Electrophysiological patterns of oropharyngeal swallowing in multiple sclerosis

•Electrophysiological abnormalities of oropharyngeal swallowing are very frequent in MS, and often occur in patients without clinical symptoms of dysphagia.•Prolongation of suprahyoid/submental muscle EMG activity and increase of the interval between onset of this activity and onset of the laryngeal–pharyngeal mechanogram during oropharyngeal swallowing seem to be markers of dysphagia in multiple sclerosis.•The most marked electrophysiological abnormalities of oropharyngeal swallowing are found in secondary progressive multiple sclerosis.

ObjectiveWe performed an electrophysiological study of swallowing (EPSS) in multiple sclerosis (MS) to describe oropharyngeal swallowing abnormalities and to analyze their correlations with dysphagia and with overall neurological impairment.MethodsNeurological examinations were quantified using the Kurtzke Functional Systems and the Expanded Disability Status Scale (EDSS). Dysphagia was evaluated using the Dysphagia in Multiple Sclerosis (DYMUS) questionnaire, while fiberoptic endoscopic evaluation of swallowing (FEES) was used to establish the degree of aspiration and penetration, graded using the penetration–aspiration scale (PAS). The EPSS measured the duration of suprahyoid/submental muscle EMG activity (SHEMG-D), the duration of the laryngeal–pharyngeal mechanogram (LPM-D), and the duration of the pause in cricopharyngeal muscle EMG activity (CPEMG-PD); it also measured the interval between onset of the suprahyoid/submental muscle EMG activity (SHEMG) and onset of the laryngeal–pharyngeal mechanogram (I-SHEMG-LPM).Results92% of patients showed at least one electrophysiological abnormality. I-SHEMG-LPM correlated positively with the DYMUS questionnaire. I-SHEMG-LPM, SHEMG-D, and DYMUS correlated positively with the PAS. Moderate to severe bladder sphincter dysfunction was associated with a significant reduction, or absence, of CPEMG-PD.ConclusionEPSS improves our understanding of the pathophysiology of dysphagia in MS.SignificanceThis investigation could be useful in MS patients with swallowing abnormalities.