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European Journal of Neurology Oct 2020Dysphagia, dysarthria and aphasia are common symptoms following acute stroke; however, limited data are available from recent prospective clinical trials. The aim of...
BACKGROUND AND PURPOSE
Dysphagia, dysarthria and aphasia are common symptoms following acute stroke; however, limited data are available from recent prospective clinical trials. The aim of this study was to determine the incidence and associated factors of dysphagia, dysarthria and aphasia following a first acute ischaemic stroke in patients admitted to a comprehensive stroke center.
METHODS
All first ischaemic stroke patients admitted to the Stroke Unit of Ghent University Hospital within 48 h after symptom onset were enrolled in this prospective study between March 2018 and October 2019. Dysphagia and communication screenings were performed within 3 days after admission. When dysphagia, dysarthria and/or aphasia were assumed, standardized assessments were performed. Incidence rates were calculated as point estimates (%) with 95% confidence intervals (CI). Associated factors were calculated via multivariate binary logistic regression analyses.
RESULTS
Dysphagia, dysarthria and aphasia were present in 23% (95% CI, 17-31), 44% (95% CI, 37-52) and 23% (95% CI, 17-30), respectively of 151 first ischaemic stroke patients [67 female, mean age 67 (SD 14) years]. Separate multivariate binary logistic regression analyses showed that dysphagia, dysarthria and aphasia were significantly associated with age-adjusted stroke severity at baseline [odds ratio (OR), 1.16; 95% CI, 1.09-1.23; OR, 1.13; 95% CI, 1.07-1.20 and OR, 1.11; 95% CI, 1.05-1.17 respectively]. Corrected for stroke severity, the risk for aphasia increased by 4% per year of age (OR, 1.04; 95% CI, 1.00-1.07). Adjusted for age and stroke severity, aphasia was significantly associated with large artery atherosclerosis as stroke etiology (OR, 3.91; 95% CI, 1.18-12.98).
CONCLUSIONS
This trial showed a high incidence of dysphagia, dysarthria and aphasia following acute ischaemic stroke. Stroke severity was an associated factor for all three symptoms.
Topics: Aged; Aphasia; Brain Ischemia; Deglutition Disorders; Dysarthria; Female; Humans; Incidence; Ischemic Stroke; Male; Prospective Studies; Stroke
PubMed: 32515514
DOI: 10.1111/ene.14385 -
Journal of Oncology Pharmacy Practice :... Apr 2023Capecitabine is a pre-metabolite of 5-fluorouracil and is used as a chemotherapeutic agent. Among the common side effects of capecitabine, there are gastrointestinal...
INTRODUCTION
Capecitabine is a pre-metabolite of 5-fluorouracil and is used as a chemotherapeutic agent. Among the common side effects of capecitabine, there are gastrointestinal side effects including nausea, vomiting, and diarrhea, and dermatological side effects including hand-foot syndrome and skin pigmentation change. However, neurological side effects of capecitabine are very rare. We describe herein a patient who developed neurological side effects in the form of agraphia and dysarthria on the 7th day of capecitabine treatment.
CASE REPORT
A 34-year-old male patient, who was being followed up with the diagnosis of colon cancer, presented with speech and writing disorder that developed while under capecitabine treatment. Dysarthria and agraphia were detected in his neurological examination. Diffusion-weighted magnetic resonance imaging (MRI) revealed acute diffusion restriction in the splenium of the corpus callosum and at the level of the bilateral centrum semiovale. Brain MRI revealed symmetrical T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) signal increases at the right temporoparietal medial, corpus callosum level, and bilateral white matter level.
MANAGEMENT & OUTCOME
The capecitabine treatment was terminated, and methylprednisolone treatment was administered and plasmapheresis procedure was carried out. Subsequently, significant improvement was observed in the clinical findings and neuroimaging.
DISCUSSION
Capecitabine is used as an oral agent; thus, it provides ease of use. Neurological side effects associated with the use of capecitabine reportedly occur very rarely. The findings of this case demonstrated that leukoencephalopathy can be seen during the use of capecitabine, imaging results are very important in the diagnosis of leukoencephalopathy, and improvement can be achieved with the termination of the capecitabine treatment.
Topics: Male; Humans; Adult; Capecitabine; Agraphia; Dysarthria; Fluorouracil; Leukoencephalopathies
PubMed: 35903929
DOI: 10.1177/10781552221116329 -
The Laryngoscope Jun 2022To investigate the presence, degree, predictors, and trajectory of dysphagia, dysphonia, and dysarthria among adults hospitalized with COVID-19 across the Republic of... (Observational Study)
Observational Study
OBJECTIVE
To investigate the presence, degree, predictors, and trajectory of dysphagia, dysphonia, and dysarthria among adults hospitalized with COVID-19 across the Republic of Ireland (ROI) during the first wave of the pandemic.
