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Prevalence and Risk Factors of Dysphagia in Patients with Multiple Sclerosis

Abstract

Dysphagia is one of the most common symptoms in multiple sclerosis (MS) patients. It can reduce the quality of life and increase the risk of mortality by developing complications such as aspiration pneumonia. The present study was conducted to estimate the prevalence of dysphagia in MS patients and investigate the associations between dysphagia and disease characteristics. The Persian version of the DYMUS questionnaire was used to assess dysphagia in 865 patients with MS, including 738 (85.3%) relapsing–remitting MS (RRMS), 106 (12.3%) secondary progressive MS (SPMS), and 21 (2.4%) primary progressive MS (PPMS). Also, demographic and clinical data, including age, sex, smoking status, Expanded Disability Status Scale (EDSS) score, disease duration, disease-modifying therapies exposure, initial symptoms of MS, were recorded. The mean (SD) age was 37.95(9.25) years, and 83.1% of the participants were female. The prevalence of dysphagia was estimated to be 25.4% among all patients. According to the DYMUS questionnaire results, the prevalence of dysphagia in RRMS, SPMS, and PPMS patients was 22.2%, 44.3%, and 42.9%, respectively. After multivariate analysis the current EDSS score (OR = 1.197, CI: 1.062, 1.350, p = 0.003), cerebellar impairment (OR = 1.335, CI: 1.450, 4.716, p = 0.004) and motor dysfunction (OR = 1.651, CI: 1.004, 2.715, p = 0.048) emerged as the risk factors for dysphagia. Since dysphagia, as previously mentioned, is a common symptom in multiple sclerosis, particularly in SPMS and PPMS courses, active screening for this condition is recommended in all patients, particularly those with identified risk factors.

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References

  1. Thompson AJ, Baranzini SE, Geurts J, Hemmer B, Ciccarelli O. Multiple sclerosis. Lancet. 2018;391(10130):1622–36. https://doi.org/10.1016/S0140-6736(18)30481-1.

    Article  PubMed  Google Scholar 

  2. Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, Correale J, Fazekas F, Filippi M, Freedman MS, Fujihara K, Galetta SL, Hartung HP, Kappos L, Lublin FD, Marrie RA, Miller AE, Miller DH, Montalban X, Mowry EM, Sorensen PS, Tintore M, Traboulsee AL, Trojano M, Uitdehaag BMJ, Vukusic S, Waubant E, Weinshenker BG, Reingold SC, Cohen JA. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162–73. https://doi.org/10.1016/S1474-4422(17)30470-2.

    Article  PubMed  Google Scholar 

  3. Mirmosayyeb O, Brand S, Barzegar M, Afshari-Safavi A, Nehzat N, Shaygannejad V, Sadeghi Bahmani D. Clinical characteristics and disability progression of early-and late-onset multiple sclerosis compared to adult-onset multiple sclerosis. J Clin Med. 2020;9(5):1326.

    Article  Google Scholar 

  4. Mirmosayyeb O, Badihian S, Manouchehri N, Basiri AK, Barzegar M, Esmaeil N, Fayyazi E, Shaygannejad V. The interplay of multiple sclerosis and menstrual cycle: which one affects the other one? Mult Scler Relat Disord. 2018;21:46–50.

    Article  Google Scholar 

  5. Cook IJ. Oropharyngeal dysphagia. Gastroenterol Clin North Am. 2009;38(3):411–31. https://doi.org/10.1016/j.gtc.2009.06.003.

    Article  PubMed  Google Scholar 

  6. Sasegbon A, Hamdy S. The anatomy and physiology of normal and abnormal swallowing in oropharyngeal dysphagia. Neurogastroenterol Motil. 2017;29(11):e13100.

    Article  Google Scholar 

  7. Daniels SK, Huckabee M-L, Gozdzikowska K. Dysphagia following stroke. Clinical Dysphagia. 3rd ed. San Diego: Plural Publishing; 2019.

    Google Scholar 

  8. Levinthal DJ, Rahman A, Nusrat S, O’Leary M, Heyman R, Bielefeldt K. Adding to the burden: gastrointestinal symptoms and syndromes in multiple sclerosis. Mult Scler Int. 2013;2013:319201. https://doi.org/10.1155/2013/319201.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Fernandes AM, Duprat Ade C, Eckley CA, Silva L, Ferreira RB, Tilbery CP. Oropharyngeal dysphagia in patients with multiple sclerosis: do the disease classification scales reflect dysphagia severity? Braz J Otorhinolaryngol. 2013;79(4):460–5. https://doi.org/10.5935/1808-8694.20130082.

