Study On Swallowing Function Changes In Motor Neuron Disease Patients And Its Relationship With TCM Syndrome

BackgroundMotor Neuron Disease is a relentlessly progressive and fatal neurodegenerative disease that involves,primarily,motor neurons in the spinal cord,cerebral cortex and brainstem.The etiology and mechanisms of it remains unclear.There is no effective treatment in western medicine.Swallowing function involvement is common symptoms,MND patients with swallowing disturbance not only suffer from dehydration and malnutrition,but also face aspiration,which may result in aspiration pneumonia and died of respiratory failure finally.Evaluating swallowing function appropriately is helpful to find out early swallowing disturbance and guide clinical treatment.However, clinical trial is insufficient and systematic conclusion is lacking so far. Traditional Chinese Medicine has obtained some effects in treating MND,but it has not established a standardization of TCM syndrome differentiation and is lacks of objective basis.PurposeThis study analyzed the patients' swallowing function assessing data,to summarize the characteristic of swallowing function in MND patients.We also studied the swallowing function differences among different TCM syndrome to explore the relationship between swallowing function and TCM syndrome.MethodsWe retrospectively analyzed 25 MND patients that fit the request.Gathered the patients ' swallowing function assessing data from swallowing videofluoroscopy examination,as well as their general data,course of illness, the duration following bulbar symptom onset and TCM syndrome.Then,we used SPSS13.0 software package to record the data and check it.Using the description analysis,one-way ANOVA and rank sum test to make the statistical analysis for summarizing the characteristic of swallowing function in MND patients and its relationship TCM syndrome.Result1.The pattern of dysphagia in'MND was mainly in the oral and pharyngeal phases.Our results clearly showed that labial phimosis and food intake,bolus leak out from mouth,bolus holding in the oral cavity,bolus transport from the mouth to the root of tongue,bolus transport from the mouth to the pharynx were significantly correlated to the duration following bulbar symptom onset.That was,these parameters became worse over time following bulbar symptom onset.In contrast,the function of upper esophageal sphincter(UES) was relatively well maintained in the late stage of dysphagia.2.Comparing to the patients with limb symptom onset,there were significant differences of labial phimosis and food intake,bolus leak out from mouth,bolus transport from the mouth to the root of tongue,bolus transport from the mouth to the pharynx in the patients with bulbar symptom onset, which showed that the degree of dysphagia of patients with bulbar symptom onset,was more serious.3.The dysphagia of the oral and pharyngeal phases in MND was more than others(80%).Swallowing videofluoroscopy examination parameters of the oral phase were significantly correlated to the duration following bulbar symptom onset,so the degree of swallowing dysfunction in the oral phase progressed over time.4.Between the ALS group and SMA group,there were no significant differences in all estimated parameters,so did among the TCM syndrome groups. Conclusion1.Our study clearly showed the progression pattern of dysphagia in MND.Data from this study showed that swallowing alterations in MND were very frequent and affected both the oral and pharyngeal phases of swallowing.We also found that,comparing to the patients with limb symptom onset,the degree of swallowing dysfunction of patients with bulbar symptom onset,was more serious.2.It is certificated that VF is a useful technique with high diagnostic capabilities in the assessment of the degree and causes of swallowing dysfunction of patients with MND.3.From our result,it would be useful to perform VF by 6 months following bulbar symptom onset,because VF can contribute to rehabilitation or appropriate diet modification at an early date.VF should again performed around 1 year following bulbar symptom onset to evaluate the progression condition of dysphagia,they needed to introduce intervention,such as tube feeding and PEG,according to their degree of dysphagia.