New Tools Needed to Assess Dysphagia in MS, Review Says

Dysphagia, or difficulty swallowing, after a multiple sclerosis (MS) diagnosis is a common symptom and is estimated to affect one-third of the patients with MS. A recent review described the strategies used to identify and assess swallowing dysfunctions in MS patients with dysphagia and said that new tools are needed.

Swallowing may be impaired in MS as a result of lesions in corticobulbar tracts, paresis of cranial nerves, disorders of cerebellum and brainstem, and cognitive dysfunctions. Dysphagia may cause serious complications such as aspiration pneumonia, malnutrition, dehydration, and airway obstruction. Patients may have difficulty swallowing and not realize it, the authors said, making screening essential.

Assessment for dysphagia is essential as it may reduce the risk of complications such as pneumonia, improve health outcomes, and lower healthcare costs.

The authors categorized screening strategies into 2 types:

• Clinical, non-instrumental strategies, to verify the presence and to determine the severity and cause of dysphagia

• Instrumental strategies, which complement clinical examination to provide objective data

While a variety of non-instrumental screening tools are available, only the Dysphagia in Multiple Sclerosis Questionnaire (DYMUS) and the Mann Assessment of Swallowing Ability (MASA) are validated specifically for MS-related dysphagia, the authors said.

However, psychometric evidence about the DYMUS questionnaire and the MASA test have been incompletely evaluated.

The Eating Assessment Tool (EAT-10) is a commonly used self-administered and symptom-specific patient-reported outcome questionnaire for assessing the patient’s perception of dysphagia in various clinical diagnoses, including MS. It is a is a validated, easy to use, easily read and understood outcome tool; the authors suggested that it be specifically validated in patients with MS.

Another test, the 3-ounce water swallow test, is a widely used sensitive test, but it has not been validated in the MS population, the researchers noted. Other tests include the Dysphagia Screening Questionnaire for MS (DSQMS) and the Northwestern Dysphagia Patient Check Sheet (NDPCS),

Instrumental screening assesses the body structure and function of swallowing; 2 such tests are the Videofluoroscopic Swallowing Examination Strategy (VFSS), or modified barium swallowing study, and the Fiberoptic Endoscopic Examination of Swallowing (FEES). VFSS is considered the gold standard and the FEES ss the second most commonly used test.

The VFSS is an X-ray visualization to determine the nature and extent of the swallowing dysfunctions; it identifies the swallowing dysfunctions by providing a real-time visualization of bolus flow, allows structural kinematic analysis, and detects aspiration. However, the authors said studies on VFSS in patients with MS are scarce.

Until new tools are developed, validation and metric evaluation of current screening and assessment tools are required, the authors said.

Reference

Nakhostin Ansari N, Tarameshlu M, Ghelichi L. Dysphagia in multiple sclerosis patients: Diagnostic and evaluation strategies [published online March 26, 2020]. Degener Neurol Neuromuscul Dis. doi: 10.2147/DNND.S198659