Dysphagia in Multiple Sclerosis - an underestimated symptom?

Background It is estimated that 240,000 people suffer from multiple sclerosis in Germany. In addition to sensory, motor, vegetative, and neuropsychological functional deficits, dysphagia is a highly relevant and disabling, although not well studied symptom of MS. Objectives The purpose of this article is to provide an overview of the scientific background, increase awareness of the symptoms of dysphagia, and to introduce diagnostic tools for its management, overall aiming at alleviating symptoms of dysphagia in persons with MS, and improving their quality of life. Methods A structured literature review was conducted of what is currently known on the development, manifestation, diagnosis and treatment options for MS-related dysphagia. Due to the lack of class 1 evidence, in particular for diagnosis and treatment options of dysphagia, also smaller studies or pilot projects were included and discussed in this review. Results Data from imaging methods such as Flexible Endoscopic Evaluation of Swallowing and Videofluoroscopic Swallowing Evaluation enabled the diagnosis. There was a high variablity in the reported frequency of dysphagia in published studies, largely related to differences in methodology to evaluate the swallowing (from 38 % up to 81 %). Overall, dysphagia as a symptom of multiple sclerosis was underestimated at the patient and the physician level. According to current data from the German MS register, specific treatments were only carried out in 30% of the affected patients