STUDY DESIGN
Prospective observational cohort study.
METHODS
Adults with confirmed COVID-19 who were admitted into 14 participating acute hospitals across ROI and referred to speech and language therapy between March 1st and June 30th 2020 were recruited. Outcomes obtained at initial SLT evaluation and at discharge were oral intake status (Functional Oral Intake Scale), perceptual voice quality (GRBAS), and global dysarthria rating (Dysarthria Severity Scale).
RESULTS
Data from 315 adults were analyzed. At initial SLT assessment, 84% required modified oral diets, and 31% required tube feeding. There were high rates of dysphonia (42%) and dysarthria (23%). History of intubation (OR 19.959, 95% CI 6.272, 63.513; P = .000), COVID-19 neurological manifestations (OR 3.592, 95% CI 1.733, 7.445; P = .001), and age (OR 1.034; 95% CI 1.002, 1.066; P = .036) were predictive of oral intake status. History of intubation was predictive of voice quality (OR 4.250, 95% CI 1.838, 9.827; P = .001) and COVID-19 neurological manifestations were predictive of dysarthria (OR 2.275; 95% CI 1.162, 4.456; P = .017). At discharge, there were significant improvements in oral intake (Z = -7.971; P = .000), voice quality (Z = -5.971; P = .000), and dysarthria severity (Z = -2.619; P = .009), although need for modified oral intake (59%), dysphonia (23%), and dysarthria (14%) persisted.
CONCLUSION
Dysphagia, dysphonia, and dysarthria were widespread among adults hospitalized with COVID-19 and they persisted for many at discharge. Prompt SLT evaluation is required to minimize complications.
LEVEL OF EVIDENCE
3 Laryngoscope, 132:1251-1259, 2022.
Topics: Adult; COVID-19; Deglutition Disorders; Dysarthria; Dysphonia; Hoarseness; Humans; Ireland; Prospective Studies
PubMed: 34622966
DOI: 10.1002/lary.29900 -
European Annals of Otorhinolaryngology,... Aug 2022
Topics: Dysarthria; Humans; Tongue; Tongue Diseases
PubMed: 34625390
DOI: 10.1016/j.anorl.2021.07.013 -
Journal of Speech, Language, and... Jan 2023While dysarthria and dysphagia are known bulbar manifestations of amyotrophic lateral sclerosis (ALS), the relative prevalence of speech and swallowing impairments and...
PURPOSE
While dysarthria and dysphagia are known bulbar manifestations of amyotrophic lateral sclerosis (ALS), the relative prevalence of speech and swallowing impairments and whether these bulbar symptoms emerge at the same time point or progress at similar rates is not yet clear. We, therefore, sought to determine the relative prevalence of speech and swallowing impairments in a cohort of individuals with ALS and to determine the impact of disease duration, severity, and onset type on bulbar impairments.
METHOD
Eighty-eight individuals with a confirmed diagnosis of ALS completed the ALS Functional Rating Scale-Revised (ALSFRS-R), underwent videofluoroscopy (VF), and completed the Sentence Intelligibility Test (SIT) during a single visit. Demographic variables including disease duration and onset type were also obtained from participants. Duplicate, independent, and blinded ratings were completed using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale and SIT to index dysphagia (DIGEST ≥ 1) and dysarthria (< 96% intelligible and/or < 150 words per minute) status. Descriptive statistics, Pearson chi-squared tests, independent-samples tests, and odds ratios were performed.
RESULTS
Dysphagia and dysarthria were instrumentally confirmed in 68% and 78% of individuals with ALS, respectively. Dysarthria and dysphagia were associated ( = .01), and bulbar impairment profile distributions in rank order included (a) dysphagia - dysarthria (59%, = 52), (b) no dysphagia - dysarthria (19%, = 17), (c) no dysphagia - no dysarthria (13%, = 11), and (d) dysphagia - no dysarthria (9%, = 8). Participants with dysphagia or dysarthria demonstrated 4.2 higher odds of exhibiting a bulbar impairment in the other domain than participants with normal speech and swallowing (95% CI [1.5, 12.2]). There were no differences in ALSFRS-R total scores or disease duration across bulbar impairment profiles ( > .05). ALSFRS-R bulbar subscale scores were significantly lower in individuals with dysphagia versus no dysphagia (8.4 vs. 10.4, < .0001) and dysarthria versus no dysarthria (8.5 vs. 10.9, < .0001). Dysphagia and onset type ( = .003) and dysarthria and onset type were associated ( < .0001).
