Ursachen, Diagnostik und Therapie neurogener Dysphagien

ZUSAMMENFASSUNG

Die neurogene Dysphagie ist eines der häufigsten und lebensbedrohlichsten Symptome neurologischer Störungen wie Hirninfarkte oder neurodegenerative Erkrankungen. Da die durchschnittliche Lebenserwartung stetig steigt, ergibt sich prognostisch ebenfalls ein Anstieg an darunter leidenden Patienten. Entsprechend befasst sich die vorliegende Arbeit mit der Erläuterung und Bewertung der im klinischen Alltag durchgeführten Maßnahmen in Bezug auf Prognose, Diagnostik und Therapie bei neurogener Dysphagie. Es wurde in 2 Literaturdatenbanken (PUBMED; EMBASE) systematisch nach Studien zu Ursachen, Diagnostik und Behandlung von neurogenen Dysphagien gesucht und eine gezielte Auswahl von Studien getroffen, die sich mit Dysphagien in Folge neurologischer Erkrankungen befassten. Einzelfallberichte wurden ausgelassen, klinische Studien jeder sonstigen Art miteingeschlossen. Das Review fasst die Ergebnisse von 24 Studien zusammen. Es zeigte sich, dass mittels flexibler endoskopischer Bewertung des Schluckens (FEES), standardisierter Schluckuntersuchung (SSA), Anamnese und Bildgebung bereits früh eine Prognose zum Ausmaß der Dysphagie möglich war. Zudem zeigte sich die SSA als sinnvolle Maßnahme zur Detektion von Aspirationen, durch eine FEES konnten vermehrt stille Aspirationen erkannt werden und die videofluoroskopische Schluckuntersuchung (VFSS) hatte Vorteile in der Bewertung des Ablaufs der Schluckphasen. Therapeutisch erwiesen sich, je nach Ergebnissen der vorangegangenen Untersuchungen, Schlucktherapie und das Andicken von Flüssigkeiten als effizient, bei bestimmten Krankheitsbildern (Z. n. Hirninfarkt bei gleichzeitig bestehendem Z. n. Dekanülierung) ergab sich bei pharyngealer Elektrostimulation ein positives Bild.

ABSTRACT

Neurogenic dysphagia is one of the most common and dangerous symptoms of neurologic diseases such as strokes or neurodegenerative illnesses. As the average age of the general population increases, the number of cases will likely grow as many these diseases associated with neurogenic dysphagia are more common in the elderly. The effects of dysphagia are severe and have a significant impact on case outcome and mortality, especially when considering that the most common complications are aspiration pneumonia, malnutrition, and dehydration. It is crucial for doctors to know how to treat it. The goal of this review is to explain and evaluate the current options in prognosis, diagnosis, and treatment of neurogenic dysphagia. It consolidates information found in 24 high quality studies collected from two platforms (pubmed, embase). Through FESS, standard swallowing assessment (SSA), anamnesis and MRI, doctors can give an early prognosis on how the dysphagia will develop. The studies reviewed showed that detecting aspirations via SSA was effective. Additionally, FEES could be used to detect more silent aspirations and VFSS could be used to evaluate all phases of swallowing. The studies also showed that correctly identifying silent aspirations and reacting to it adequately reduces the mortality. Furthermore, carbonated liquids and position changes were effective therapeutic options in some patients. Lastly, pharyngeal electric stimulation proved to be effective in most studies and pharmacological therapy was found to be effective in one study. All in all, one can conclude that diagnosis, logopedic treatment and nutrition changes are well explored. This probably leads to a significant decline of the mortality rate. Regarding future diagnostics, pharyngeal electrical stimulation and pharmacological therapy will likely be the important areas of future science.

