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Ultrasonographic and manometric study of the tongue as biomarkers of dysphagia in patients with amyotrophic lateral sclerosis

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Abstract

Background

The possibility of having methods to assess dysphagia in amyotrophic lateral sclerosis (ALS) patients in a minimally invasive manner could facilitate follow-up and allow performing of therapeutic interventions at earlier stages of the disease. The aim of the study was to analyze the role of tongue strength and thickness in ALS patients and their correlation with dysphagia and bulbar function.

Methods

A sample of outpatients with ALS was evaluated for demographic and clinical features. Tongue thickness and strength have been measured for each patient, and quantitative and qualitative data of the videofluoroscopy swallow study have been analyzed.

Results

Of the 38 ALS patients studied, 47.4% were women, and 26.3% had bulbar onset. The median time between symptom onset and the study was 24 months (IQR 11.5–48), and 55.3% of the patients were carriers of non-invasive mechanical ventilation. Tongue strength identified patients with impaired oral and pharyngeal transit and those with bolus residue scale (BRS) > 1 or penetration-aspiration scale (PAS) ≥ 3. In contrast, tongue thickness is only associated with impaired oral transit. Finally, anterior tongue strength ≤ 34 kPa and posterior tongue strength ≤ 34.5 kPa detected ALS penetrators/aspirators (PAS ≥ 3) and patients with ALS with post-swallow residue (BRS > 1).

Conclusions

Our results suggest that measures that assess the functionality (strength) of the tongue are more valuable than morphological measurements (thickness) for the follow-up of patients with ALS. Alterations of the anterior and posterior lingual strength correlate with the presence of bronchoaspiration and post-swallowing residue (BRS > 1).

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Acknowledgements

This research would not have been possible without the support of the Catalan Society of Neurology and Associació Catalana d’afectats d’ELA (CatELA).

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Authors and Affiliations

  1. ALS/Motor Neuron Diseases Unit, Neurology Department, Hospital del Mar, Barcelona, Spain

    Bernat Bertran Recasens, Greta Garcia Escobar & Miguel Angel Rubio

  2. ALS/Motor Neuron Diseases Unit, Physical Medicine and Rehabilitation Department, Hospital del Mar, Barcelona, Spain

    Anna Guillen-Sola

  3. Rehabilitation Research Group, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain

    Anna Guillen-Sola

  4. ALS/Motor Neuron Diseases Unit, Pneumology Department, Hospital del Mar, Barcelona, Spain

    Juana María Martínez Llorens & Ana Balaña Corberó

  5. Universitat Pompeu Fabra, Barcelona, Spain

    Juana María Martínez Llorens

  6. ALS/Motor Neuron Diseases Unit, Dietetics and Nutrition Department, Hospital del Mar, Barcelona, Spain

    Montserrat Villatoro Moreno

  7. Musculoskeletal Unit, Radiodiagnostic Department, Hospital del Mar, Barcelona, Spain

    Anna Agustí Claramunt

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  1. Bernat Bertran Recasens
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Correspondence to Miguel Angel Rubio.

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Recasens, B.B., Guillen-Sola, A., Llorens, J.M.M. et al. Ultrasonographic and manometric study of the tongue as biomarkers of dysphagia in patients with amyotrophic lateral sclerosis. Neurol Sci 44, 931–939 (2023). https://doi.org/10.1007/s10072-022-06486-x

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