Arquivo da categoria: Neuromuscular Disorders

Disfagia orofaríngea em pacientes com esclerose múltipla: as escalas de classificação da doença refletem a gravidade da disfagia?

Fernandes, Alessandro Murano Ferré; Duprat, André de Campos; Eckley, Cláudia Alessandra; Silva, Leonardo da; Ferreira, Roberta Busch; Tilbery, Charles Peter.

Braz. j. otorhinolaryngol.;79(4): 460-465, ILUS.

RESUMO

A esclerose múltipla é uma afecção neurológica que envolve distúrbios da deglutição. Muitos estudos têm mostrado associação entre o comprometimento neurológico e o desempenho da deglutição, porém, os resultados têm sido conflitantes.


OBJETIVO: Identificar a frequência de disfagia nos pacientes com esclerose múltipla e os indicadores neurológicos que podem representar o desempenho da deglutição.


MÉTODO: Neste estudo (estudo transversal), 120 pacientes com esclerose múltipla foram submetidos à avaliação funcional da deglutição por fibronasofaringolaringoscopia, cujos resultados foram comparados com a pontuação das escalas de classificação (Formas Clínicas Evolutivas da Doença, Escala de Incapacidade Funcional por Sistemas e Escala Ampliada de Incapacidade Funcional [Kurtzke Expanded Disability Status Scale]).


RESULTADOS: A disfagia foi identificada em 90% dos pacientes. Dentre as formas clínicas, as formas progressivas (primária progressiva e secundária progressiva) apresentaram com maior frequência disfagia grave, enquanto a forma remitente-recorrente apresentou mais frequentemente disfagia leve e moderada. Em relação à Escala de Incapacidade Funcional por Sistemas, as funções cerebelares, do tronco encefálico e mental tiveram associação com a disfagia, especialmente na forma grave. Quanto à Escala Ampliada de Incapacidade Funcional, pontuações mais altas se associaram aos quadros graves de disfagia.


CONCLUSÃO: A disfagia é frequente em pacientes com esclerose múltipla, especialmente naqueles com maior comprometimento das funções neurológicas.

LEIA O ARTIGO NA ÍNTEGRA!

Anúncios

Exemplo de um título de artigo bem atraente!

Surv Ophthalmol. 2011 Sep-Oct;56(5):461-5. doi: 10.1016/j.survophthal.2010.11.007. Epub 2011 Mar 3.

The man who could not see what he could not eat.

Source

Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California, San Diego, California, USA.

Abstract

A 55-year-old Hispanic man born in New Mexico presented with progressively worsening bilateral upper eyelid ptosis and dysphagia. External levator advancement 5 years before did not improve his ptosis. A thorough systemic workup for myasthenia gravis was negative, but electromyography suggested a myopathic process. Molecular genetic testing was positive for oculopharyngeal muscular dystrophy.

http://www.ncbi.nlm.nih.gov/pubmed/21371731

Myotonic dystrophy (DM1) and dysphagia: the need for dysphagia management guidelines and an assessment tool.

Can J Neurosci Nurs. 2011;33(1):42-6.

Source

University of Western Ontario, London, ON. Kladonna@uwo.ca

Abstract

Myotonic dystrophy (DM1) is the most prevalent muscular dystrophy occurring in adulthood. DM1 is a multi-systemic disorder resulting in early-onset cataracts, cardiac rhythm problems, muscle weakness, ptosis, and cognitive and psychiatric manifestations. Dysphagia is one of the most problematic symptoms of DM1 because it may cause weight loss, aspiration pneumonias or sudden death. The purpose of this review is to describe the characteristics of DM1 that make dysphagia management problematic, and to address the need for disease-specific guidelines and a clinical tool to aid in diagnosing and managing dysphagia in this population.

http://www.ncbi.nlm.nih.gov/pubmed/21560885

Cricopharyngeal Dilatation for the Long-term Treatment of Dysphagia in Oculopharyngeal Muscular Dystrophy.

Dysphagia. 2011 Jul 30. [Epub ahead of print]

Abstract

Oculopharyngeal muscular dystrophy (OPMD) is a rare autosomal dominant, progressive degenerative muscle disorder featuring dysphagia with limited therapeutic options. The aim of this study was to evaluate the safety and efficacy of repeated endoscopic dilatation for OPMD over a 15-year period. All patients seen at our Regional Swallowing Clinic with OPMD confirmed by genetic analysis were included. Cricopharyngeal dilatation was performed as an outpatient procedure using a wire-guided 18-mm (54 Fr) Savary-Gilliard bougie with the patient under sedation. Patients were offered repeat endoscopic dilatation when symptoms recurred. Symptom severity prior to initial dilatation and at follow-up was evaluated using the Sydney Swallow Questionnaire (SSQ). Nine patients (7 female, 2 male) were included for analysis. Median total treatment period was 13 years (range = 3-15), median number of dilatations per patient was 7.2 (range = 1-16), and median interval between treatments was 15 months (range = 4.5-45). All patients recorded sustained symptom improvement. Mean SSQ score (out of 1,700) was 1,108.11 (SD ± 272.85) prior to first dilatation and 297.78 (SD ± 189.14) at last follow-up, representing a 73% decrease (95% CI = 52-94) in degree of dysphagia symptoms (paired t-test, P = 0.0001). All mean scores for individual questions also showed significant improvement (P < 0.05). No adverse events were reported with all patients maintaining oral feeding at last follow-up. Repeated cricopharyngeal dilatation is a safe, effective, well-tolerated, and long-lasting treatment for dysphagia in OPMD.

http://www.ncbi.nlm.nih.gov/pubmed/21805106