    Article  PubMed  Google Scholar 

  10. Printza A, Triaridis S, Kalaitzi M, Nikolaidis I, Bakirtzis C, Constantinidis J, Grigoriadis N. Dysphagia prevalence, attitudes, and related quality of life in patients with multiple sclerosis. Dysphagia. 2019. https://doi.org/10.1007/s00455-019-10075-0.

    Article  PubMed  Google Scholar 

  11. Marchese-Ragona R, Restivo D, Marioni G, Ottaviano G, Masiero S, Staffieri A. Evaluation of swallowing disorders in multiple sclerosis. Neurol Sci. 2006;27(4):s335–7.

    Article  Google Scholar 

  12. Matsuo K, Palmer JB. Anatomy and physiology of feeding and swallowing: normal and abnormal. Phys Med Rehabil Clin N Am. 2008;19(4):691–707. https://doi.org/10.1016/j.pmr.2008.06.001.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol Rev. 2001;81(2):929–69.

    CAS  Article  Google Scholar 

  14. Filippi M, Preziosa P, Banwell BL, Barkhof F, Ciccarelli O, De Stefano N, Geurts JJG, Paul F, Reich DS, Toosy AT, Traboulsee A, Wattjes MP, Yousry TA, Gass A, Lubetzki C, Weinshenker BG, Rocca MA. Assessment of lesions on magnetic resonance imaging in multiple sclerosis: practical guidelines. Brain. 2019;142(7):1858–75. https://doi.org/10.1093/brain/awz144.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ansari NN, Tarameshlu M, Ghelichi L. Dysphagia in multiple sclerosis patients: diagnostic and evaluation strategies. Degener Neurol Neuromuscul Dis. 2020;10:15–28. https://doi.org/10.2147/DNND.S198659.

    Article  PubMed  PubMed Central  Google Scholar 

  16. D’Amico E, Zanghì A, Serra A, Murabito P, Zappia M, Patti F, Cocuzza S. Management of dysphagia in multiple sclerosis: current best practice. Expert Rev Gastroenterol Hepatol. 2019;13(1):47–54. https://doi.org/10.1080/17474124.2019.1544890.

    CAS  Article  PubMed  Google Scholar 

  17. Solaro C, Rezzani C, Trabucco E, Amato M, Zipoli V, Portaccio E, Giannini M, Patti F, D’Amico E, Frau J. Prevalence of patient-reported dysphagia in multiple sclerosis patients: an Italian multicenter study (using the DYMUS questionnaire). J Neurol Sci. 2013;331(1–2):94–7.

    CAS  Article  Google Scholar 

  18. Poorjavad M, Derakhshandeh F, Etemadifar M, Soleymani B, Minagar A, Maghzi A-H. Oropharyngeal dysphagia in multiple sclerosis. Mult Scler. 2010;16(3):362–5.

    Article  Google Scholar 

  19. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33(11):1444–52. https://doi.org/10.1212/wnl.33.11.1444.

    CAS  Article  PubMed  Google Scholar 

  20. Lorscheider J, Buzzard K, Jokubaitis V, Spelman T, Havrdova E, Horakova D, Trojano M, Izquierdo G, Girard M, Duquette P, Prat A, Lugaresi A, Grand’Maison F, Grammond P, Hupperts R, Alroughani R, Sola P, Boz C, Pucci E, Lechner-Scott J, Bergamaschi R, Oreja-Guevara C, Iuliano G, Van Pesch V, Granella F, Ramo-Tello C, Spitaleri D, Petersen T, Slee M, Verheul F, Ampapa R, Amato MP, McCombe P, Vucic S, Sanchez Menoyo JL, Cristiano E, Barnett MH, Hodgkinson S, Olascoaga J, Saladino ML, Gray O, Shaw C, Moore F, Butzkueven H, Kalincik T, Group MSS. Defining secondary progressive multiple sclerosis. Brain. 2016;139(Pt 9):2395–405. https://doi.org/10.1093/brain/aww173.

    Article  PubMed  Google Scholar 

  21. Lublin FD, Reingold SC, Cohen JA, Cutter GR, Sorensen PS, Thompson AJ, Wolinsky JS, Balcer LJ, Banwell B, Barkhof F, Bebo B Jr, Calabresi PA, Clanet M, Comi G, Fox RJ, Freedman MS, Goodman AD, Inglese M, Kappos L, Kieseier BC, Lincoln JA, Lubetzki C, Miller AE, Montalban X, O’Connor PW, Petkau J, Pozzilli C, Rudick RA, Sormani MP, Stuve O, Waubant E, Polman CH. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014;83(3):278–86. https://doi.org/10.1212/WNL.0000000000000560.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bergamaschi R, Crivelli P, Rezzani C, Patti F, Solaro C, Rossi P, Restivo D, Maimone D, Romani A, Bastianello S, Tavazzi E, D’Amico E, Montomoli C, Cosi V. The DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis. J Neurol Sci. 2008;269(1–2):49–53. https://doi.org/10.1016/j.jns.2007.12.021.

