臨床神経学

<シンポジウム22―3>難治性嚥下障害に対する治療戦略

筋萎縮性側索硬化症,パーキンソン病に対する嚥下障害の評価と対策

山本 敏之

国立精神・神経医療研究センター病院神経内科〔〒187―8551 東京都小平市小川東町4―1―1〕

As both amyotrophic lateral sclerosis (ALS) and Parkinson's disease (PD) exhibit a variety of patterns of dysphagia, appropriate symptomatic treatment is provided after evaluation of swallowing function through videofluoroscopic examination of swallowing. In ALS, disease progression is rapid, therefore, respiratory function, swallowing function and nutritional status should be evaluated regularly. When the oral or pharyngeal stage of swallowing are affected early in dysphagia, adjusting swallowing volume and varying consistency can be beneficial in ALS. When all stages of swallowing are impaired in ALS, such complications as pneumonia, dehydration and malnutrition, are observed. In such patients, it is necessary to consider an alternative to oral dietary intake. In PD, dysphagia is not necessarily associated with severity of parkinsonism and can appear at any time during the course of the disease. Dysphagia in PD can occur at any stage of swallowing and frequently accompanies multiple abnormalities. In particular, aspiration is an important risk factor for pneumonia in PD. The effect of L-dopa treatment for dysphagia is often insufficient; however, this treatment remains the first choice because dysphagia is exacerbated during off state. Rehabilitation for dysphagia in PD has also some effect.
Full Text of this Article in Japanese PDF (284K)

(臨床神経, 51:1072−1074, 2011)
key words:筋萎縮性側索硬化症,パーキンソン病,嚥下障害,嚥下造影検査

(受付日:2011年5月20日)