Characteristics of Early Oropharyngeal Dysphagia in Patients with Multiple System Atrophy

Abstract

Background/Aims: Dysphagia, a symptom of multiple system atrophy (MSA), is a major clinical concern. In this study, we investigate the characteristics of early oropharyngeal dysphagia (OD) in patients with MSA, and the differences between MSA subtypes. Methods: Patients enrolled in the study had previously been diagnosed with MSA at the clinic of the Department of Neurology, and had been referred for a videofluoroscopic swallowing study (VFSS), between 2005 and 2014, to check for dysphagia. The clinical characteristics and VFSS findings were analyzed and compared between the MSA subtypes. Results: This study enrolled 59 patients with MSA (24 men; 31 with MSA-P, 21 with MSA-C, and 7 with MSA-PC). Dysphagia symptoms were mostly limited to aspiration symptoms (90.48%) in patients with MSA-C, while difficulty in swallowing, increased mealtime, and drooling were frequent in those with MSA-P. The most common VFSS finding amongst patients was vallecular residue (n = 53, 89.8%), followed by penetration/aspiration (n = 40, 67.8%), and coating of the pharyngeal wall (n = 39, 66.1%). Comparison analysis between subtypes showed that apraxia and vallecular residue were more frequent and severe in MSA-P than in MSA-C (p = 0.033 and p = 0.010, respectively). Conclusion: Understanding early OD characteristics in patients with MSA and the differences between MSA subtypes could be helpful in managing dysphagia in patients with MSA. Several dysphagia symptoms similar to those of Parkinson disease were frequently observed in MSA-P, but not in MSA-C. A follow-up study is needed to elucidate the natural course of OD in MSA patients and the difference between MSA subtypes.

The Shaking Palsy of the Larynx—Potential Biomarker for Multiple System Atrophy: A Pilot Study and Literature Review

“…Petrovic in contrast described a much later onset of dysphagia in MSA-P patients at 9.0 ± 3.7 years (63). A recent study in 59 Korean MSA patients showed a much earlier dysphagia onset in both MSA sub-types (MSA-P: 2.94 ± 1.43 years, MSA-C: 3.05 ±1.24 years) (64).…”

Dysphagia in neurological diseases: a literature review

“…Dysphagia is defined as an impairment of this complex and integrated sensorimotor system. Neurogenic dysphagia (ND) is typically occurring in patients with neurological disease of different etiologies (see Table 1), and it is associated to high mortality, morbidity, and social costs [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Neurological problems that cause dysphagia can be categorized in many different ways: anatomic location of the lesion (e.g., central nervous system, peripheral nervous system or muscle), pathogenetic mechanism of disease (e.g., ischemic injury or degenerative process), etiology, or clinic presentation (e.g., dementia or movement disorders).…”

Various Motor and Non-Motor Symptoms in Early Multiple System Atrophy

“…Those with MSA often exhibit symptoms of dysphagia much earlier than those with PD [13]. A previous study on dysphagia in MSA reported that dysphagia was mostly limited to aspiration symptoms in MSA-C, while difficulty in swallowing, increased mealtime, and drooling were frequent in MSA-P [6]. In another study, the latency from the onset of dysphagia symptoms to the onset of dietary modification was 2.3 years in MSA-P and 5.1 years in MSA-C [24].…”

“…The type of MSA was determined according to the predominant motor symptoms at the last visit: predominantly parkinsonian (MSA-P) or predominantly cerebellar (MSA-C). If a patient had both parkinsonism and cerebellar dysfunctions with no clear predominance, the patient was designated MSA-PC (also known as MSA-mixed) [4][5][6]. Disease onset was defined as the initial presentation of any motor symptoms, because the onset of autonomic symptoms was unclear in many patients.…”