Schlüsselwörter

Neurogene Dysphagie - Dysphagie - Schluckuntersuchung - endoskopische Schluckuntersuchung

Key words

Neurogenic Dysphagia - dysphagia - swallowing Assessment - endoscopic swallowing

Publication History

Article published online:
02 November 2021

• literatur

• 1 Dziewas R, Auf dem Brinke M, Birkmann U. et al Safety and clinical impact of FEES – results of the FEES-registry. Neurol Res Pract 2019; 1: 16 DOI: 10.1186/s12909-016-0587-3.
• 2 Kurth BM, Scheidt-Nave C. Demographic change in Germany-threat or challenge? Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010; 53(5): 389-391 DOI: 10.1007/s00103-010-1056-5.
• 3 Sura L, Madhavan A, Carnaby G. et al Dysphagia in the elderly: management and nutritional consideration. Clin Interv Aging 2012; 7: 287-298 DOI: 10.2147/CIA.S23404..
• 4 Nakashima T, Maeda K, Tahira K. et al Silent aspiration predicts mortality in older adults with aspiration pneumonia admitted to acute hospitals. Geriatr Gerontol Int 2018; 18(6): 828-832 DOI: 10.1111/ggi.13250.
• 5 Kim JY, Lee YW, Kim HS. et al The mediating and moderating effects of meaning in life on the relationship between depression and quality of life in patients with dysphagia. J Clin Nurs 2019; 28(15–16): 2782-2789 DOI: 10.1111/jocn.14907.
• 6 Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 1988; 2(4): 216-219 DOI: 10.1007/BF02414429.
• 7 Prosiegel M. Neurogene Dysphagien im höheren Lebensalter. NeuroGeriatrie 2005; 2(3): 135-142
• 8 Keller J, Durwen H. Die fiberendoskopische Evaluation des Schluckens (FEES®) in der Geriatrie – mit besonderer Berücksichtigung des akuten Schlaganfalls Beobachtbare Symptome und therapeutische Interventionen. NeuroGeriatrie 2010; 7: 59-64
• 9 Lancaster J. Dysphagia: its nature, assessment and managemen. Br J Community Nurs. 2015 Suppl Nutrition 28-32 DOI: 10.12968/bjcn.2015.20.Sup6a.S28
• 10 Sdravou K, Walshe M, Dagdilelis L. Effects of carbonated liquids on oropharyngeal swallowing measures in people with neurogenic dysphagia. Dysphagia 2012; 27(2): 240-50 DOI: 10.1007/s00455-011-9359-8.
• 11 Cervo F, Bryan L, Farber S. To PEG or not to PEG: a review of evidence for placing feeding tubes in advanced dementia and the decision-making process. Geriatrics 2006; 61(6): 30-5
• 12 Suttrup I, Warnecke T. Dysphagia in Parkinson’s Disease. Dysphagia Dysphagia 2016; 31(1): 24-32 DOI: 10.1007/s00455-015-9671-9.
• 13 Prosiegel M, Höling R, Heintze M. et al. Swallowing therapy--a prospective study on patients with neurogenic dysphagia due to unilateral paresis of the vagal nerve, Avellis’ syndrome, Wallenberg’s syndrome, posterior fossa tumours and cerebellar hemorrhage. Acta Neurochir Supp 2005; (93) 35-37 DOI: 10.1007/3-211-27577-0_4.
• 14 Galovic M, Stauber AJ, Leisi N. et al Development and Validation of a Prognostic Model of Swallowing Recovery and Enteral Tube Feeding After Ischemic Stroke. JAMA Neurol 2019; 76(5): 561-570
• 15 Ickenstein GW, Höhlig C, Prosiegel M. et al Prediction of outcome in neurogenic oropharyngeal dysphagia within 72 hours of acute stroke. J Stroke Cerebrovasc Dis 2012; 21(7): 569-76 DOI: 10.1016/j.jstrokecerebrovasdis.2011.01.004.
• 16 Ickenstein GW, Kelly PJ, Furie KL. et al Predictors of feeding gastrostomy tube removal in stroke patients with dysphagia. J Stroke Cerebrovasc Dis 2003; 12(4): 169-74 DOI: 10.1016/S1052-3057(03)00077-6.
• 17 Aviv JE. Prospective, randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia. Laryngoscope 2000; 110(4): 563-74 DOI: 10.1097/00005537-200004000-00008.
• 18 Tabaee A, Johnson PE, Gartner CJ. et al Patient-controlled comparison of flexible endoscopic evaluation of swallowing with sensory testing (FEESST) and videofluoroscopy. Laryngoscope 2006; 116(5): 821-5 DOI: 10.1097/01.mlg.0000214670.40604.45.
