to current data from the German MS register, specific treatments were only carried out in 30% of the affected patients.

Screening of dysphagia by DYMUS (Dysphagia in multiple sclerosis) and SWALQoL (Swallowing quality of life) surveys in patients with multiple sclerosis

BackgroundDysphagia is a life-threating symptom in patients with multiple sclerosis (MS) because aspiration pneumonia develops as a consequence of swallowing disorders. Dysphagia can be detected by using patient-reported outcome measures in order to prevent complications. ObjectiveTo identify the dysphagia prevalence, severity, and swallowing related quality of life (QoL), by using two validated dysphagia questionnaires. MethodDysphagia in Multiple Sclerosis (DYMUS) and Swallowing Quality of Life (SWALQoL) questionnaires were collected from 64 patients with MS. ResultsThe mean total SWALQoL score was 67.9 (±11.2) and the mean DYMUS score was 2.02 (±1.3). The highest mean SWALQoL subdomain score belonged to communication (76.7 ± 15.8), and the lowest score belonged to sleep (54.2 ± 12.2). There was a significant correlation between age and DYMUS and SWALQoL scores (r: 0.539 and r: -0.610 respectively, P < .001). Additionally, there was a significant moderate correlation between disease duration and DYMUS and SWALQoL scores (r: 0.693 and r: -0.697 respectively, P < .001). DYMUS and SWALQoL scores did not vary between males and females (P > .05). Patients with secondary progressive MS had higher DYMUS and lower SWALQoL scores (more dysphagia) than in primary progressive or relapsing-type MS.There was a strong, negative and statistically significant correlation between DYMUS and total SWALQoL scores (Spearman's rho: -0.862, p < .001). ConclusionMS causes dysphagia and reduces QoL. Age, disease duration, and MS type are major factors that influence SWALQoL. DYMUS and SWALQoL are well correlated. DYMUS is an easy to answer tool that may advised for screening dysphagia in patients with MS.

Swallowing Disorder in Multiple Sclerosis: Modified Version of the Screening Tool

Objective: Dysphagia is commonly encountered in Multiple Sclerosis (MS). It can consequently cause severe complications such as the increased risk of dehydration, malnutrition and aspiration pneumonia that associated with an increased risk of death in the late stages of the disease. These complications can be prevented with an effective screening protocol. The Dysphagia in Multiple Sclerosis (DYMUS) is the only questionnaire developed specifically for patients with MS. The aim of the present study was translation and cross-culturally adaptation of DYMUS for the Persian population and estimation of the questionnairechr('39')s reliability and validity. Also, we investigated the frequency and severity of dysphagia in the patients referring to the Tehran MS Society and its association with the course of MS, disease duration, and Expanded Disability Status Scale (EDSS). Materials &amp; Methods: This is a methodological and descriptive-analytic study. The statistical populations consist of the patients with MS referring to the Tehran Multiple Sclerosis Society in 2018. The study sample consisted of 108 patients who were selected through a convenient sampling method. The research instruments consisted of 10-items DYMUS questionnaire (in the first part of the study, translated and its psychometric properties examined), Dysphagia Handicap Index and a demographic information questionnaire. In methodological section, translation and cross-cultural adaptation were fulfilled and the Confirmatory Factor Analysis (CFA) was used to assess the construct validity and to test the goodness-of-fit of the presented model. The association between the DYMUS and Dysphagia Handicap Index (DHI) scores investigated to convergent validity. ‏ The inter-item correlation matrix was calculated to assess the homogeneity of the questionnaire items. Kuder - Richardson (KR-20) was measured to assess the internal consistency of the questionnaire. Also, the test-retest procedure was conducted on the 19 subjects understudy to assess the reliability. Finally, the frequency and severity of dysphagia and its association with the course of MS, disease duration, and EDSS was investigated. KR-20 reliability coefficient, Intraclass Correlation Coefficient (ICC), inter-item correlation matrix, Mann-Whitney U test and rank correlation coefficient or Spearmanchr('39')s were used to inferential statistical analysis. Results: Analysis of the inter-item correlations matrix indicated a positive correlation between all items, exception item 10. Based on the results of the inter-item correlation, item 10 had the lowest correlation coefficient that was deleted from the questionnaire. CFA results confirmed the two-factor model of DYMUS, “dysphagia for solids” and “dysphagia for liquids”, and revealed that the item 10 was minimally contributing to the measurement of "dysphagia of solids" and internal consistency increased after the deletion of this item. Also, the solution of the 9-item Model was the best goodness-of-fit indicator for the sample. The obtained results from the convergent validity indicated a positive significant correlation between the DYMUS and DHI (rs=0.693, P&lt;0.001). A KR-20 reliability coefficient of the DYMUS was 0.856, indicating high internal consistency of the Persian translation of the questionnaire items. Test-retest reliability was excellent with 0.965 value. The results also showed that 65.7% of multiple sclerosis patients had a swallowing disorder. In terms of the dysphagia severity, 25.9% of participants had mild dysphagia, and 39.8% of participants had alarming dysphagia. DYMUS values were significantly correlated with disease duration (rs=0.198, P= 0.040), and EDSS (rs=0.235, P= 0.014) and significantly higher mean scores were observed in the patients with secondary progressive than the other subgroups of multiple sclerosis. Conclusion: The Persian adjusted 9-item questionnaire was demonstrated to be a simple, consistent, valid and reliable tool for the detection of patients who need more specific instrumental evaluations of swallowing. Also, about the dysphagia is very frequent in these patients, it is important that clinicians monitor these patients carefully even in early stages of the disease‏ for early detection and planning a rehabilitation program to the prevention of serious subsequence complications.

