RADIOLOGICAL EVIDENCE OF SUBCLINICAL DYSPHAGIA IN MOTOR-NEURON DISEASE

Dysphagia in motor neuron disease (MND) may lead to dangerous complica tions such as cachexia and aspiration pneumonia, Functional evaluation of the oropharyngeal tract is crucial for identifying specific swallo wing dysfunctions and planning appropriate rehabilitation. As part of a multidisciplinary study on the treatment of dysphagia in patients wi th neuromuscular diseases, 23 MND patients with different degrees of d ysphagia underwent videoflouroscopy, videopharyngolaryngoscopy and pha ryngo-oesophageal manometry. The results of the three instrumental inv estigations were analysed in order (1) to define the pattern of swallo wing in MND patients complaining of dysphagia; (2) to evaluate whether subclinical abnormalities may be detected; and (3) to assess the role of videofluoroscopy. videopharyngolaryngoscopy and manometry in the e valuation of MND patients with deglutition problems. Correlations betw een the instrumental findings and clinical features (age of the patien ts, duration and severity of the disease, presence and degree of dysph agia) were also assessed. The results of our study showed that: (1) Th e oral phase of deglutition was compromised most often following by th e pharyngeal phase. (2) In all patients without clinical evidence of d ysphagia, subclinical videofluoroscopic alterations were present in a pattern similar to that found in the dysphagic group. (3) Videofluoros copy was the most sensitive technique in identifying oropharyngeal alt erations of swallowing. Impairment of the oral phase. abnormal pharyng o-oesophageal motility and incomplete relaxation of the upper oesophag eal sphincter were the changes most sensitive in detecting dysphagia. Videofluoroscopy was also capable of detecting preclinical abnormaliti es in non-dysphagic patients who later developed dysphagia. Practical guidelines for the use of instrumental investigations in the assessmen t and management of dysphagia in MND patients are proposed.