PHARMACOLOGICAL TREATMENT OF DYSPHAGIA IN STROKE

The pharynx is important for a normal swallow and it has been suggeste d that pharmacological agents may play a role in the management of pha ryngeal dysphagia, but none have been formally evaluated. A pilot doub le-blind, placebo-controlled study was undertaken in 17 hospitalized p atients with persistent dysphagia 2 weeks after stroke. Patients were randomized to treatment with slow-release nifedipine 30 mg orally (n = 8) or placebo (n = 9) following specialist swallowing assessment and videofluoroscopy to exclude severe dysphagia. Videofluoroscopy was rep eated after 4 weeks of treatment. Fourteen patients (active 6, placebo 8) completed the study. Two patients died (active 1, placebo 1) and 1 patient in the active group had to be withdrawn because of progressiv e heart failure. Initial assessment showed impairment in the pharyngea l phase with delayed triggering of swallow, poor laryngeal elevation, and prolonged pharyngeal transit times in all patients. Silent aspirat ion was seen in 4 patients (active 2, placebo 2). Improvement in swall owing was seen in 8 patients (active 5, placebo 3) at the end of 4 wee ks. There were significant changes in the pharyngeal transit time (mea n -1.34 second; 95% C.I. -2.56, -0.11) and swallow delay (mean -1.91 s econds; 95% C.I. -3.58, -0.24) in the active group suggesting improvem ent in the initiation of pharyngeal contractions and reduction in the time taken for the bolus to transverse the pharynx. A similar change w as not seen in the placebo group. It is suggested that pharmacological agents such as nifedipine may have a role in the management of stroke -related dysphagia and merit further investigation.