Multiple Sclerosis: Impact on Oral Hygiene, Dysphagia, and Quality of Life.

Multiple sclerosis (MS) is an autoimmune disease in which the immune system reacts by damaging the central nervous system, specifically myelin and oligodendrocytes. It is the most debilitating neurological disease among young adults, causing personal, familiar, social, and professional limitations. Multiple sclerosis can cause disturbances in the orofacial district, due to a demyelination process on the nerves of the head and neck district. The aim of this study was to evaluate the oral health status, dysphagia, and quality of life of patients affected by MS. For this study, 101 patients aged between 12 and 70 (47 males, 54 females) affected by MS were selected, and three questionnaires were handed out and anonymously filled in by them: An oral hygiene test, DYMUS (DYsphagia in MUltiple Sclerosis), and IOHIP-14 (Italian version Oral Health Impact Profile). Through the analysis of the questionnaires it was possible to observe pathological conditions, such as gingival inflammation, xerostomia, dysphagia, neuralgia, and dysarthria. Through the analysis it was possible to outline how the roles of a medical team, composed of a dentist, otolaryngologist, and dental hygienist, are fundamental in coping with other medical figures, during the whole development of the diseases, as well as to prevent possible complications.

The modified DYMUS questionnaire is a reliable, valid and easy‐to‐use tool in the assessment of dysphagia in multiple sclerosis

Many patients with multiple sclerosis (MS) present swallowing difficulties. Dysphagia is associated with significant morbidity and mortality, has a profound impact on the quality of life but is under-reported by patients. The objective was to investigate the psychometric properties of the Dysphagia in Multiple Sclerosis (DYMUS) questionnaire and examine whether item reduction improves them. The participants, 153 patients with MS and 104 healthy controls, completed the DYMUS and the Eating Assessment Tool 10 (EAT-10). The study consisted of factor, reliability and validity analysis of DYMUS, and item reduction, reliability, validity analysis and normative data generation for the modified DYMUS (mod-DYMUS). The internal consistency of DYMUS was excellent (Cronbach's alpha 0.886). Test-retest reliability was good for all the items. Factor and reliability analysis, along with other psychometric features, supported item reduction. The mod-DYMUS (consisting of items 1 and 3-7) showed improved internal consistency (Cronbach's alpha 0.903) and inter-item correlation coefficients (0.558-0.657), good test-retest reliability, excellent criterion validity and improved convergent validity. Patients had significantly higher mean mod-DYMUS score than controls (P<0.001), and dysphagic patients (EAT-10≥3) had significantly higher mod-DYMUS than non-dysphagic patients (P<0.001). A strong positive and significant correlation was noted between the mod-DYMUS and the EAT-10 (P<0.001). A mod-DYMUS score of 1 or higher indicates dysphagia. Item reduction improves the psychometric properties of DYMUS. The mod-DYMUS is a valid, reliable, low-burden, screening tool for the detection of dysphagia in MS, which can enhance personalized assessment and guide management decisions that better respond to individual patients' needs.

Dysphagia Prevalence, Attitudes, and Related Quality of Life in Patients with Multiple Sclerosis.

Dysphagia in patients with multiple sclerosis (MS) is associated with significant morbidity and has profound impact on the quality of life (QoL). This study aimed to analyze the dysphagia prevalence, attitudes, and dysphagia-related QoL in patients with MS, not at relapse. A prospective study of 108 consecutively recruited patients. The patients were asked to report dysphagia and completed a general dysphagia questionnaire (the Eating Assessment Tool-10, EAT-10), a disease-specific dysphagia questionnaire (the Dysphagia in Multiple Sclerosis, DYMUS), and a dysphagia-related QoL questionnaire (the Swallowing-Quality of Life). Twenty-six percent of the patients reported dysphagia. Many more were classified as dysphagic by the questionnaires (34.3% by EAT-10 and 44.4% by DYMUS). Overall, one out of four patients reported difficulties or choking while drinking fluids and eating food, cough related to eating, food sticking in the throat, need for food and drink segmentation, and repetitive swallows. The pleasure of eating was found to be moderately affected. The patients seem to cope well with the psychological and social impact of dysphagia. Serious consideration must be given to patients' perceptions and attitudes towards dysphagia. Our patients reported very little fear associated with their swallowing difficulties and choking. Apparently, they do not perceive the severity of their symptoms as an actual danger, as they have developed coping strategies. Dysphagia is common in MS patients not at relapse, even with mild disease-related impairment. Swallowing should be systematically assessed with validated questionnaires in all patients with MS at the course of the disease.

