Dysphagia in neurological diseases: a literature review
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REVIEW ARTICLE
Dysphagia in neurological diseases: a literature review M. Panebianco 1
&
R. Marchese-Ragona 2 & S. Masiero 3 & D. A. Restivo 4
Received: 14 June 2019 / Accepted: 30 May 2020 # The Author(s) 2020
Abstract Dysphagia is defined as an impairment of this complex and integrated sensorimotor system. It is estimated that 400,000 to 800,000 individuals worldwide develop neurogenic dysphagia per year. Neurogenic dysphagia is typically occurring in patients with neurological disease of different etiologies. A correct and early diagnosis and an appropriate management of dysphagia could be useful for improving patient’s quality of life and may help to prevent or delay death. In the present review, we discuss thoroughly the anatomy and physiology of swallowing and also the pathophysiological mechanisms involved in impaired swallowing, as well as the diagnosis, management, and potential treatments of neurogenic dysphagia. Assessment of neurogenic dysphagia includes medical history, physical exam, and instrumental examinations (fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, electromyography). Pharmacological treatment of these problems includes oral anticholinergic drugs. Surgical myotomy of the cricopharyngeal muscle showed an important improvement of oropharyngeal dysphagia associated to upper esophageal sphincter hyperactivity. Chemical myotomy of the upper esophageal sphincter by local injections of botulinum toxin type A into the cricopharyngeal muscle has been proposed as an alternative less invasive and less unsafe than surgical myotomy. Keywords Dysphagia . Swallowing . Neurological diseases
Introduction Swallowing is defined as the semiautomatic motor action of the muscles of respiratory, oropharyngeal, and
* M. Panebianco [email protected] R. Marchese-Ragona [email protected] S. Masiero [email protected] D. A. Restivo [email protected] 1
Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, L69 3BX, Liverpool, UK
2
ENT Department, University of Padova, Via 8 Febbraio 1848, 2, 35122 Padova, PD, Italy
3
School of Physical Medicine and Rehabilitation, University of Padova, Via 8 Febbraio 1848, 2, 35122 Padova, PD, Italy
4
Neurology Department, Garibaldi Hospital, Catania, Italy
gastrointestinal tract that propels the food from oral cavity to the stomach and protects airway from food, liquids, and other substances. During a swallow, different levels of the central nervous system from the cerebral cortex to the medulla oblongata are involved. About 50 pairs of striated cranial muscles are excited and/or inhibited sequentially allowing the bolus transit from the mouth to the stomach. Dysphagia is defined as an impairment of this complex and integrated sensorimotor system. Neurogenic dysphagia (ND) is typically occurring in patients with neurological disease of different etiologies (see Table 1), and it is associated to high mortality, morbidity, and social costs [1–16]. Neurological pro
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