Neurogenic Dysphagia

Foreword
Preface

1 Neuroanatomy and physiology of deglutition

• 1.1 The unimpaired swallow
• 1.2 The imparied swallow
• 1.3 Central coordination of swallowing
• 1.3.1 Brainstem and swallowing centers
• 1.3.2 Supramedullary coordination of swallowing
• 1.3.3 Hemispheric specialization
• 1.3.4 Cortical plasticity - Compensation of disease-related dysfunction
• 1.3.5 Cortical plasticity - Sensory stimulation to enhance reorganization

2 Clinical procedures

• 2.1 Introduction
• 2.2 History
• 2.3 Aspiration screening
• 2.4 The clinical swallowing examination

3 FEES and other instrumental methods for swallowing evaluation

• 3.1 FEES
• 3.1.1 Introduction
• 3.1.2 Equipment
• 3.1.3 Standard FEES protocol
• 3.1.4 Specific neurological protocols
• 3.1.5 Key findings and their rating
• 3.1.6 Endoscopic classification of neurogenic dysphagia
• 3.1.7 Documentation of endoscopic findings
• 3.1.8 Training curriculum: "FEES for Neurogenic Dysphagia"
• 3.2 Videofluoroscopic swallowing study (VFSS)
• 3.2.1 Indications
• 3.2.2 Technique
• 3.2.3 Radiation exposure
• 3.2.4 Contrast agents
• 3.2.5 Procedure
• 3.2.6 Findings
• 3.2.7 Comparing VFSS and FEES
• 3.3 Manometric evaluation of swallowing
• 3.3.1 Conventional manometry
• 3.3.2 High-resolution manometry
• 3.4 Electromyographic evaluation of swallowing
• 3.5 Sonographic evaluation of swallowing
• 3.6 Magnetic resonance imaging and computer tomography for the evaluation of swallowing
• 3.7 Differential indication of instrumental dysphagia diagnostics

4 Special findings in neurogenic dysphagia

• 4.1 Stroke
• 4.2 Dementia
• 4.2.1 Alzheimer's disease
• 4.2.2 Vascular dementia
• 4.2.3 Frontotemporal dementia
• 4.2.4 Dementia with Lewy bodies
• 4.2.5 Excursus: Presbyphagia
• 4.3 Movement disorders
• 4.3.1 Parkinsonian syndromes
• 4.3.2 Chorea
• 4.3.3 Dystonias
• 4.3.4 Wilson's disease
• 4.4 Inflammatory diseases of the central nervous system
• 4.4.1 Multiple scerosis
• 4.4.2 Bacterial and viral meningoencephalitis
• 4.4.3 CNS listeriosis
• 4.4.4 Poliomyelitis and post-polio syndrome
• 4.4.5 Tetanus
• 4.5 Tumors
• 4.5.1 Brain tumors and metasteses
• 4.5.2 Meningeosis neoplastica
• 4.5.3 Paraneoplastic syndromes
• 4.6 Motor neuron disorders
• 4.6.1 Amyotrophic lateral sclerosis
• 4.6.2 Hereditary spastic paraplegia
• 4.6.3 Spinal and bulbar muscular atrophy (Kennedy's disease)
• 4.7 Polyneuropathy
• 4.7.1 Guillain-Barré syndrome
• 4.7.2 Critical illness polyneuropathy and myopathy
• 4.8 Diseases affecting neuromuscular transmission
• 4.8.1 Myasthenia gravis
• 4.8.2 Lambert-Eaton myasthenic syndrome
• 4.8.3 Botulism
• 4.9 Myopathies
• 4.9.1 Myositis
• 4.9.2 Oculopharyngeal muscular dystrophy
• 4.9.3 Oculopharyngodistal myopathy
• 4.9.4 Metabolic myopathies
• 4.9.5 Facioscapulohumeral muscular dystrophy
• 4.9.6 Myotonic dystrophies
• 4.10 Trauma
• 4.10.1 Traumatic brain injury
• 4.10.2 Spinal cord trauma
• 4.11 Psychogenic dysphagia
• 4.12 Others
• 4.12.1 Hereditary ataxias
• 4.12.2 Niemann-Pick disease, type C
• 4.12.3 Chiari type I malformation
• 4.12.4 Palatal myoclonus (palatal tremor)
• 4.12.5 Diffuse idiopathic skeletal hyperostosis
• 4.12.6 Surgery
• 4.12.7 Anti-IgLON5 syndrome
• 4.12.8 Internal diseases
• 4.13 Algorithm for a structured assessment of patients with neurogenic dysphagia

