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MS research update - How common are problems with swallowing in people with MS? - 9 February 2015

Summary

Swallowing problems can occur in MS. Although it is not clear how common a problem it is. This study was a review of the previous research into the number of people with MS who have swallowing problems, to work out how common they are.

The review found that at least a third of people with MS had some sort of swallowing difficulty. Although the number of people with MS diagnosed with a swallowing problem was different depending on the method used for diagnosis. For people diagnosed using questionnaire, 36% were found to have a swallowing problem, however for those diagnosed using a special test or by physical examination by a health professional 81% were found to have a problem.

The authors suggest that their results should be viewed with caution as the studies and the number of people with MS diagnosed with a swallowing problem varied a lot. They suggest that further studies would be needed to gain a better understanding of swallowing in MS, but their analysis helps to highlight how common swallowing problems can be and raise awareness.

Background

Swallowing problems can occur in MS. Although it is not clear how common a problem it is. The consequences of swallowing problems can vary, from a poor and unbalanced diet as certain foods are too difficult to eat, to the life threatening as if food gets stuck in the throat, it can cause choking. Having a better understanding of how swallowing is affected in MS and how many people have problems with swallowing, is important to highlight to health professionals and people with MS that this is something they should pay attention too.

How this study was carried out

This study was a review of the previous research into the number of people with MS who have swallowing problems. The researchers looked at all studies published between 1980 and August 2014. To be included in the review the studies had to be focused on examining swallowing problems and the paper had to include enough data to show how many people did and did not have swallowing problems in the study.

15 studies met the criteria and were included in the analysis. These included a total of 4,510 participants.

The studies were further classified into two groups objective and subjective, based on how the swallowing problem was diagnosed. In the objective group swallowing was assessed using objective measurements such as a clinical examination from a specialist or a test such as videofluoroscopy, where a recording is made of a moving x-ray while the person is swallowing. In the subjective group swallowing was assessed and diagnosed using questionnaires to detect problems, based on the answers given.

What was found

The study found that at least a third of people with MS had a swallowing problem. In the studies in the subjective diagnosis group, 36% of participants had a swallowing problem. In the studies that assessed swallowing function in an objective way, it was found that 81% of participants had some sort of swallowing problem.

Swallowing problems were more likely to be found in those participants who had a higher EDSS score or who had lived with MS for a longer period of time.

What does it mean?

The study is the first to review all of the studies that counted how many people with MS had swallowing problems and it found that at least a third had some sort of swallowing difficulty. The authors suggest that their results should be viewed with caution as the studies were very varied and the number of people with MS diagnosed with a swallowing problem was different depending on the method used for diagnosis. They suggest that further studies would be needed to gain a better understanding of swallowing in MS, but their analysis helps to highlight how common swallowing problems can be and raise awareness.

Guan XL, Wang H, Huang HS, et al.
Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis..
Neurol Sci. 2015 Feb 3. [Epub ahead of print]
abstract

More about swallowing problems

Difficulty swallowing (also known as dysphagia) is not regarded as a common symptom of MS, but this study has found that at least a third of people with MS experience swallowing difficulties to some degree.

In MS, problems with swallowing can be caused by damage in the central nervous system affecting the coordination of the various muscles involved. If the various processes involved in holding food in the mouth, chewing and swallowing are not synchronised, a number of different problems can occur. Food may get stuck in the throat, which causes choking; may move too slowly in the oesophagus (the tube connecting the mouth to the stomach), which causes coughing and spluttering; or may go into the windpipe (which should be closed during swallowing) or the lungs, which is known as aspiration.

For people with MS who experience swallowing problems a speech and language therapist will be able to assess how well someone is swallowing. Following this, the therapist can advise on posture, consistencies of food, amounts, eating environment and possible exercises.

Difficulty with swallowing can also make it a challenge to get enough energy and nutrients from food, so a dietitian can suggest types of food and ways of preparing food that makes them easier to swallow.

You might need a referral from another health professional to access some of these services. So if you have been having trouble eating or swallowing, speak to your MS nurse, neurologist or GP, and they can arrange for you to be assessed.

Research by topic areas...

Assessment tools

Fry DK, Huang M, Rodda BJ.
Core muscle strength and endurance measures in ambulatory persons with multiple sclerosis: validity and reliability.
Int J Rehabil Res. 2015 Feb 2. [Epub ahead of print]
abstract

Physical activity

Sandroff BM, Hillman CH, Benedict RH, et al.
Acute effects of walking, cycling, and yoga exercise on cognition in persons with relapsing-remitting multiple sclerosis without impaired cognitive processing speed.
J Clin Exp Neuropsychol. 2015 Feb 6:1-11. [Epub ahead of print]
abstract

Frau J, Coghe G, Lorefice L, et al.
Attitude towards physical activity in patients with multiple sclerosis: a cohort study.
Neurol Sci. 2015 Feb 4. [Epub ahead of print]
abstract

Rehabilitation

Lozano-Quilis JA, Gil-Gómez H, Gil-Gómez JA, et al.
Virtual rehabilitation for multiple sclerosis using a kinect-based system: randomized controlled trial.
JMIR Serious Games. 2014 Nov 12;2(2):e12.
abstract
Read the full text of this paper

Stem cells

Michailidou I, de Vries HE, Hol EM, et al.
Activation of endogenous neural stem cells for multiple sclerosis therapy.
Front Neurosci. 2014;8:454.
abstract
Read the full text of this paper

Symptoms and symptom management

Fernández-Muñoz JJ, Morón-Verdasco A, Cigarán-Méndez M, et al.
Disability, quality of life, personality, cognitive and psychological variables associated with fatigue in patients with multiple sclerosis.
Acta Neurol Scand. 2015 Feb 3. [Epub ahead of print]
abstract

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