Prevalence of dysphagia in multiple sclerosis and its related factors; systematic review and meta-analysis

Background: Dysphagia is the most prevalent sign of multiple sclerosis (MS) which can reduce the quality of life and augment mortality in the final stages of MS. We presented a systematic review to estimate the prevalence of dysphagia in general and separately for each evaluation method (subjective and objective), and to analyze the causes of this rampant disease. Methods: Cross-sectional and prospective cohort studies were reviewed and scientific proofs were evaluated consistent with the pre-specified levels of certainty. Results: Twenty-two articles entered the meta-analysis phase; the estimation of the general prevalence of dysphagia in MS-affected patients was 43.33% related to all the 22 studies. Moreover, the estimate of the prevalence via the subjective (16 studies) and objective (6 studies) methods were 37.21% and 58.47%, respectively. Conclusion: This study obtained the prevalence rate of dysphagia in patients affected by MS globally, yet there was infinite statistical society and limited methodological quality. Thus, more extensive studies are required for a better understanding of the global epidemiology regarding dysphagia in MS.

Validation of the Persian version of dysphagia in multiple sclerosis questionnaire for the assessment of dysphagia in multiple sclerosis

Background: About one third of patients with multiple sclerosis (MS) experience dysphagia. Dysphagia can cause complications such as malnutrition, lung infections, aspiration pneumonia and dehydration, thus it is very helpful to diagnose dysphagia as soon as possible. The aim in this study was to translate dysphagia in multiple sclerosis (DYMUS) questionnaire into Farsi and and validate it. Methods: Forward-backward method was used to translate original English version of DYMUS into farsi, and then the questionnaire (one for each patient) was filled in through asking questions from 200 patients with MS by a speech and language pathologist. Confirmatory factor analysis (CFA) was used to examine the construct validity. Internal consistency and test-retest reliability of the DYMUS were evaluated using Cronbach's alpha and the intraclass correlation coefficient (ICC), respectively. Results: CFA showed that a two-factor model of DYMUS including "dysphagia for solid" and "dysphagia for liquid" fitted the data well [relative chi-square [χ2/degree of freedom (df) = 1.55, CFI = 0.967, Tucker-Lewis index (TLI) = 0.957, root mean square error of approximation (RMSEA) = 0.053, and weighted root mean square residual (WRMR) = 0.874]. The Cronbach's alpha for total score and liquid and solid subscales were 0.776, 0.557, and 0.725, respectively. The DYMUS showed adequate test-retest reliability for the total and subscales (ICC: 0.880-0.956). Moreover, this study has shown a significant relationship between DYMUS score and Expanded Disability Status Scale (EDSS) score, disease duration, type of MS, and self-reported dysphagia. Conclusion: The Persian version of DYMUS is a reliable and valid tool to screen dysphagia among patients with MS.

Validation of the Persian version of the dysphagia in multiple sclerosis questionnaire for the assessment of dysphagia in multiple sclerosis.

BackgroundThis study is to evaluate swallowing problems (dysphasia) in multiple sclerosis (MS) patients; the importance of using tools that are durable and appropriate is well understood. One of the most trusted tools is the dysphagia in multiple sclerosis (DYMUS) test. The aim of this study was to prepare a Persian version and to evaluate the validity and reliability of the test.Materials and MethodsThis methodological study was conducted on 236 MS patients in Southeast of Iran from August 2015 to February 2016. After translation and cultural adaptation of the test in Persian, the validity of this test was determined using expert opinions accordance with the International Quality of Life Assessment Project. In addition, exploratory factor analysis (EFA) was performed with varimax rotation. The confirmatory factor analysis (CFA) was conducted and the goodness of fit indices was calculated. Moreover, to test the reliability, Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were used.Results:In total, 236 MS patients were included in the study (81 males and 155 females). All the questions in the test's Persian version obtained an acceptable face and content validity (content validity ratio = 1, Scale content validity index/Ave = 1). EFA revealed that the scale has two factors (solid–liquid) with 67.5% cumulative variance. CFA indicated a good fit to the intended two-factor structure, and the ratio of Chi-square to the degree of freedom was 1.79, and the root mean square error of approximation was 0.058. The internal consistency of total test indicated the appropriate level (Cronbach's alpha coefficient = 0.775), and test–retest reliability total questionnaire was found to be ICC = 0.985, indicating its high reliability.Conclusion:The results of this study indicated that the Persian version of the DYMUS questionnaire had good reliability and validity for patients with MS.

Management of dysphagia in multiple sclerosis: current best practice

ABSTRACTIntroduction: Multiple sclerosis (MS) is characterized by extreme variability in both severity and clinical course. It can show severe disabling symptoms, and among them dysphagia is frequently described. However, its management still represents a challenge in the daily care.Areas covered: In this review, we will focus on the clinical recognition and therapeutic strategies to identify and manage dysphagia in people with MS. In the view of a personalized approach, different interventions should be tailored to every single patient.Expert commentary: Multidisciplinary evaluation is mandatory in MS management, and dysphagia represents a perfect model of taking care of a disabling symptom in a chronic disease. Further research is required to better organize a personalized and long-term management of dysphagia phenomenon, through the different subtypes of MS.