Dysphagia and multiple sclerosis: a study and discussion of its nature and impact

Dysphagia by any cause is at least unpleasant, may be frightening and can be life-threatening. This study attempted to highlight dysphagia as a symptom of multiple sclerosis. Seven patients were identified with multiple sclerosis and dysphagia. Their notes were reviewed. One patient was deceased; the six remaining were visited at home. This enabled a detailed questionnaire to be applied and simple examination to be performed. The home visit allowed carers to be interviewed also and provided insight into the full impact of this symptom. By these means we delineated several types of swallowing problem, choking being predominant. The pattern of the problem was shown to vary, being continuous or intermittent. Associated symptoms were noted to reflect brain stem involvement. We looked at the consequences of the symptom, which ranged from embarrassment and distress to pneumonia and death. We discussed with the patients and their carers compensating mechanisms. Our study suggests the importance of this easily overlooked symptom in multiple sclerosis. It should be actively sought even in early multiple sclerosis, particularly where other brain stem features exist, since it may be palliated by simple, conservative means. More research on the nature, prevalence and palliation of dysphagia in multiple sclerosis is required because of its effects on patients, families and carers.