Longitudinal analysis of progression of dysphagia in amyotrophic lateral sclerosis
Longitudinal analysis of progression of dysphagia in amyotrophic lateral sclerosis
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DOI：
10.1016/j.anl.2004.05.009
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发表时间：
2004-09-01
影响因子：
1.7
通讯作者：
Nito, T
中科院分区：
文献类型：
--
作者：
Higo, R;Tayama, N;Nito, T
目的：根据两种不同的量表：延髓症状发作后的持续时间和ALS严重程度量表（ALSSS），使用视频透视（VF）研究肌萎缩侧索硬化症（ALS）吞咽困难的进展。研究方法：在不同时间点对50例ALS患者进行了72次VF检查，并分析了延髓症状发作后口腔和咽部VF结果随时间的变化。还评估了根据ALS严重程度量表进展的变化。结果如下：在大约一半的无延髓主诉的患者中，观察到从口腔到咽部的延迟食团运输和梨状窦（PS）的食团停滞。相反，上食管括约肌（UES）的开放在吞咽困难的晚期维持得相对较好。其他参数，如口腔中的丸剂保持、咽部收缩和喉部抬高，在延髓症状发作后随着时间的推移变得更糟。随着ALSSS的进展，VF检查的这些参数也变得更糟;然而，即使是饮食习惯正常的患者也显示出从口腔到咽部的食团运输受到干扰，咽部收缩减弱，PS处食团停滞。一般来说，在大多数参数中，功能障碍在需要改变食物的患者中显著进展;然而。晚期ALSSS患者的LIES开口和喉抬高相对保持良好。结论：在这项研究中，我们清楚地显示了ALS吞咽困难的进展模式，我们还强调VF是一个有用的工具，以遵循ALS患者的吞咽功能。根据我们的结果，在延髓症状发作后6个月进行VF是有用的，因为VF有助于康复或适当的饮食调整;之后，在延髓症状发作后约1年，应再次进行VF。因为ALS患者显示出广泛的营养摄入模式，并且他们需要在这个时间点根据他们不同的吞咽困难状态进行评估以引入干预，例如管饲。(C)2004爱思唯尔爱尔兰有限公司保留所有权利。
Objective: To investigate the progression of dysphagia in amyotrophic lateral sclerosis (ALS) using videofluoroscopy (VF), according to two different scales: the duration following bulbar symptom onset, and the ALS severity scale (ALSSS). Methods: Seventy-two VF examinations, on 50 ALS patients, were performed at various time points, and the change in VF findings in the oral and pharyngeal phases was analyzed over time following bulbar symptom onset. The change according to advancement of the ALS severity scale was also assessed. Results: Delayed bolus transport from the oral cavity to the pharynx, and bolus stasis at the pyriform, sinus (PS), were seen in about half of the patients with no bulbar complaints. In contrast, upper esophageal sphincter (UES) opening was relatively well maintained in the late stage of dysphagia. The other parameters, such as bolus holding in the oral cavity, constriction of the pharynx, and elevation of the larynx, became worse over time following bulbar symptom onset. These parameters on VF examination also became worse as the ALSSS advanced; however, even patients in the group with normal eating habits showed disturbed bolus transport from the mouth to the pharynx, weak constriction of the pharynx, and bolus stasis at the PS. Generally, dysfunction had progressed dramatically, in most of the parameters, in the patients that required modification of food; however. LIES opening and elevation of the larynx were relatively well maintained in advanced-ALSSS patients. Conclusion: In this study, we clearly show the progression pattern of dysphagia in ALS, and we also emphasize that VF is a useful tool to follow swallowing function in ALS patients. From our results, it would be useful to perform VF by 6 months following bulbar symptom onset, because VF can contribute to rehabilitation or appropriate diet modification; and later, around I year following bulbar symptom onset, VF should again be performed. since ALS patients show wide-ranging nutrition intake patterns, and they need assessment to introduce intervention, such as tube feeding, according to their varying status of dysphagia, around at this time point. (C) 2004 Elsevier Ireland Ltd. All rights reserved.