    CAS  Article  PubMed  Google Scholar 

  23. Jafari Z, Shahbodaghi MR, Maroufizadeh S, Moghadasi AN. Validation of the Persian version of dysphagia in multiple sclerosis questionnaire for the assessment of dysphagia in multiple sclerosis. Iran J Neurol. 2018;17(3):99–104.

    PubMed  PubMed Central  Google Scholar 

  24. Field A. Discovering statistics using IBM SPSS statistics. 5th ed. London: SAGE Publications Ltd; 2017.

    Google Scholar 

  25. Lasemi E, Sahraian MA, Kalantar Motamedi MH, Valayi N, Moradi N, Lasemi R. Prevalence of oral and maxillofacial manifestations in patients with multiple sclerosis. SRM J Res Dent Sci. 2011;8(1):20–6.

    Google Scholar 

  26. Terre-Boliart R, Orient-Lopez F, Guevara-Espinosa D, Ramon-Rona S, Bernabeu-Guitart M, Clave-Civit P. Oropharyngeal dysphagia in patients with multiple sclerosis (in Spanish). Rev Neurol. 2004;39(8):707–10.

    CAS  PubMed  Google Scholar 

  27. Aghaz A, Alidad A, Hemmati E, Jadidi H, Ghelichi L. Prevalence of dysphagia in multiple sclerosis and its related factors: systematic review and meta-analysis. Iran J Neurol. 2018;17(4):180–8.

    PubMed  PubMed Central  Google Scholar 

  28. Solaro C, Rezzani C, Trabucco E, Amato MP, Zipoli V, Portaccio E, Giannini M, Patti F, D’Amico E, Frau J, Lorefice L, Bonavita S, Della Corte M, Grasso MG, Finamore L, Ghezzi A, Annovazzi P, Rottoli M, Gasperini C, Restivo D, Maimone D, Rossi P, Stromillo ML, Bergamaschi R. Prevalence of patient-reported dysphagia in multiple sclerosis patients: an Italian multicenter study (using the DYMUS questionnaire). J Neurol Sci. 2013;331(1–2):94–7. https://doi.org/10.1016/j.jns.2013.05.020.

    CAS  Article  PubMed  Google Scholar 

  29. Alfonsi E, Bergamaschi R, Cosentino G, Ponzio M, Montomoli C, Restivo DA, Brighina F, Ravaglia S, Prunetti P, Bertino G, Benazzo M, Fontana D, Moglia A. Electrophysiological patterns of oropharyngeal swallowing in multiple sclerosis. Clin Neurophysiol. 2013;124(8):1638–45. https://doi.org/10.1016/j.clinph.2013.03.003.

    CAS  Article  PubMed  Google Scholar 

  30. Solaro C, Cuccaro A, Gamberini G, Patti F, D’Amico E, Bergamaschi R, Berra E, Giusti A, Rezzani C, Uccelli MM. Prevalence of dysphagia in a consecutive cohort of subjects with MS using fibre-optic endoscopy. Neurol Sci. 2019. https://doi.org/10.1007/s10072-019-04198-3.

    Article  PubMed  Google Scholar 

  31. Tarameshlu M, Azimi AR, Ghelichi L, Ansari NN. Prevalence and predictors of dysphagia in Iranian patients with multiple sclerosis. Med J Islam Repub Iran. 2017;31:133.

    Article  Google Scholar 

  32. Calcagno P, Ruoppolo G, Grasso M, De Vincentiis M, Paolucci S. Dysphagia in multiple sclerosis–prevalence and prognostic factors. Acta Neurol Scand. 2002;105(1):40–3.

    CAS  Article  Google Scholar 

  33. Rangarathnam B, Kamarunas E, McCullough GH. Role of cerebellum in deglutition and deglutition disorders. Cerebellum. 2014;13(6):767–76. https://doi.org/10.1007/s12311-014-0584-1.

    Article  PubMed  Google Scholar 

  34. Kumral E, Kisabay A, Atac C. Lesion patterns and etiology of ischemia in the anterior inferior cerebellar artery territory involvement: a clinical - diffusion weighted - MRI study. Eur J Neurol. 2006;13(4):395–401. https://doi.org/10.1111/j.1468-1331.2006.01255.x.

