Scintigraphic Evaluation of Mild to Moderate Dysphagia in Motor Neuron Disease.

PURPOSE OF THE REPORT: Approximately 30% of patients with motor neuron disease (MND) present swallowing difficulties even in early disease stages. The aim of this study was to examine the usefulness of esophageal scintigraphy in detecting early stage of dysphagia in MND. METHODS: Esophageal scintigraphy (ES) including mean transit time (MTT) estimation was performed in 121 MND patients presenting various levels of upper (UMN) and lower motor neuron (LMN) degeneration. RESULTS: ES detected dysphagia in more than 80% of MND patients who had referenced swallowing difficulties. In MND patients with ES-confirmed dysphagia, the MTT was increased approximately 2-fold without significant differences between the clinical phenotypes. The MTT was significantly longer in patients with bulbar-pseudobulbar syndrome in comparison to patients with isolated pseudobulbar syndrome, which indicates a higher involvement of the LMN deficiency in developing dysphagia in MND. The esophageal passage in MND was not dependent on age, sex, disease duration, or diagnosis delay. Interestingly, ES was also able to detect dysphagia in almost 70% of MND individuals who had no swallowing complaints (subclinical dysphagia). A more benign disease course and a higher percentage of male patients characterized this group. CONCLUSIONS: Esophageal scintigraphy is a helpful screening tool in determining early swallowing impairment in a high percent of patients with MND of various clinical phenotypes.

A trial of the use of pedobarography in the assessment of the effectiveness of rehabilitation in patients with coxarthrosis.

BACKGROUND: Pedobarography is an evidence-based diagnostic method that allows quantitative, qualitative and repeatable measurement of pressures on every square centimetre of the sole area of the foot as well as centre of gravity sway, with graphic and numerical recording of results. The aim of the study was to assess the progress of a selected model of rehabilitation on the basis of subpedal pressure distribution and centre of gravity sway in pedobarographic examination as well as to evaluate changes in pain intensity in patients with a history of coxarthrosis. MATERIAL AND METHODS: The study included 21 patients with Altman grade 2 coxarthrosis. A postural pedobarographic examination was performed immediately before and after a 15-day course of rehabilitation with a PEL 38 electronic pedobarograph and computer image analyser with TWINN 99 software, version 2.08. RESULTS: Following the rehabilitation, the study group displayed a statistically significant reduction in pain intensity, improved balance between the average and maximum subpedal pressures of both feet as well as a decrease in the velocity of centre of gravity sway. CONCLUSIONS: 1. A correlation between reduced pain intensity and improved balance of loads on both feet, as well as decreased velocity of centre of gravity sway were observed in the study group after the rehabilitation. 2. The pedobarographic examination may become a new method of diagnosis and follow-up in rehabilitation. 3. Pedobarography, owing to its ease of repeatability and non-invasiveness, may constitute a valuable attempt at objective monitoring of the progress of rehabilitation and its results. 4. The study results encourage further research based on a larger cohort of patients and a control group with a multi-stage prospective design.

Swallowing disorders in Parkinson's disease.

The aim of this study was to assess the reflex and oral, pharyngeal, esophageal phase of swallowing in patients with Parkinson's disease (PD). Eighteen patients with PD and 22 healthy control subjects were investigated using electromyography (EMG) and esophageal scintigraphy. This study demonstrated delayed triggering of the swallowing reflex (443+/-84 ms in patients with PD vs. 230+/-96 ms in controls, p<0.05) and prolongation of laryngeal movement (980+/-140 vs. 649+/-145 ms, p<0.05). We found prolongation of the esophageal phase of swallowing (14.46+/-5.30 vs. 7.45+/-1.64 s, p<0.001) in PD patients. The dysphagia limit i.e. the maximum amount of water swallowed at once was smaller in PD patients than in controls (6.23+/-3.67 vs. >20 ml). Dysphagia was observed in all patients studied although only 13 of them complained about it. In the remaining five cases swallowing impairment was subclinical and it consisted of decreased dysphagia limit and prolongation of the esophageal phase. Dysphagia at the subclinical level may be one of the early symptoms of PD.

[Swallowing disorders in Parkinson's disease]. / Zaburzenia polykania w chorobie Parkinsona.

Impairment of swallowing is a common symptom in advanced stage of Parkinson's disease and severe defect of this function may cause aspiration pneumonia, problems with food intake and cachexy. The aim of this study was to assess the reflex and oral, pharyngeal, oesophageal phase of swallowing. Eleven patients with Parkinson's disease and 9 healthy subjects were investigated by electromyography (EMG) and oesophageal scintigraphy. The study demonstrates delayed triggering of swallowing reflex (543 +/- 84 ms in patients with PD vs. 230 +/- 66 ms in controls, p < 0.05) and prolongation of laryngeal movement (1880 +/- 140 ms vs. 1349 +/- 154 ms, p < 0.05). The prolongation of the oesophageal phase of swallowing with predilection to retention of water in lower one/third part of esophagus (12.45 +/- 2.45 s vs. 6.45 +/- 1.18 s, p < 0.001) was observed. The dysphagia limit, that is the maximum amount of water swallowed at once, was also evaluated (all normal subjects are able to swallow 20 ml water or more at once). In the studied patients with Parkinson's disease it was 4.5 +/- 0.86 ml. These results evidently and objectively indicate the presence of swallowing disorders in Parkinson's disease. Dysphagia was observed in all studied patients, although only 8 of them complained about it. In other 3 cases the impairment of swallowing was subclinical and it was connected with prolongation of oesophageal phase.