Swallowing function in patients with multiple-system atrophy with a clinical predominance of cerebellar symptoms (MSA-C)

Abstract

We investigated the swallowing function of 21 patients with multiple system atrophy with a clinical predominance of cerebellar symptoms (MSA-C) by videofluoroscopy (VF). Twenty-six VF examinations were performed at various time points, and they were divided into three groups according to the duration following disease onset: Group A had 1 to 3 years following disease onset (the early stage of the disease), group B had 4 to 6 years following disease onset (the middle stage of the disease), and group C had more than 7 years following disease onset (the late stage of the disease). Swallowing function in the oral phase became gradually disturbed over the progression of MSA. Delayed bolus transport from the oral cavity to the pharynx was already seen in 50% of the patients in group A, and it was seen in more than 85% of the patients in group C. Bolus holding in the oral cavity was slightly disturbed in group A, but it was seen in 57% of the patients in group C. Our study shows that parkinsonism is related to swallowing dysfunction in MSA, but cerebellar dysfunction also affects coordination of the tongue; bolus transport in the oral cavity was disturbed in the early stage of disease. Progression of cerebellar dysfunction and overlapped parkinsonism will worsen tongue movement, and in the late stage of the disease, swallowing function of the oral phase (bolus transport and bolus holding) was remarkably disturbed. Swallowing function in the pharyngeal phase was not significantly correlated to the duration of the disease; however, our study showed that swallowing function in the pharyngeal phase was not assessed fully by VF examination in MSA-C only. Combination with other examinations, such as manometry and electromyography, may be useful, especially in the late stage of the disease. In addition, an analysis concerning the relationship between aspiration seen on VF examination and a history of aspiration pneumonia in MSA-C patients suggested that the sensory system at the larynx and trachea should also be assessed in patients in the late stage of MSA-C.

Characteristics of Early Oropharyngeal Dysphagia in Patients with Multiple System Atrophy

“…One study demonstrated swallowing functions in patients with MSA-C [7]. They found that cerebellar dysfunction affects the swallowing function in the oral phase from an early stage of the disease, although it has little effect on the opening of the upper esophageal sphincter throughout all disease stages.…”

Dysphagia in Multiple System Atrophy of Cerebellar and Parkinsonian Types

“…Incomplete relaxation of the upper esophageal sphincter was seen in 23.1% of patients with MSA [15]. Higo et al have indicated that bolus transportation from the oral cavity to the pharynx is already disturbed in patients in the early stage of MSA-C [2]. The results of their study showed that 50% of the patients with MSA-C in the early stage (1−3 years following disease onset) and more than 85% in the late stage (>7 years following disease onset) suffered from delayed bolus transportation in the oral phase.…”

“…A study by Higo et al implied that the swallowing function in MSA patients may be more influenced by Parkinsonism than by cerebellar dysfunction and that Parkinsonism mainly affects the oral phase of swallowing [2]. They suggested that dysphagia in patients with MSA with predominant Parkinsonism (MSA-P) is caused by Parkinsonism, whereas in patients with MSA with predominant cerebellar ataxia (MSA-C), the progression of the cerebellar dysfunction and overlapping Parkinsonism worsens the tongue movements.…”

Orofaryngeale slikstoornissen bij neurodegeneratieve aandoeningen

“…Waar verslikken door een parkinsonpatiënt uitblijft tijdens onderzoek met sliktests, omdat die kan compenseren door concentratie en het overwinnen van de hypokinesie, zal de MSA-patiënt door spierzwakte onvoldoende kunnen compenseren bij sliktests die uitdagen om sliksnelheid en volume te vergroten. 32 Krachtsverlies leidt ook tot moeite met kauwen en slikken van vaste voeding en ataxie verklaart bijvoorbeeld het zomaar verslikken in speeksel 33 . Terwijl sondevoeding bij parkinsonpatiënten ook in het gevorderde stadium van de ziekte maar bij 10% nodig zou zijn, 34 komt sondevoeding bij MSApatiënten in de klinische praktijk meer voor.…”