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https://revistacefac.org.br/article/doi/10.1590/1982-0216/202426211123
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A longitudinal study of the progression of Huntington’s disease and oropharyngeal dysphagia: A four-case follow-up

Adriana Ponsoni; Daniella Priscila Lima; Maria Amélia Brito Luz; Paula Christina Azevedo; Lúcia Figueiredo Mourão

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Abstract

Huntington's disease (HD) is a neurodegenerative disorder, with dysphagia being a common symptom of the disease. Few studies established a relationship between neuromotor impairment and dysphagia. There is also a lack of described therapeutic approaches for dysphagia in HD. This study aimed to better understand the progression of neurological clinical aspects, instrumental swallowing and dysphagia management in four patients presented with HD in an outpatient follow-up setting. The longitudinal follow-up period was 36 to 43 months through neuroclinical assessments (Unified Huntington’s Disease Rating Scale) and fiberoptic endoscopic swallowing evaluations. Case 1 - a moderate decline of independence with safe swallowing. Case 2 - a moderate motor impairment, safe swallowing and moderate dysphagia during follow-up. Case 3 - a longer disease duration and increased motor impairment associated with moderate/severe dysphagia. Case 4 - a longer disease duration, need of assistance to perform daily activities, severe dysphagia and palliative care, considering the family decision of exclusive oral feeding. This longitudinal study revealed that the progression of neuromotor damage was not directly related to dysphagia development. This case series demonstrates the importance of follow-up settings with instrumental swallowing evaluations and careful consideration of early palliative care for HD patients.

Keywords

Deglutition Disorders; Huntington Disease; Rehabilitation; Neurodegenerative Diseases

Referências

1. Podvin S, Reardon HT, Yin K, Mosier C, Hook V. Multiple clinical features of Huntington's disease correlate with mutant HTT gene CAG repeat lengths and neurodegeneration. J Neurol. 2019;266(3):551-64. https://doi.org/10.1007/s00415-018-8940-6 PMID: 29956026.

2. Fisher ER, Hayden MR. Multisource ascertainment of Huntington disease in Canada: Prevalence and population at risk. Mov Disord. 2014;29(1):105-14. https://doi.org/10.1002/mds.25717 PMID: 24151181.

3. Tabrizi SJ, Schobel S, Gantman EC, Mansbach A, Borowsky B, Konstantinova P et al. A biological classification of Huntington's disease: The Integrated Staging System. Lancet Neurol. 2022;21(7):632-44. https://doi.org/10.1016/S1474-4422(22)00120-X PMID: 35716693.

4. Bates GP, Dorsey R, Gusella JF, Hayden MR, Kay C, Leavitt BR et al. Huntington disease. Nat Rev Dis Primers. 2015;1(1):1-21. https://doi.org/10.1038/nrdp.2015.5 PMID: 27188817.

5. Gusella JF, Lee JM, MacDonald ME. Huntington's disease: Nearly four decades of human molecular genetics. Hum Mol Genet. 2021;30(R2):R254-R263. https://doi.org/10.1093/hmg/ddab170 PMID: 34169318.

6. Schumann-Werner B, Dogan I, Mirzazade S, Mall B, Overbeck R, Honrath P et al. Clinical predictors and neural correlates for compromised swallowing safety in Huntington disease. Eur J Neurol. 2021;28(9):2855-62. https://doi.org/10.1111/ene.14953 PMID: 34077591.

7. Hamilton A, Heemskerk AW, Loucas M, Twiston-Davies R, Matheson KY, Simpson SA et al. Oral feeding in Huntington's disease: A guideline document for speech and language therapists. Neurodegenerative Disease Management. 2012;2(1):45-53. https://doi.org/10.2217/nmt.11.77

8. Heemskerk AW, Roos RAC. Dysphagia in Huntington's disease: A review. Dysphagia. 2011;26(1):62-6. https://doi.org/10.1007/s00455-010-9302-4 PMID: 20838817.

9. de Tommaso M, Nuzzi A, Dellomonaco AR, Sciruicchio V, Serpino C, Cormio C et al. Dysphagia in Huntington's disease: Correlation with clinical features. Eur Neurol. 2015;74(1-2):49-53. https://doi.org/10.1159/000435833 PMID: 26183666.

10. Cichero JAY, Lam P, Steele CM, Hanson B, Chen J, Dantas RO et al. Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: The IDDSI framework. Dysphagia. 2017;32(2):293-314. https://doi.org/10.1007/s00455-016-9758-y PMID: 27913916.

11. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93-8. https://doi.org/10.1007/BF00417897 PMID: 8721066.

12. Crary MA, Mann GDC, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med and Rehabil. 2005;86(8):1516-20. https://doi.org/10.1016/j.apmr.2004.11.049 PMID: 16084801.

13. O'Neil KH, Purdy M, Falk J, Gallo L. The Dysphagia Outcome and Severity Scale. Dysphagia. 1999;14(3):139-45. https://doi.org/10.1007/PL00009595 PMID: 10341109.

14. Aziz NA, Anguelova GV, Marinus J, Van Dijk JG, Roos RAC. Autonomic symptoms in patients and pre-manifest mutation carriers of Huntington's disease. Eur J Neurol. 2010;17(8):1068-74. https://doi.org/10.1111/j.1468-1331.2010.02973.x PMID: 20192977.

15. Estevez-Fraga C, Flower MD, Tabrizi SJ. Therapeutic strategies for Huntington's disease. Curr Opin in Neurol. 2020;33(4):508. https://doi.org/10.1097/WCO.0000000000000835 PMID: 32657893.

16. Heemskerk AW. H1 Dysphagia in Huntington's disease: Symptoms and a patient perspective. Journal of Neurology, Neurosurgery & Psychiatry. 2016;87(Suppl 1): A56-A57. https://doi.org/10.1007/s12603-022-1743-6

17. Heemskerk AW, Roos RAC. Aspiration pneumonia and death in Huntington's disease. PLoS Curr. 2012;4:RRN1293. https://doi.org/10.1371/currents.RRN1293 PMID: 22307361.

18. Kindell J. Feeding and swallowing disorders in dementia. London: Routledge; 2017. https://doi.org/10.4324/9781315170947

19. Aldaz T, Nigro P, Sánchez-Gómez A, Painous C, Planellas L, Santacruz P et al. Non-motor symptoms in Huntington's disease: A comparative study with Parkinson's disease. J Neurol. 2019;266(6):1340-50. https://doi.org/10.1016/j.parkreldis.2020.10.003 PMID: 30834978.

20. Traynor V. Feeding and swallowing disorders in dementia Jacqueline Kindell feeding and swallowing disorders in dementia Speechmark. Nurs Older People. 2002;14(7):34. https://doi.org/10.7748/nop.14.7.34.s18 PMID: 27316734.

21. Boersema-Wijma DJ, van Duijn E, Heemskerk AW, van der Steen JT, Achterberg WP. Palliative care in advanced Huntington's disease: A scoping review. BMC Palliat Care. 2023;22(1):54. https://doi.org/10.1186/s12904-023-01171-y PMID: 37138329.
 

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