Evaluation of Neurological Therapy in a Patient with Ataxic-Spastic Dysarthria and Neurogenic Dysphagia in the Course of Multiple Sclerosis

Abstract

Introduction. Multiple sclerosis, in which there is continuous Central Nervous System damage due to chronic demyelination, is one of the most common causes of neurogenic dysphagia. Failure to adequately manage patients with dysphagia and weakness of the muscles responsible for swallowing can lead to aspiration of food or liquids into the airways, resulting in aspiration pneumonia.

Aim. This study aimed to evaluate neurological therapy in a patient with ataxic-spastic dysarthria and neurogenic dysphagia in the course of multiple sclerosis. In dysphagia therapy, the priority was to improve soft palate and upper esophageal sphincter function.

Case Report. The patient, aged 52, has suffered from Multiple Sclerosis for 28 years. Neurogenic dysphagia — EAT-10 test score =16 points and DYMUS test score =9 points. Poor oral control with leakage of saliva and fluids into the throat before triggering the swallowing reflex. Periodic nasal leakage during drinking due to soft palate dysfunction and velopharyngeal insufficiency. Incidental coughing and choking after swallowing solid foods due to delayed swallowing reflex. Sensation of throat obstruction and pain during swallowing and the need to swallow a bite several times due to soft palate dysfunction and upper esophageal sphincter opening disorders. In realisation speech, there are disorders of mixed dysarthria (ataxic-spastic), as well as the so-called scanning and explosive speech (irregular symptoms).

Discussion. The knowledge and skills acquired to manage swallowing disorders and dysarthria have enabled the patients to restore, as far as possible, the physiological conditions of swallowing and word formation. Early recognition of dysphagia and dysarthria in multiple sclerosis enables the implementation of therapy to improve primary functions and articulation of sounds, which not only affects the patients’ quality of life, but also minimises the risk of disorder-related complications.

Conclusions. As a result of therapy, there has been an improvement in mouth and cheek muscle tone, oral movements and tactile and thermal sensation. During a repeat breathing test, the average phonation time in three attempts was close to the lower limit of normal at 19 seconds (4 seconds more). There has been a lengthening of the inspiratory and expiratory phases and phonation time, as well as an improvement in the coordination of the speech and breathing apparatus. With work on melody and accent, an improvement in prosody has been noted as well. (JNNN 2025;14(2):91–100)