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Outcome of Surgery to Improve Swallowing in Patients with Lateral Medullary Syndrome: A Retrospective Cohort Study

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Abstract

The study investigated surgical interventions to improve dysphagia in patients with lateral medullary syndrome (LMS), along with optimal scheduling of surgery and prognostic factors. In this retrospective, single-center cohort study, dysphagia patients with LMS who underwent surgery between January 2010 and December 2021 were enrolled. The National Outcomes Measurement System (NOMS) was used to classify swallowing function (level 1: only tube feeding, level 5: without tube feeding). Patients were divided into four groups. Groups 1 and 2, LMS onset within 1 year, and groups 3 and 4, onset after 1 year. Groups 1 and 3 had infarctions confined to the oblongata. Groups 2 and 4 had infarctions extending to the cerebellum. The primary outcome was the time to achieve NOMS ≥ 5. The final NOMS level and pathological findings were considered. Nineteen cases were included. Group 4 comprised one case and was excluded. The mean overall preoperative NOMS was 1.11. The mean time to NOMS ≥ 5 was 9.6 months (95% confidence interval: 5.04–14.2), and that to NOMS ≥ 5 was 1.67 (1.07–2.26), 11.4 (4.71–18.1), and 7.6 (5.15–10.1) months for groups 1, 2, and 3, respectively. Group 1 achieved NOMS ≥ 5 earlier than groups 2 and 3 (P = 0.01 and 0.03, respectively). The overall final NOMS value was 4.68. Fourteen patients had atrophy or fibrosis of the cricopharyngeal muscle. In conclusion, surgery was effective for effective for treating dysphagia in LMS patients. However, improvement is prolonged if > 1 year has passed since onset or the infarction extended to the cerebellum.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Sacco RL, Freddo L, Bello JA, Odel JG, Onesti ST, Mohr JP. Wallenberg’s lateral medullary syndrome. Clinical-magnetic resonance imaging correlations. Arch Neurol. 1993;50:609–14. https://doi.org/10.1001/archneur.1993.00540060049016.

    Article  CAS  PubMed  Google Scholar 

  2. Norrving B, Cronqvist S. Lateral medullary infarction: prognosis in an unselected series. Neurology. 1991;41(2 Pt 1):244–8. https://doi.org/10.1212/wnl.41.2_part_1.244.

    Article  CAS  PubMed  Google Scholar 

  3. Meng NH, Wang TG, Lien IN. Dysphagia in patients with brainstem stroke: incidence and outcome. Am J Phys Med Rehabil. 2000;79:170–5. https://doi.org/10.1097/00002060-200003000-00010.

    Article  CAS  PubMed  Google Scholar 

  4. Jang SH, Kim MS. Dysphagia in lateral medullary syndrome: a narrative review. Dysphagia. 2021;36:329–38. https://doi.org/10.1007/s00455-020-10158-3.

    Article  PubMed  Google Scholar 

  5. National Outcomes Measurement System (NOMS). American Speech-Language-Hearing Association.

  6. Chiba Y, Sano D, Ikui Y, et al. Predictive value of the Hyodo score in endoscopic evaluation of aspiration during swallowing. Auris Nasus Larynx. 2018;45:1214–20. https://doi.org/10.1016/j.anl.2018.03.005.

    Article  PubMed  Google Scholar 

  7. Knigge MA, Thibeault SL. Swallowing outcomes after cricopharyngeal myotomy: a systematic review. Head Neck. 2018;40:203–12. https://doi.org/10.1002/hed.24977.

    Article  PubMed  Google Scholar 

  8. Kocdor P, Siegel ER, Tulunay-Ugur OE. Cricopharyngeal dysfunction: a systematic review comparing outcomes of dilatation, botulinum toxin injection, and myotomy. Laryngoscope. 2016;126:135–41. https://doi.org/10.1002/lary.25447.

    Article  CAS  PubMed  Google Scholar 

  9. Kos MP, David EF, Klinkenberg-Knol EC, Mahieu HF. Long-term results of external upper esophageal sphincter myotomy for oropharyngeal Dysphagia. Dysphagia. 2010;25:169–76. https://doi.org/10.1007/s00455-009-9236-x.

    Article  PubMed  Google Scholar 

  10. Nair SS, Surendaran AJ, Menon JR, Sreedharan SE, Sylaja PN. Persistent post-stroke dysphagia treated with cricopharyngeal myotomy. Ann Indian Acad Neurol. 2016;19:249–51. https://doi.org/10.4103/0972-2327.160055.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Stinear CM, Lang CE, Zeiler S, Byblow WD. Advances and challenges in stroke rehabilitation. Lancet Neurol. 2020;19:348–60. https://doi.org/10.1016/S1474-4422(19)30415-6.

    Article  CAS  PubMed  Google Scholar 

  12. Panebianco M, Marchese-Ragona R, Masiero S, Restivo DA. Dysphagia in neurological diseases: a literature review. Neurol Sci. 2020;41:3067–73. https://doi.org/10.1007/s10072-020-04495-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We want to thank Editage (www.editage.com) for English language editing.

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The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Otolaryngology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan

    Kenshiro Taniguchi, Katsuhiro Tsutsumiuchi, Yukiko Sagara & Niro Tayama

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  1. Kenshiro Taniguchi
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  2. Katsuhiro Tsutsumiuchi
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  3. Yukiko Sagara
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  4. Niro Tayama
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by KT, KT, and NT. The first draft of the manuscript was written by KT and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Kenshiro Taniguchi.

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Conflicts of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The study protocol was approved by the ethics committee at the National Center for Global Health and Medicine (approval no. NCGM-S-004535-00).

Consent

This study is retrospective study. Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. And also, we applied Opt-out method to obtain consent on this study by using the poster described later. The poster was approved by the Institutional Review Board.

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Taniguchi, K., Tsutsumiuchi, K., Sagara, Y. et al. Outcome of Surgery to Improve Swallowing in Patients with Lateral Medullary Syndrome: A Retrospective Cohort Study. Dysphagia (2024). https://doi.org/10.1007/s00455-024-10675-5

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