Dysphagia in NMOSD and MOGAD as a surrogate of brain involvement

Published on Jan 12, 2021in European Journal of Neurology4.516
· DOI :10.1111/ENE.14691
Marc Pawlitzki11
Estimated H-index: 11
(WWU: University of Münster),
Marc Pawlitzki1
Estimated H-index: 1
(WWU: University of Münster)
+ 7 AuthorsBendix Labeit5
Estimated H-index: 5
(WWU: University of Münster)
BACKGROUND AND PURPOSE 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. METHODS 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. RESULTS 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). CONCLUSION Oropharyngeal dysphagia can occur in NMOSD and MOGAD and might be associated with pneumonia and disability. FEES may help to detect subclinical brain involvement.
#1Samra HamzicH-Index: 1
#2Tobias BraunH-Index: 8
Last. Tibo GerrietsH-Index: 35
view all 11 authors...
The Functional Oral Intake Scale (FOIS) is the most frequently used scale for the evaluation of functional oral intake by dysphagia patients. FOIS was validated using data from Videofluoroscopic Swallowing Study (VFSS). Until now, a validated German version of FOIS for Flexible Endoscopic Evaluation of Swallowing (FEES) is lacking. The aim of this study was a cross-cultural validation of the German version of FOIS (FOIS-G) for FEES. The translation of the original FOIS was carried out according ...
4 CitationsSource
#1Tobias WarneckeH-Index: 30
#2Bendix Labeit (WWU: University of Münster)H-Index: 5
Last. Rainer DziewasH-Index: 42
view all 10 authors...
Objective: Introduction and validation of a phenotypic classification of neurogenic dysphagia based on flexible endoscopic evaluation of swallowing (FEES). Methods: A systematic literature review was conducted, searching MEDLINE from inception to 05/2020 for FEES findings in neurological diseases of interest. Based on a retrospective analysis of FEES-videos in neurological diseases and considering the results from the review, a classification of neurogenic dysphagia was developed distinguishing ...
1 CitationsSource
#1Daniel Whittam (Walton Centre)H-Index: 9
#2Venkatraman Karthikeayan (Walton Centre)H-Index: 2
Last. Anu Jacob (Cleveland Clinic)H-Index: 9
view all 64 authors...
INTRODUCTION While monophasic and relapsing forms of myelin oligodendrocyte glycoprotein antibody associated disorders (MOGAD) are increasingly diagnosed world-wide, consensus on management is yet to be developed. OBJECTIVE To survey the current global clinical practice of clinicians treating MOGAD. METHOD Neurologists worldwide with expertise in treating MOGAD participated in an online survey (February-April 2019). RESULTS Fifty-two responses were received (response rate 60.5%) from 86 invited ...
15 CitationsSource
#1Claudio SolaroH-Index: 36
#2Alessandro CuccaroH-Index: 3
Last. Maria Grazia GrassoH-Index: 34
view all 11 authors...
Introduction Multiple sclerosis (MS) refers to chronic inflammation of the central nervous system including the brain and spinal cord. Dysphagia is a symptom that represents challenges in clinical practice. The aim of the present study was to evaluate the prevalence of dysphagia in an Italian cohort of subjects with MS using the Dysphagia Outcome Severity Score (DOSS), based on fibre-optic endoscopy, and determine factors that correlate with the presence of swallowing problems.
3 CitationsSource
#1Romana Höftberger (Medical University of Vienna)H-Index: 53
#2Yong Guo (Mayo Clinic)H-Index: 18
Last. Claudia F. Lucchinetti (Mayo Clinic)H-Index: 85
view all 12 authors...
We sought to define the pathological features of myelin oligodendrocyte glycoprotein (MOG) antibody associated disorders (MOGAD) in an archival autopsy/biopsy cohort. We histopathologically analyzed 2 autopsies and 22 brain biopsies from patients with CNS inflammatory demyelinating diseases seropositive for MOG-antibody by live-cell-based-assay with full length MOG in its conformational form. MOGAD autopsies (ages 52 and 67) demonstrate the full spectrum of histopathological features observed wi...
41 CitationsSource
#1Marc DeneveH-Index: 2
#2Damien BiottiH-Index: 11
Last. Fabrice BonnevilleH-Index: 28
view all 20 authors...
Abstract The spectrum of Myelin Oligodendrocytes Glycoprotein (MOG) antibody disease constitutes a recently described challenging entity, referring to a relatively new spectrum of autoimmune disorders with antibodies against MOG predominantly involving the optic nerve and spinal cord. The purpose of this article is to describe MRI features of MOG-AD involvement in the optic nerves, spinal cord and the brain of adults.
22 CitationsSource
#1Oliver Cousins (East Kent Hospitals University Nhs Foundation Trust)H-Index: 1
#2Elena Girelli ('KCL': King's College London)H-Index: 1
Last. Sreedharan Harikrishnan ('KCL': King's College London)H-Index: 1
view all 3 authors...
Neuromyelitis optica spectrum disorder (NMOSD) is a rare neurological condition infrequently associated with dysphagia on initial presentation. We describe the case of a 54-year-old woman who presented multiple times to healthcare professionals with severe vomiting, followed by sudden profound dysphagia. Her diagnosis was elusive, initially attributed to achalasia cardia and subsequently to stroke. A dorsal medullary lesion was revealed on MRI of the brain, which involved and extended beyond the...
1 CitationsSource
#1Sven Jarius (University Hospital Heidelberg)H-Index: 65
#2Friedemann Paul (Charité)H-Index: 82
Last. Brigitte Wildemann (University Hospital Heidelberg)H-Index: 63
view all 19 authors...
Over the past few years, new-generation cell-based assays have demonstrated a robust association of autoantibodies to full-length human myelin oligodendrocyte glycoprotein (MOG-IgG) with (mostly recurrent) optic neuritis, myelitis and brainstem encephalitis, as well as with acute disseminated encephalomyelitis (ADEM)-like presentations. Most experts now consider MOG-IgG-associated encephalomyelitis (MOG-EM) a disease entity in its own right, immunopathogenetically distinct from both classic mult...
243 CitationsSource
#1Sven Jarius (University Hospital Heidelberg)H-Index: 65
#2Ingo Kleiter (RUB: Ruhr University Bochum)H-Index: 35
Last. Brigitte Wildemann (University Hospital Heidelberg)H-Index: 63
view all 28 authors...
Background Myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) are present in a subset of aquaporin-4 (AQP4)-IgG-negative patients with optic neuritis (ON) and/or myelitis. Little is known so far about brainstem involvement in MOG-IgG-positive patients.
129 CitationsSource
#1Sven Jarius (Heidelberg University)H-Index: 65
#2Klemens Ruprecht (Charité)H-Index: 52
Last. Brigitte Wildemann (Heidelberg University)H-Index: 63
view all 30 authors...
A subset of patients with neuromyelitis optica spectrum disorders (NMOSD) has been shown to be seropositive for myelin oligodendrocyte glycoprotein antibodies (MOG-IgG). To describe the epidemiological, clinical, radiological, cerebrospinal fluid (CSF), and electrophysiological features of a large cohort of MOG-IgG-positive patients with optic neuritis (ON) and/or myelitis (n = 50) as well as attack and long-term treatment outcomes. Retrospective multicenter study. The sex ratio was 1:2.8 (m:f)....
386 CitationsSource
Cited By0