• 19 Gerek M, Atalay A, Cekin E. et al [The effectiveness of fiberoptic endoscopic swallow study and modified barium swallow study techniques in diagnosis of dysphagia]. Kulak Burun Bogaz Ihtis Derg 2005; 15(5–6): 103-11
• 20 Lindner-Pfleghar B, Neugebauer H, Stösser S. et al [Management of dysphagia in acute stroke : A prospective study for validation of current recommendations]. Nervenarzt 2017; 88(2): 173-179 DOI: 10.1007/s00115-016-0271-1.
• 21 Linden P, Kuhlemeier KV, Patterson C. The probability of correctly predicting subglottic penetration from clinical observations. Dysphagia 1993; 8(3): 170-9 DOI: 10.1007/BF01354535.
• 22 Groves-Wright KJ, Boyce S, Kelchner L. Perception of wet vocal quality in identifying penetration/aspiration during swallowing. J Speech Lang Hear Res. 2010: 53 (3) 620–32 DOI: 10.1044/1092-4388(2009/08-0246)
• 23 Warms T, Richards J. “Wet Voice” as a predictor of penetration and aspiration in oropharyngeal dysphagia. Dysphagia 2000; 15(2): 84-8 DOI: 10.1007/s004550010005.
• 24 Collins MJ, Bakheit AM. Does pulse oximetry reliably detect aspiration in dysphagic stroke patients?. Stroke 1997; 28(9): 1773-5 DOI: 10.1161/01.str.28.9.1773.
• 25 Ramsey D, Smithard D. et al Can pulse oximetry or a bedside swallowing assessment be used to detect aspiration after stroke?. Stroke 2006; 37(12): 2984-8 DOI: 10.1161/01.STR.0000248758.32627.3b.
• 26 Dziewas R, Stellato R, van der Tweel I. et al Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial. Lancet Neurol 2018; 17(10): 849-859 DOI: 10.1016/S1474-4422(18)30255-2.
• 27 Suntrup S, Marian T, Schröder JB. et al Electrical pharyngeal stimulation for dysphagia treatment in tracheotomized stroke patients: a randomized controlled trial. Intensive Care Med 2015; 41(9): 1629-37 DOI: 10.1007/s00134-015-3897-8.
• 28 Bath PM, Scutt P, Love J. et al Pharyngeal Electrical Stimulation for Treatment of Dysphagia in Subacute Stroke: A Randomized Controlled Trial. Stroke 2016; 47(6): 1562-70 DOI: 10.1161/STROKEAHA.115.012455.
• 29 Lundine JP, Bates DG, Yin H. Analysis of carbonated thin liquids in pediatric neurogenic dysphagia. Pediatr Radiol 2015; 45(9): 1323-32 DOI: 10.1007/s00247-015-3314-z.
• 30 Shanahan TK, Logemann JA, Rademaker AW. et al Chin-down posture effect on aspiration in dysphagic patients. Arch Phys Med Rehabil 1993; 74(7): 736-9 DOI: 10.1016/0003-9993(93)90035-9.
• 31 Ohma Y T, Karaho Y. Hanyu et al. Effect of posture strategies on preventing aspiration. Nihon Jibiinkoka: Gakkai Kaiho; 1997
• 32 Rasley A, Logemann JA, Kahrilas PJ. Prevention of barium aspiration during videofluoroscopic swallowing studies: value of change in posture. AJR Am J Roentgenol 1993; 160(5): 1005-9 DOI: 10.2214/ajr.160.5.8470567.
• 33 Terré R, Mearin F. Effectiveness of chin-down posture to prevent tracheal aspiration in dysphagia secondary to acquired brain injury. A videofluoroscopy study Neurogastroenterol Motil 2012; 24(5): 414-9 e206 DOI: 10.1111/j.1365-2982.2011.01869.x.
• 34 Balashova IN, Vanchakova NP, Afanasiev VV. et al Diagnosis and treatment of neurogenic dysphagia after acute ischemic stroke. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118: 64-69 DOI: 10.17116/jnevro201811812264.
• 35 Dziewas R, Pflug C. et al Neurogene Dysphagie, S1-Leitlinie, 2020, in: Deutsche Gesellschaft für Neurologie (Hrsg.). Leitlinien für Diagnostik und Therapie in der Neurologie. www.dgn.org/leitlinien
• 36 Warnecke T, Labeit B, Schroeder J. et al Neurogenic Dysphagia: Systematic Review and Proposal of a Classification System. Neurology 2021; 96 (06) e876-e889 DOI: 10.1212/WNL.0000000000011350.