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Dysphagia in Lateral Medullary Syndrome: A Narrative Review

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Abstract

Dysphagia is a common clinical feature of lateral medullary syndrome (LMS) and is clinically relevant because it is related to aspiration pneumonia, malnutrition, increased mortality, and prolonged hospital stay. Herein, the pathophysiology, prognosis, and treatment of dysphagia in LMS are reviewed. The pathophysiology, prognosis, and treatment of dysphagia in LMS are closely interconnected. Although the pathophysiology of dysphagia in LMS has not been fully elucidated, previous studies have suggested that the medullary central pattern generators coordinate the pharyngeal phases of swallowing. Investigation of the extensive neural connections of the medulla oblongata is important in understanding the pathophysiologic mechanism of dysphagia in LMS. Previous studies have reported that most patients with dysphagia in LMS have a relatively good prognosis. However, some patients require tube feeding for several months, even years, due to severe dysphagia, and little has been reported about conditions associated with a poor prognosis of dysphagia in LMS. Concerning specific therapeutic modalities for dysphagia in LMS, in addition to general modalities used for dysphagia treatment in stroke patients, non-invasive modalities, including repetitive transcranial magnetic stimulation and transcranial direct current stimulation, as well as invasive modalities, such as botulinum toxin injection, balloon catheter dilatation, and myotomy for relaxation of the cricopharyngeal muscle, have been applied. For the appropriate application of therapeutic modalities, clinicians should be aware of the recovery mechanisms and prognosis of dysphagia in LMS. Further studies on this topic, as well as studies involving large numbers of subjects on specific therapeutic modalities, should be encouraged.

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Abbreviations

LMS:

Lateral medullary syndrome

NA:

Nucleus ambiguus

NTS:

Nucleus tractus solitarius

rTMS:

Repetitive transcranial magnetic stimulation

tDCS:

Transcranial direct current stimulation

CP:

Cricopharyngeal

UES:

Upper esophageal sphincter

MRI:

Magnetic resonance imaging

BTX-A:

Botulinum toxin type A

DOSS:

Dysphagia Outcome and Severity Scale

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Acknowledgment

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean Government (MSIP) (No. 2018R1A2B6000996).

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  1. Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Daegu, 705-717, Republic of Korea

    Sung Ho Jang & Min Son Kim

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Jang, S.H., Kim, M.S. Dysphagia in Lateral Medullary Syndrome: A Narrative Review. Dysphagia 36, 329–338 (2021). https://doi.org/10.1007/s00455-020-10158-3

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