Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

Abstract

Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).

A Stimulator of the Salivary Excretion Based on Physical Vibration of the Parotid Glands

“…Xerostomia in the context of neurogenic dysphagia has been anecdotal. However, at present, a guide has been published [ 25 ] which they indicate that, in addition to dietary interventions and behavioral treatment of swallowing, interventions to improve oral hygiene, pharmacological treatment, and different neurostimulation modalities are addressed. However, before starting the treatment of dysphagia with a neurostimulation approach where our device can play a role, the pattern of swallowing deficiency should be determined considering that neurostimulation methods should be used as a complement due to the scarcity of data; neurostimulation methods, in principle, should be used only in clinical trials.…”

The Preventive Effect of Dysphagia Screening on Pneumonia in Acute Stroke Patients: A Systematic Review and Meta-Analysis

“…Various tools have been used in previous studies for dysphagia screening. A swallowing test with water or a semisolid food and a survey asking about the presence of aspiration and swallowing function were used to evaluate the presence of dysphagia [ 15 , 16 , 17 , 18 ]. The videofluoroscopic swallowing study (VFSS) is a gold-standard tool for assessing swallowing disorders and oropharyngeal aspiration [ 19 ].…”

TRPA1s act as chemosensors but not as cold sensors or mechanosensors to trigger the swallowing reflex in rats

“…Therefore, targeting TRPA1s in the peripheral swallowing-related regions may be a promising pharmacological treatment strategy for the management of oropharyngeal dysphagia. Recently, pharmacological therapies using TRP channel agonists have been recommended in guideline for the treatment of neurogenic dysphagia as a supplement to behavioral swallowing interventions particularly in patients with a delayed swallow response 55 , 56 .…”

“…Each event that contained high amplitude firing in the EMG signal corresponded with one swallowing reflex 45 , 46 . Using EMG-signal from the muscles activated during triggering of swallowing reflex is an established method to identify/detect swallowing in scientific studies 1 , 2 , 6 , 8 , 55 , 66 , 67 . Swallowing reflexes were identified by two examiners.…”