Prevalence of Dysphagia in Multiple Sclerosis and Correlation with Disability

Friday, June 3, 2016: 3:45 PM
Maryland D
Rola Mahmoud, MD , Neurology, Baylor College of Medicine, Houston, TX
George J Hutton, MD , Neurology, Baylor College of Medicine, Houston, TX
Kenneth W Altman, MD PhD , Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, TX
Felicia Carter, MA, CCC-SLP , Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, TX
S.Richard Dunham, MD , Neurology, Baylor College of Medicine, Houston, TX


Dysphagia represents a significant challenge in the management of Multiple Sclerosis (MS) patients. Aspiration pneumonia is consequently the leading cause of death in MS. The incidence of dysphagia varies depending on the severity of the disability from 24% to 65%. Dysphagia starts to appear in mildly impaired MS subjects with an Extended Disability Status Scale (EDSS) of 2–3, and becomes increasingly common in the most severely disabled subjects (EDSS 8–9). It has also been reported in about 17% of patients with an EDSS score lower than 2.5

The disturbances usually involve oral and pharyngeal phases of swallowing, although upper esophageal sphincter dysfunction has also been detected. The DYMUS (Dysphagia in MS) questionnaire proved to be a useful and consistent instrument to detect dysphagia in MS. It also showed a very good correlation with swallowing problems and EDSS scores. On the other hand, EAT-10 (Eating assessment tool 10) has displayed excellent internal consistency, test-retest reproducibility, and criterion-based validity, but it was not tested in Multiple Sclerosis patients. The administration of  both questionnaires can be used to identify individuals in need of more objective evaluations of swallowing and to direct programs for prevention of aspiration


To improve the identification of MS patients at greatest risk using both questionnaires. We will screen 1000 patients and correlate the findings of the objective swallowing evaluation results with the questionnaire scores, EDSS and type of Multiple Sclerosis. 


This ongoing study is using a cross-sectional design. All eligible MS patients will complete the questionnaires. Those with a positive screen will undergo further speech pathology evaluation. They will also be evaluated using EDSS to measure their disability


At present, 214 patients with Multiple Sclerosis were screened at our clinic. About 30% reported swallowing problems using either questionnaire. Updated prevalence and correlations with objective measures will be presented. 


Identifying MS patients with swallowing difficulties in the early stages of the disease can lead to a rehabilitation program to prevent aspiration pneumonia and to advise patients on food intake, and at the same time to alert the physician for careful monitoring of these patients. The availability of a reliable tool for a preliminary screening and quantification of swallowing problems in MS patients would be useful in order to identify those patients who need further swallowing investigations and interventions