Doniraj
I remember being quite surprised when a survey of multiple sclerosis (MS) patients conducted
by MSAA several years ago revealed that 39 percent of respondents indicated they had some
degree of swallowing difficulty. Fortunately, most of the swallowing (medically known as
dysphagia) problems are mild and are self-managed by the patients.
For individuals who are more severely affected with associated coughing, a choking sensation,
or breathing difficulties, tests that include swallowing studies – utilizing x-ray imaging and
direct endoscopic visualization of the throat – may yield important information. Such testing
can identify specific issues and ensure that problems other than neurological ones are not
present.
Swallowing is a complex process starting with jaw and tongue movements, which prepare the
solid or liquid (known as the bolus) for transport. Coordination between the tongue and upper
throat muscles allows the portion of bolus to be actively moved to the back of the mouth and
received by the upper throat.
Coordinated contraction of some throat muscles is needed to protect the upper windpipe
(larynx), while the relaxation of another muscle allows for the opening of the upper food
transport tube (esophagus). This results in the transfer of the bolus to the esophagus. From
this point, involuntary contraction of the esophageal smooth muscle moves the bolus down to
the stomach, completing the process.
Disorders of the tongue and the throat muscles or their nerve supply will cause swallowing
problems. MS patients may have lesions of the brainstem affecting the direct nerve supply to
the tongue and throat muscles. More commonly in my experience, multiple lesions (MS
plaques) involving both cerebral hemispheres of the brain cause a lack of coordination of the
tongue and throat swallowing muscles. This results in a type of swallowing problem known as
pseudobulbar palsy.
For many individuals with MS, altering the consistency of solid food and liquids may be very
helpful and improve swallowing function. Retraining to swallow, usually carried out by speech
pathologists to ensure advantageous head and neck posture during swallowing, is another
useful tool for many people with MS. Other strategies for proper swallowing include: eating
smaller, more frequent meals to avoid fatigue while eating; taking smaller bites and chewing
these well to reduce the chance of choking; and consciously coordinating breathing with
swallowing to reduce the risk of aspiration (inhaling food), which can result in pneumonia.