CONCLUSIONS
Over half of the individuals with ALS in this study demonstrated both dysphagia and dysarthria. Of those with only one bulbar impairment, speech was twice as likely to be the first bulbar symptom to degrade. Future studies are needed to confirm these findings and determine the longitudinal progression of bulbar impairments in this patient population.
Topics: Humans; Amyotrophic Lateral Sclerosis; Severity of Illness Index; Deglutition Disorders; Dysarthria; Deglutition
PubMed: 36525626
DOI: 10.1044/2022_JSLHR-22-00312 -
Developmental Medicine and Child... Apr 2021To investigate whether dysarthria syndromes acquired in adulthood can also be observed in children with cerebral palsy (CP) and, if so, whether they align with...
AIM
To investigate whether dysarthria syndromes acquired in adulthood can also be observed in children with cerebral palsy (CP) and, if so, whether they align with children's CP subtypes.
METHOD
Twenty-six children with CP participated (mean age 7y 8mo [SD 1y 2mo], 5y 1mo-9y 10mo; 16 males and 10 females). Speech samples were elicited in a computer-based game and were analysed using the auditory perceptual criteria of the Bogenhausen Dysarthria Scales (BoDyS). For statistical classification, three comparison groups of adults with standard dysarthria syndromes (i.e. spastic, hyperkinetic, and ataxic) were used. Their BoDyS data were entered into a mixture discriminant analysis, with data from the comparison groups as the training sample and those from the children with CP as the test sample. Results were related to findings in a group of adults with CP.
RESULTS
Among the children with CP, most had spastic (n=14), while fewer had ataxic (n=9) or hyperkinetic (n=3), dysarthria. However, syndrome allocations were significantly more ambiguous than in adults with CP. For 11 children, their dysarthria syndromes did not align with their CP subtype.
INTERPRETATION
Dysarthria syndromes are less clear cut in children than in adults with CP because of a number of developmental factors.
WHAT THIS PAPER ADDS
Children with cerebral palsy (CP) show diverse patterns of dysarthric symptoms. Dysarthria syndromes do not seem to manifest fully during childhood. Dysarthria syndrome and CP subtype may not align in children with CP.
Topics: Cerebral Palsy; Child; Child, Preschool; Dysarthria; Female; Humans; Male; Speech
PubMed: 32970343
DOI: 10.1111/dmcn.14679 -
Brain Sciences Mar 2022Communicative participation is restricted in many conditions associated with dysarthria. This position paper defines and describes the construct of communicative...
Communicative participation is restricted in many conditions associated with dysarthria. This position paper defines and describes the construct of communicative participation. In it, the emergence of this construct is reviewed, along with the predictors of and variables associated with communicative participation in the dysarthrias. In doing so, the features that make communicative participation unique and distinct from other measures of dysarthria are highlighted, through emphasizing how communicative participation cannot be predicted solely from other components of the World Health Organization's International Classification of Functioning, Disability and Health (ICF), including levels of impairment or activity limitations. Next, the empirical literature related to the measurement of communicative participation and how this research relates to dysarthria management is presented. Finally, the development of robust clinical measures of communicative participation and approaches to management is described from the point of view of the clinician. We argue that communicative participation should be a primary focus of treatment planning and intervention to provide patient-centered, holistic, and value-based clinical interventions which are responsive to the needs of individuals living with dysarthria.
PubMed: 35447952
DOI: 10.3390/brainsci12040420 -
BMJ Case Reports Mar 2020Severe hyperhomocysteinemia (>100 µmol/L) is often associated with inborn errors of homocysteine metabolism. It manifests typically in neonatal period with...
Severe hyperhomocysteinemia (>100 µmol/L) is often associated with inborn errors of homocysteine metabolism. It manifests typically in neonatal period with developmental delay, hypotonia, feeding problems or failure to thrive. Adult-onset forms are rare and include less severe manifestations. Early diagnosis is crucial because effective treatment is available. A 23-year-old man presented with a 3-week history of speech and gait impairment, and numbness in lower limbs. Neurological examination revealed dysarthria, decreased vibratory sensation in both legs and appendicular and gait ataxia. Brain MRI revealed T2-hyperintense symmetric white matter lesions and cortical atrophy. He had folate and vitamin B deficiency, a markedly elevated serum homocysteine and low methionine. Despite vitamin supplementation homocysteine levels remained elevated. Molecular studies of 5,10-methylenetetrahydrofolate reductase () gene revealed a new pathogenic mutation (c.1003C>T (p.Arg335Cys)) and a polymorphism (C677T (p.Ala222Val)) associated with hyperhomocysteinemia, both in homozygosity. The patient started betaine with clinical and biochemical improvement.
