Swallowing difficulty or dysphagia occurs in a third of MS cases.
Aside from the discomfort, it is dangerous for small bits of food to go down the wrong way into the lungs rather than in to the gullet. The latter can lead to chest infections (termed aspiration pneumonia), and is the leading cause of death in neurodegenerative conditions including MS.
Early review of swallowing by Speech and Language Therapists improves morbidity and mortality when this occurs.
When a group of MS patients with swallowing difficulties were surveyed for swallowing difficulties in Turkey, they found that age correlated with dysphagia (i.e. older you were the more likely it was to occur), and those with a progressive disease course were more likely to have a problem.
In the progressive phenotype, secondary progressive MS was more likely to have more serious problems with swallowing than primary progressive MS (see Figure below). Why? Secondary progressive MS has a more prolonged disease course and tend to be older.
Interestingly, this study also found that sleep and fatigue also deteriorated in accordance with more symptoms, hence the psychological burden of swallowing difficulties mustn’t be overlooked.
Mult Scler Relat Disord 2020 Jul 14;45:102397. doi: 10.1016/j.msard.2020.102397. Online ahead of print.
Screening of dysphagia by DYMUS (Dysphagia in multiple sclerosis) and SWALQoL (Swallowing quality of life) surveys in patients with multiple sclerosis
Background: Dysphagia is a life-threating symptom in patients with multiple sclerosis (MS) because aspiration pneumonia develops as a consequence of swallowing disorders. Dysphagia can be detected by using patient-reported outcome measures in order to prevent complications.
Objective: To identify the dysphagia prevalence, severity, and swallowing related quality of life (QoL), by using two validated dysphagia questionnaires.
Method: Dysphagia in Multiple Sclerosis (DYMUS) and Swallowing Quality of Life (SWALQoL) questionnaires were collected from 64 patients with MS.
Results: The mean total SWALQoL score was 67.9 (±11.2) and the mean DYMUS score was 2.02 (±1.3). The highest mean SWALQoL subdomain score belonged to communication (76.7 ± 15.8), and the lowest score belonged to sleep (54.2 ± 12.2). There was a significant correlation between age and DYMUS and SWALQoL scores (r: 0.539 and r: -0.610 respectively, P < .001). Additionally, there was a significant moderate correlation between disease duration and DYMUS and SWALQoL scores (r: 0.693 and r: -0.697 respectively, P < .001). DYMUS and SWALQoL scores did not vary between males and females (P > .05). Patients with secondary progressive MS had higher DYMUS and lower SWALQoL scores (more dysphagia) than in primary progressive or relapsing-type MS. There was a strong, negative and statistically significant correlation between DYMUS and total SWALQoL scores (Spearman’s rho: -0.862, p < .001).
Conclusion: MS causes dysphagia and reduces QoL. Age, disease duration, and MS type are major factors that influence SWALQoL. DYMUS and SWALQoL are well correlated. DYMUS is an easy to answer tool that may advised for screening dysphagia in patients with MS.