, Volume 31, Issue 5, pp 610–618 | Cite as

Treatment Effects for Dysphagia in Adults with Multiple Sclerosis: A Systematic Review

  • Dalal AlaliEmail author
  • Kirrie Ballard
  • Hans Bogaardt
Review Article


Dysphagia or swallowing difficulties have been reported to be a concern in adults with multiple sclerosis (MS). This problem can result in several complications including aspiration pneumonia, reduced quality of life and an increase in mortality rate. No previous systematic reviews on treatment effects for dysphagia in MS have been published. The main objective of this study is to summarise and qualitatively analyse published studies on treatment effects for dysphagia in MS. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied to conduct a systematic search of seven databases, using relevant key words, and subsequent analysis of the identified studies. The studies were required to meet all three inclusion criteria of including a statement on intention to treat, or measure the effects of treatment for dysphagia in adults with MS and data on treatment outcomes for at least one adult diagnosed with MS. Retained studies were evaluated by two independent reviewers using a critical appraisal tool. This study has not been registered. A total of 563 studies were identified from the database searches. After screening and assessment of full articles for eligibility, five studies were included in the review. Three examined electrical stimulation and two examined the use of botulinum toxin. One study testing electrical stimulation was a randomised controlled trial, two were well-designed case series and two were case series lacking experimental control. All studies reported some positive effects on dysphagia; however, treatments that involved the use of electrical stimulation showed larger effect sizes. There is a paucity of evidence to guide treatment of dysphagia in MS, with only electrical stimulation and botulinum toxin treatment represented in the literature search conducted here. While both treatments show initial promise for reducing the swallowing impairment, they require further research using well-controlled experimental designs to determine their clinical applicability and long-term treatment effects for dysphagia across different types and severity of MS.


Dysphagia Deglutition Multiple sclerosis Treatment Systematic review 


Compliance with Ethical Standards

Conflict of interest

No conflicts of interest to declare.


  1. 1.
    Tassorelli C, et al. Dysphagia in multiple sclerosis: from pathogenesis to diagnosis. Neurol Sci. 2008;29(S4):360–3.Google Scholar
  2. 2.
    Marchese-Ragona R, et al. Evaluation of swallowing disorders in multiple sclerosis. Neurol Sci. 2006;27(S4):s335–7.Google Scholar
  3. 3.
    Compston A, Coles A. Multiple sclerosis. Lancet. 2008;372(9648):1502–17.PubMedGoogle Scholar
  4. 4.
    Inglese M. Multiple sclerosis: new insights and trends. AJNR Am J Neuroradiol. 2006;27(5):954.PubMedGoogle Scholar
  5. 5.
    Calcagno P, et al. Dysphagia in multiple sclerosis prevalence and prognostic factors. Acta Neurol Scand. 2002;105(1):40–3.PubMedGoogle Scholar
  6. 6.
    Hartelius L, Svensson P. Speech and swallowing symptoms associated with Parkinson’s disease and multiple sclerosis: a survey. Folia phoniatrica et logopaedica Off organ Int Assoc Logop Phoniatr (IALP). 1994;46(1):9–17.Google Scholar
  7. 7.
    De Pauw A, et al. Dysphagia in multiple sclerosis. Clin Neurol Neurosurg. 2002;104(4):345–51.PubMedGoogle Scholar
  8. 8.
    Battel I, et al. Multiple sclerosis and dysphagia: new assessment tool to evaluate swallowing disorders. Mult Scler J. 2013;19(11):550–1.Google Scholar
  9. 9.
    Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33(11):1444–52.PubMedGoogle Scholar
  10. 10.
    Poorjavad M, et al. Oropharyngeal dysphagia in multiple sclerosis. Mult Scler. 2010;16(3):362–5.PubMedGoogle Scholar
  11. 11.
    Giusti A, Giambuzzi M. Management of dysphagia in patients affected by multiple sclerosis: state of the art. Neurol Sci. 2008;29(S4):364–6.Google Scholar
  12. 12.
    Goldman MD, Motl RW, Rudick RA. Possible clinical outcome measures for clinical trials in patients with multiple sclerosis. Ther Adv Neurol Disord. 2010;3(4):229–39.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Moher D, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ Br Med J. 2009;339(7716):332–6.Google Scholar
  14. 14.
    Restivo DA, et al. Pharyngeal electrical stimulation for dysphagia associated with multiple sclerosis: a pilot study. Brain Stimul. 2013;6(3):418–23.PubMedGoogle Scholar
  15. 15.
    Marrosu F, et al. Vagal nerve stimulation improves cerebellar tremor and dysphagia in multiple sclerosis. Mult Scler. 2007;13(9):1200–2.PubMedGoogle Scholar
  16. 16.
    Bogaardt H, et al. Use of neuromuscular electrostimulation in the treatment of dysphagia in patients with multiple sclerosis. Ann Otol Rhinol Laryngol. 2009;118(4):241–6.PubMedGoogle Scholar
  17. 17.
    Alfonsi E, et al. An electrophysiological approach to the diagnosis of neurogenic dysphagia: implications for botulinum toxin treatment. J Neurol Neurosurg Psychiatry. 2010;81(1):54–60.PubMedGoogle Scholar
  18. 18.
    Restivo DA, et al. Botulinum toxin improves dysphagia associated with multiple sclerosis. Eur J Neurol. 2011;18(3):486–90.PubMedGoogle Scholar
  19. 19.
    Ney JP, Joseph KR. Neurologic uses of botulinum neurotoxin type A. Neuropsychiatr Dis Treat. 2007;3(6):785–98.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.University of SydneyLidcombeAustralia
  2. 2.University of SydneyLidcombeAustralia
  3. 3.University of SydneyLidcombeAustralia

Personalised recommendations