Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany.
Institute for Biomagnetism and Biosignal Analysis, University of Muenster, Muenster, Germany.
Eur J Neurol. 2021 May;28(5):1765-1770. doi: 10.1111/ene.14691. Epub 2021 Jan 12.
Neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD) are demyelinating disorders that typically affect the optic nerves and the spinal cord. However, recent studies have demonstrated various forms of brain involvement indicating encephalitic syndromes, which consequently are included in the diagnostic criteria for both. Swallowing is processed in a distributed brain network and is therefore disturbed in many neurological diseases. The aim of this study was to investigate the occurrence of oropharyngeal dysphagia in NMOSD and MOGAD using flexible endoscopic evaluation of swallowing (FEES) as a surrogate parameter of brain involvement.
Thirteen patients with NMOSD and MOGAD (mean age 54.2 ± 18.6 years, six men) who received FEES during clinical routine were retrospectively reviewed. Their extent of oropharyngeal dysphagia was rated using an ordinal dysphagia severity scale. FEES results were compared to a control group of healthy individuals. Dysphagia severity was correlated with the presence of clinical and radiological signs of brain involvement, the Expanded Disability Status Scale (EDSS) and the occurrence of pneumonia.
Oropharyngeal dysphagia was present in 8/13 patients, including six patients without other clinical indication of brain involvement. Clinical or subclinical swallowing impairment was significantly more severe in patients with NMOSD and MOGAD compared to the healthy individuals (p = 0.009) and correlated with clinical signs of brain involvement (p = 0.038), higher EDSS (p = 0.006) and pneumonia (p = 0.038).
Oropharyngeal dysphagia can occur in NMOSD and MOGAD and might be associated with pneumonia and disability. FEES may help to detect subclinical brain involvement.
视神经脊髓炎谱系疾病（NMOSD）和髓鞘少突胶质细胞糖蛋白抗体病（MOGAD）是脱髓鞘疾病，通常影响视神经和脊髓。然而，最近的研究表明，多种形式的脑受累表明存在脑炎综合征，因此这两种疾病的诊断标准都包含了这些综合征。吞咽是在一个分布式的大脑网络中进行的，因此在许多神经疾病中都会受到干扰。本研究旨在通过使用纤维内镜吞咽评估（FEES）作为脑受累的替代参数，来研究 NMOSD 和 MOGAD 中口咽吞咽困难的发生情况。
回顾性分析了 13 例在临床常规中接受 FEES 的 NMOSD 和 MOGAD 患者（平均年龄 54.2±18.6 岁，6 名男性）。使用一个等级吞咽困难严重程度量表对其口咽吞咽困难的程度进行评分。将 FEES 结果与健康对照组进行比较。将吞咽困难的严重程度与脑受累的临床和影像学表现、扩展残疾状态量表（EDSS）和肺炎的发生进行相关性分析。
13 例患者中有 8 例存在口咽吞咽困难，其中 6 例患者无其他脑受累的临床指征。NMOSD 和 MOGAD 患者的临床或亚临床吞咽障碍明显比健康对照组严重（p=0.009），并且与脑受累的临床体征（p=0.038）、较高的 EDSS（p=0.006）和肺炎（p=0.038）相关。
NMOSD 和 MOGAD 可出现口咽吞咽困难，并且可能与肺炎和残疾有关。FEES 可能有助于检测亚临床脑受累。
