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Characteristics of Dysphagia Based on the Type of ALS in Korean Patients Evaluated Using Videofluoroscopic Study: A Retrospective Analysis

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Abstract

Dysphagia is one of the main serious issues for amyotrophic lateral sclerosis (ALS) patients because of causing malnutrition and aspiration pneumonia. Early detection and management of dysphagia are essential for the long-term survival. In this study, videofluoroscopic swallowing study (VFSS) results of bulbar and spinal onset ALS patients were compared. VFSS results and revised ALS Functional Rating Scale (ALSFRS-R) score were also analyzed to assess the correlation between dysphagia and functional status of patients. ALS patients with swallowing difficulties who underwent VFSS were recruited retrospectively. Two oral, seven pharyngeal, and two esophageal components of VFSS were evaluated. An ALSRFRS-R bulbar subtype score < 9 was used to divide the groups with severe bulbar symptoms. Total 109 Korean ALS patients (39 bulbar vs 70 spinal) were included. Bulbar ALS patients exhibited a significantly longer oral transit time (OTT) then spinal ALS patients, especially in severe bulbar patients with low ALSRFRS-R bulbar subscale. In bulbar ALS patients, penetration (thick liquid), aspiration, OTT, and Penetration-Aspiration Scale (PAS) were significantly correlated with ALSFRS-R bulbar subscale score. However, in spinal ALS patients, only OTT (thin liquid) and aspiration (thick liquid) were significantly correlated with ALSFRS-R bulbar subscale score. Bulbar ALS patients demonstrated significantly longer OTT than spinal ALS patients, and ALSFRS-R bulbar subscale score also correlated well with bulbar ALS patients. Therefore, high vigilance and aggressive treatment for dysphagia especially in bulbar ALS patients rather than spinal ALS patients are mandatory.

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Abbreviations

ADL:

Activities of daily living

ALS:

Amyotrophic lateral sclerosis

ALSFRS:

Amyotrophic Lateral Sclerosis Functional Rating Scale

ALSFRS-R:

Revised Amyotrophic Lateral Sclerosis Functional Rating Scale

FEES:

Fiberoptic endoscopic evaluation of swallowing

GE:

Gastroesophageal

IDDSI:

International dysphagia diet standardization initiative

OTT:

Oral transit time

PAS:

Penetration-Aspiration Scale

PTT:

Pharyngeal transit time

VFSS:

Videofluoroscopic swallowing study

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Authors and Affiliations

  1. Department of Rehabilitation Medicine, Hanyang University College of Medicine, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea

    Yu Chan Park, Jae Young Lee & Mi Jung Kim

  2. Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea

    Jung Soo Lee, Jin Seok Park, Ki Wook Oh & Seung Hyun Kim

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  1. Yu Chan Park
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Correspondence to Mi Jung Kim.

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Park, Y.C., Lee, J.Y., Lee, J.S. et al. Characteristics of Dysphagia Based on the Type of ALS in Korean Patients Evaluated Using Videofluoroscopic Study: A Retrospective Analysis. Dysphagia 37, 1748–1756 (2022). https://doi.org/10.1007/s00455-022-10430-8

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