Ultrasound and Videofluoroscopic Imaging in Oral-Pharyngeal Dysphagia in Neurolog

Sonies, Barbara

Abstract

We completed a study on the effects of physostigmine on swallowing using a double-blind placebo crossover model in patients with progressive supranuclear palsy (PSP). Eight patients were evaluated with ultrasound and an oral motor examination at baseline and after administration of drug or placebo. There was no significant improve- ment in swallowing or oral motor function as the result of medication. Because PSP patients have increased sensitivity to cholinergic blockade, newer, more potent cholinergic stimulat-ing agents will be used on PSP patients who are less impaired to determine if medication is helpful in improving swallowing. We are currently examining the effects of denepezil on oral motor and swallowing function in another group of patients with PSP. Patients do not receive treatment but are re-evaluated using ultrasound and vocal fremitus before, during, and after drug administration. We have seen 33 patients and are conducting follow-up studies. Eleven Parkinsons patients with bilateral pallidotomy were studied. Analysis of pre- and post-pallidotomy swallowing and oral motor function revealed a mixed pattern of recovery with no significant findings. Whereas some patients improved, others remained unchanged or slightly worse. We conclude that the globus pallidus is minimally involved during swallowing and oral motor tasks. We are conducting swallowing assessment on patients with corticobasal degeneration who have apraxia of swallowing. Data analysis of a study using simultaneous EMG and VF is in progress to understand the ability of the deglutitive motor system to accommodate to changing demands required in different swallowing patterns. The concept of a delay in the pharyngeal swallow has been considered a primary diagnostic sign of dysphagia on the VF examination. We are studying this finding and it appears that the pattern may be part of the normal swallow. - swallowing, neurological conditions, dysphagia, videofluorography, ultrasound imaging - Human Subjects & Human Subjects: Interview, Questionaires, or Surveys Only