    CAS  Article  PubMed  Google Scholar 

  35. Moon HI, Pyun SB, Kwon HK. Correlation between location of brain lesion and cognitive function and findings of videofluoroscopic swallowing study. Ann Rehabil Med. 2012;36(3):347–55. https://doi.org/10.5535/arm.2012.36.3.347.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Thomas FJ, Wiles CM. Dysphagia and nutritional status in multiple sclerosis. J Neurol. 1999;246(8):677–82. https://doi.org/10.1007/s004150050431.

    CAS  Article  PubMed  Google Scholar 

  37. Sasegbon A, Watanabe M, Simons A, Michou E, Vasant DH, Magara J, Bath PM, Rothwell J, Inoue M, Hamdy S. Cerebellar repetitive transcranial magnetic stimulation restores pharyngeal brain activity and swallowing behaviour after disruption by a cortical virtual lesion. J Physiol. 2019;597(9):2533–46.

    CAS  Article  Google Scholar 

  38. Vasant DH, Sasegbon A, Michou E, Smith C, Hamdy S. Rapid improvement in brain and swallowing behavior induced by cerebellar repetitive transcranial magnetic stimulation in poststroke dysphagia: a single patient case-controlled study. Neurogastroenterol Motil. 2019;31(7):e13609.

    Article  Google Scholar 

  39. Lang IM. Brain stem control of the phases of swallowing. Dysphagia. 2009;24(3):333–48. https://doi.org/10.1007/s00455-009-9211-6.

    Article  PubMed  Google Scholar 

  40. Calcagno P, Ruoppolo G, Grasso MG, De Vincentiis M, Paolucci S. Dysphagia in multiple sclerosis—prevalence and prognostic factors. Acta Neurol Scand. 2002;105(1):40–3. https://doi.org/10.1034/j.1600-0404.2002.10062.x.

    CAS  Article  PubMed  Google Scholar 

  41. Meng NH, Wang TG, Lien IN. Dysphagia in patients with brainstem stroke: incidence and outcome. Am J Phys Med Rehabil. 2000;79(2):170–5. https://doi.org/10.1097/00002060-200003000-00010.

    CAS  Article  PubMed  Google Scholar 

  42. Guan XL, Wang H, Huang HS, Meng L. Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis. Neurol Sci. 2015;36(5):671–81. https://doi.org/10.1007/s10072-015-2067-7.

    Article  PubMed  Google Scholar 

  43. Twork S, Wiesmeth S, Spindler M, Wirtz M, Schipper S, Pohlau D, Klewer J, Kugler J. Disability status and quality of life in multiple sclerosis: non-linearity of the Expanded Disability Status Scale (EDSS). Health Qual Life Outcomes. 2010;8:55. https://doi.org/10.1186/1477-7525-8-55.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Giraldo-Cadavid LF, Leal-Leaño LR, Leon-Basantes GA, Bastidas AR, Garcia R, Ovalle S, Abondano-Garavito JE. Accuracy of endoscopic and videofluoroscopic evaluations of swallowing for oropharyngeal dysphagia. Laryngoscope. 2017;127(9):2002–10.

    Article  Google Scholar 

  45. Langmore SE. History of fiberoptic endoscopic evaluation of swallowing for evaluation and management of pharyngeal dysphagia: changes over the years. Dysphagia. 2017;32(1):27–38.

    Article  Google Scholar 

  46. Grasso MG, Gamberini G, Patti F, D’Amico E, Bergamaschi R, Berra E, Giusti A, Cuccaro A, Uccelli MM, Solaro C. The dysphagia in multiple sclerosis questionnaire correlates with fiber-optic endoscopic examination for detecting swallowing deficits in MS. Dysphagia. 2020. https://doi.org/10.1007/s00455-020-10119-w.

    Article  PubMed  Google Scholar 

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Funding

This study was funded by Isfahan University of Medical Sciences.

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Correspondence to Geir Bjørklund or Vahid Shaygannejad.

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Barzegar, M., Mirmosayeb, O., Rezaei, M. et al. Prevalence and Risk Factors of Dysphagia in Patients with Multiple Sclerosis. Dysphagia 37, 21–27 (2022). https://doi.org/10.1007/s00455-021-10245-z

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  • DOI: https://doi.org/10.1007/s00455-021-10245-z

Keywords

  • Multiple sclerosis
  • Dysphagia
  • Deglutition
  • Deglutition disorders
  • DYMUS questionnaire