Neurogenic Dysphagia

Foreword 

Preface     

1             Neuroanatomy and physiology of deglutition  

1.1          The unimpaired swallow   

1.2          The imparied swallow   

1.3          Central coordination of swallowing 

1.3.1      Brainstem and swallowing centers 

1.3.2      Supramedullary coordination of swallowing 

1.3.3      Hemispheric specialization  

1.3.4      Cortical plasticity – Compensation of disease-related dysfunction  

1.3.5      Cortical plasticity – Sensory stimulation to enhance reorganization  

2             Clinical procedures 

2.1          Introduction  

2.2          History 

2.3          Aspiration screening 

2.4          The clinical swallowing examination  

3             FEES and other instrumental methods for swallowing evaluation  

3.1          FEES 

3.1.1      Introduction  

3.1.2      Equipment 

3.1.3      Standard FEES protocol

3.1.4      Specific neurological protocols 

3.1.5      Key findings and their rating 

3.1.6      Endoscopic classification of neurogenic dysphagia 

3.1.7      Documentation of endoscopic findings 

3.1.8      Training curriculum: “FEES for Neurogenic Dysphagia” 

3.2          Videofluoroscopic swallowing study (VFSS) 

3.2.1      Indications 

3.2.2      Technique  

3.2.3      Radiation exposure  

3.2.4      Contrast agents 

3.2.5      Procedure  

3.2.6      Findings 

3.2.7      Comparing VFSS and FEES 

3.3          Manometric evaluation of swallowing 

3.3.1      Conventional manometry 

3.3.2      High-resolution manometry 

3.4          Electromyographic evaluation of swallowing 

3.5          Sonographic evaluation of swallowing 

3.6          Magnetic resonance imaging and computer tomography for the evaluation of swallowing 

3.7          Differential indication of instrumental dysphagia diagnostics 

4             Special findings in neurogenic dysphagia 

4.1          Stroke  

4.2          Dementia 

4.2.1      Alzheimer’s disease  

4.2.2      Vascular dementia 

4.2.3      Frontotemporal dementia 

4.2.4      Dementia with Lewy bodies 

4.2.5      Excursus: Presbyphagia 

4.3          Movement disorders 

4.3.1      Parkinsonian syndromes 

4.3.2      Chorea 

4.3.3      Dystonias 

4.3.4      Wilson’s disease  

4.4          Inflammatory diseases of the central nervous system   

4.4.1      Multiple scerosis 

4.4.2      Bacterial and viral meningoencephalitis 

4.4.3      CNS listeriosis 

4.4.4      Poliomyelitis and post-polio syndrome  

4.4.5      Tetanus 

4.5          Tumors 

4.5.1      Brain tumors and metasteses 

4.5.2      Meningeosis neoplastica 

4.5.3      Paraneoplastic syndromes 

4.6          Motor neuron disorders 

4.6.1      Amyotrophic lateral sclerosis 

4.6.2      Hereditary spastic paraplegia 

4.6.3      Spinal and bulbar muscular atrophy (Kennedy’s disease) 

4.7          Polyneuropathy 

4.7.1      Guillain–Barré syndrome  

4.7.2      Critical illness polyneuropathy and myopathy 

4.8          Diseases affecting neuromuscular transmission  

4.8.1      Myasthenia gravis 

4.8.2      Lambert–Eaton myasthenic syndrome  

4.8.3      Botulism   

4.9          Myopathies 

4.9.1      Myositis 

4.9.2      Oculopharyngeal muscular dystrophy 

4.9.3      Oculopharyngodistal myopathy 

4.9.4      Metabolic myopathies 

4.9.5      Facioscapulohumeral muscular dystrophy 

4.9.6      Myotonic dystrophies 

4.10       Trauma 

4.10.1    Traumatic brain injury 

4.10.2    Spinal cord trauma 

4.11       Psychogenic dysphagia 

4.12       Others 

4.12.1    Hereditary ataxias 

4.12.2    Niemann–Pick disease, type C  

4.12.3    Chiari type I malformation  

4.12.4    Palatal myoclonus (palatal tremor) 

4.12.5    Diffuse idiopathic skeletal hyperostosis 

4.12.6    Surgery 

4.12.7    Anti-IgLON5 syndrome  

4.12.8    Internal diseases 

4.13       Algorithm for a structured assessment of patients with neurogenic dysphagia 

5             Using FEES in the stroke unit and the intensive care unit 

5.1          Stroke unit 

5.1.1      Dysphagia management in the stroke unit 

5.1.2      Classification and management of post-stroke dysphagia 

5.2          Intensive care unit 

5.2.1      Epidemiology and complications of critical-illness dysphagia 

5.2.2      Etiopathogenesis of critical-illness dysphagia 

5.2.3      Applications of FEES in the ICU  

6             Treatment of neurogenic dysphagia 

6.1          Evidence-based medicine  

6.2          General treatment options 

6.2.1      Behavioral swallowing therapy 

6.2.2      Pharmacotherapy 

6.2.3      Surgical treatment options 

6.3          Disease-specific therapy 

6.3.1      Stroke  

6.3.2      Dementia 

6.3.3      Parkinson’s disease (idiopathic Parkinson’s disease) 

6.3.4      Progressive supranuclear paralysis 

6.3.5      Multiple system atrophy 

6.3.6      Dystonias 

6.3.7      Wilson’s disease  

6.3.8      Huntington’s disease  

6.3.9      Multiple sclerosis 

6.3.10    Tetanus 

6.3.11    Brain tumors 

6.3.12    Amyotrophic lateral sclerosis (ALS) 

6.3.13    Spinobulbar muscular atrophy (Kennedy’s disease) 

6.3.14    Guillain–Barré syndrome  

6.3.15    Myasthenia gravis 

6.3.16    Myopathies (including myositides) 

6.3.17    Traumatic brain injury 

6.3.18    Hereditary ataxia 

6.4          Neurostimulation  

6.4.1      Transcranial magnetic stimulation  

6.4.2      Transcranial direct-current stimulation  

6.4.3      Pharyngeal electrical stimulation  

6.4.4      Neuromuscular electrical stimulation  

7             Nutritional requirements in patients with neurogenic dysphagia 

7.1          Introduction  

7.2          Pathophysiology of malnutrition  

7.3          Diagnostics 

7.4          Treatment of malnutrition  

7.4.1      Oral nutritional therapy 

7.4.2      Artificial nutrition  

Bibliography

Abbreviations

Index

Appendix: Scales and scores

Questionnaire: “Quality of Life for Individuals with Dysphagia”:

Questionnaire for the assessment of dysphagia in Parkinson’s patients with swallowing problems (SDQ-PD-dV) (Simons 2012)

Munich Dysphagia Test – Parkinson’s Disease (MDT-PD) (Simons 2012)

Gugging Swallowing Screen (GUSS)

Bogenhausener Dysphagie Score (BODS) (Bartolome et al., 2013)

Flexible Endoscopic Dysphagia Severity Scale for Acute Stroke Patients (FEDSS, “Münster Dysphagia Scale”) (Dziewas et al., 2008b)

FEES Levodopa Test (Warnecke et al., 2010c)

FEES Tensilon Test (Warnecke et al., 2008b)

Murray’s 4-Point Secretion–Assessment Scale

Rosenbek’s 8-Point Penetration–Aspiration Scale (Rosenbek et al., 1996a; Hey et al., 2014)

The Functional Oral Intake Scale (FOIS)

The Dysphagia Outcome and Severity Scale (DOSS) (O’Neil et al., 1999)