Dysphagia and multiple sclerosis

Over 30% of persons with multiple sclerosis (pwMS) suffer from swallowing symptoms, a higher rate than previously assumed. Neurogenic dysphagia (ND) may cause many different kinds of oropharyngeal sensorimotor dysfunctions in pwMS, and is associated with both the amount of disability and brainstem signs. About 15% of pwMS with mild disability may also suffer from ND. Diagnostic tools comprise history taking, bedside screening examination (50 ml water test combined with assessment of pharyngeal sensation or with pulse oximetry) and sometimes a videofluoroscopic swallowing study (VFSS) and fibreoptic endoscopic evaluation of swallowing (FEES). VFSS and FEES are complementary methods and both have advantages and disadvantages. Interventions for ND in pwMS are mainly based on functional swallowing therapy, including methods of restitution, compensation and adaptation. The aim of intervention is to prevent aspiration and aspiration pneumonia. Outcome assessment should focus on clinically relevant parameters, such as activity limitation, participation restriction and health-related quality of life.