5 Using FEES in the stroke unit and the intensive care unit

• 5.1 Stroke unit
• 5.1.1 Dysphagia management in the stroke unit
• 5.1.2 Classification and management of post-stroke dysphagia
• 5.2 Intensive care unit
• 5.2.1 Epidemiology and complications of critical-illness dysphagia
• 5.2.2 Etiopathogenesis of critical-illness dysphagia
• 5.2.3 Applications of FEES in the ICU

This book is a clinical manual that covers the whole spectrum of swallowing and its disorders. It starts with physiology of swallowing, pathophysiology of disordered deglutition, diagnostic methods (clinical and instrumental) and ends with an in-depth's and up-to-date presentation of current treatment options. The clinically most relevant topics of dysphagia management on the stroke unit and the intensive care unit are dealt with in separate chapters. Also the closely intertwined issue of nutritional management is specifically addressed. Most importantly, the book covers all obligatory topics of the Flexible Endoscopic Evaluation of Swallowing (FEES)-curriculum, an educational initiative that started in Germany in 2014 and is currently being extended to other European and non-European countries. The book is richly illustrated and an online video section provides a number of typical patient cases.

FEES is probably the most commonly chosen method for the objective assessment of swallowing and its disorders. It is used in stroke units, intensive care facilities, geriatric wards but also in rehabilitation clinics and within dedicated outpatient services.

This book on neurogenic dysphagia therefore addresses a wide range of different medical disciplines, such as neurologists, geriatricians, intensive care physicians, rehabilitation physicians, gastroenterologists, otolaryngologists, phoniatrists and also speech-language pathologists.

Tobias Warnecke is Professor of Neurology at the department of Neurology, University of Muenster (Director: Prof. Dr. H. S. Wiendl), head of the section for Parkinson's Disease and Movement Disorders. Dr. Warnecke acts in several Guideline committees dealing with problems related to neurologically ill patients (Parkinson's disease and atypical Parkinsonism, feeding and nutrition in clinical neurology, diagnosis and therapy of stroke-related dysphagia, FEES in neurology) of the German Society of Neurology, the German Stroke Society and the German Society for Parkinson's Disease and Movement disorders. He is member of several German and international Societies as well, and is author of peer-reviewed articles, letters and case histories, reviews, guideline publications, 2 books and 6 book chapters. Dr. Warnecke has also a peer-review activity for international journals such as Movement Disorders, Stroke, Neurology, JNNP, Acta Neuropathologica, Cerebrovascular Diseases, Parkinsonism and related Disorders, Dysphagia.

Rainer Dziewas is a Professor of Neurology at the university hospital Muenster, Germany, where he is the head of the stroke unit and the neurological intensive care unit. Rainer Dziewas is a Fellow of the European Stroke Organization (ESO), board member of the European Society for Swallowing Disorders (ESSD) and vice-chairman of the German Dysphagia Society. He holds visiting professorships at the Fujita Health University, Nagoya, Japan, the Catholic University of Leuven, Belgium and the Sun-Yat Sen University, Guangzhou, China. He is a member of national and international guideline-committees and author of several peer-reviewed articles, reviews and books. He has significantly contributed to the development of the German FEES-curriculum and the ESSD-FEES accreditation program.

Dr. Susan Langmore is Professor in the Department of Otolaryngology, Boston University School of Medicine. She was formerly Clinical Professor, Speech, Language, Hearing Sciences. Over the years, she has held a full clinical case load in addition to teaching at Boston University. She currently is conducting research in several areas related to dysphagia and is based out of California. She is best known for developing the FEES procedure and she has taughtmany clinicians how to become proficient in using this procedure. She is also well known for her research in aspiration pneumonia. Recently, she completed a clinical trial with head/neck cancer patients. She has been awarded Fellow of ASHA and Honors of the Association. She is on the Editorial Board of the journal Dysphagia. This year, Dr Langmore is President of the Dysphagia Research Society.