From: Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology
Main findings | Neurological diseases | |
---|---|---|
Peripheral | Central | |
I) Premature spillage | Early-stage ALS | Early-stage ALS, early-stage PSP, frontotemporal dementia, SPG7-HSP, acute stroke* |
II) Delayed swallow reflex | Acute stroke* | |
III) Impaired pharyngeal bolus clearance (residue in valleculae >>> residue in piriform sinus) | Bulbospinal muscular atrophy, myotonic dystrophy type II, (critical illness neuropathy/myopathy,) early stage ALS | Early ALS, early-stage PD |
IV) Impaired opening of upper oesophageal sphincter (residue in piriform sinus >>> residue in valleculae) | Inclusion body myositis (IBM) | Dorsolateral medulla oblongata infarction |
V) Complex pathology (combination of I-IV, at least 2 equivalent patterns) | Severe myasthenia gravis, end-stage ALS, (GBS), myotonic dystrophy type I | End-stage ALS, advanced stages of PD and PSP |
VI) Extrapyramidal motor impairment (one out of I-IV) plus movement disorder | – | Neuroleptic-induced dysphagia, PD, MSA, Huntington’s disease |
VII) Fatigable oropharyngeal dysphagia (one out of I-IV plus swallowing fatigability) | Myasthenia gravis | (PD, ALS) |