Topics: Age of Onset; Betaine; Dysarthria; Folic Acid; Gait Ataxia; Homocystinuria; Humans; Male; Methylenetetrahydrofolate Reductase (NADPH2); Muscle Spasticity; Psychotic Disorders; Tremor; Vitamin B 12; Young Adult
PubMed: 32161077
DOI: 10.1136/bcr-2019-232241 -
Neurology Sep 2023Bilateral vestibulopathy (BVP) is a chronic debilitating neurologic disorder with no monogenic cause established so far despite familiar presentations. We hypothesized...
BACKGROUND AND OBJECTIVES
Bilateral vestibulopathy (BVP) is a chronic debilitating neurologic disorder with no monogenic cause established so far despite familiar presentations. We hypothesized that replication factor complex subunit 1 (RFC1) repeat expansions might present a recurrent monogenic cause of BVP.
METHODS
The study involved RFC1 screening and in-depth neurologic, vestibulo-oculomotor, and disease evolution phenotyping of 168 consecutive patients with idiopathic at least "probable BVP" from a tertiary referral center for balance disorders, with127 of them meeting current diagnostic criteria of BVP (Bárány Society Classification).
RESULTS
Biallelic AAGGG repeat expansions in RFC1 were identified in 10/127 patients (8%) with BVP and 1/41 with probable BVP. Heterozygous expansions in 10/127 patients were enriched compared with those in reference populations. RFC1-related BVP manifested at a median age of 60 years (range 34-72 years) and co-occurred predominantly with mild polyneuropathy (10/11). Additional cerebellar involvement (7/11) was subtle and limited to oculomotor signs in early stages, below recognition of classic cerebellar ataxia, neuropathy, and vestibular areflexia syndrome. Clear dysarthria, appendicular ataxia, or cerebellar atrophy developed 6-8 years after onset. Dysarthria, absent patellar reflexes, and downbeat nystagmus best discriminated RFC1-positive BVP from RFC1-negative BVP, but neither sensory symptoms nor fine motor problems. Video head impulse gains of patients with RFC1-positive BVP were lower relative to those of patients with RFC1-negative BVP and decreased until 10 years disease duration, indicating a potential progression and outcome marker for RFC1-disease.
DISCUSSION
This study identifies RFC1 as the first-and frequent-monogenic cause of BVP. It characterizes RFC1-related BVP as part of the multisystemic evolution of spectrum disease, with implications for designing natural history studies and future treatment trials.
CLASSIFICATION OF EVIDENCE
This study provides Class II evidence that RFC1 repeat expansions cause BVP.
Topics: Humans; Ataxia; Bilateral Vestibulopathy; Cerebellar Ataxia; Dysarthria; Phenotype; Reflex, Abnormal; Vestibular Diseases
PubMed: 37460231
DOI: 10.1212/WNL.0000000000207553 -
Journal of the International... May 2021To investigate the impact of cognitive impairment on spoken language produced by speakers with multiple sclerosis (MS) with and without dysarthria.
OBJECTIVE
To investigate the impact of cognitive impairment on spoken language produced by speakers with multiple sclerosis (MS) with and without dysarthria.
METHOD
Sixty speakers comprised operationally defined groups. Speakers produced a spontaneous speech sample to obtain speech timing measures of speech rate, articulation rate, and silent pause frequency and duration. Twenty listeners judged the overall perceptual severity of the samples using a visual analog scale that ranged from no impairment to severe impairment (speech severity). A 2 × 2 factorial design examined main and interaction effects of dysarthria and cognitive impairment on speech timing measures and speech severity in individuals with MS. Each speaker group with MS was further compared to a healthy control group. Exploratory regression analyses examined relationships between cognitive and biopsychosocial variables and speech timing measures and perceptual judgments of speech severity, for speakers with MS.
RESULTS
Speech timing was significantly slower for speakers with dysarthria compared to speakers with MS without dysarthria. Silent pause durations also significantly differed for speakers with both dysarthria and cognitive impairment compared to MS speakers without either impairment. Significant interactions between dysarthria and cognitive factors revealed comorbid dysarthria and cognitive impairment contributed to slowed speech rates in MS, whereas dysarthria alone impacted perceptual judgments of speech severity. Speech severity was strongly related to pause duration.
CONCLUSIONS
The findings suggest the nature in which dysarthria and cognitive symptoms manifest in objective, acoustic measures of speech timing and perceptual judgments of severity is complex.
Topics: Cognitive Dysfunction; Dysarthria; Humans; Language; Multiple Sclerosis; Speech Acoustics
PubMed: 33190658
DOI: 10.1017/S1355617720001113