Treatment approach and outcomes to severe and chronic dysphagia in lateral medullary syndrome: A case series.

Introduction: Dysphagia is more profound in lateral medullary syndrome (LMS) patients. LMS patients are susceptible to be dependent on tube feeding for months to years post stroke. The objectives of this study are to characterize and understand the extent of functional impairment in the swallowing phases, to strategize the noninvasive methods as per the deficits present, and to document swallowing outcomes of severe and chronic dysphagia following rehabilitation in patients with LMS.

Materials and methods: This is an ambispective observational study on chronic LMS (≥1 year) patients with complete dependency on tube feeding. Dysphagia was assessed with clinical bedside swallowing examination and video fluoroscopy swallowing study (VFSS), penetration-aspiration scale (PAS), dysphagia severity rating scale (DSRS), bolus residue scale (BRS), and functional oral intake scale (FOIS).

Results: Six patients were included in our study for the final analysis. Initial VFSS was done at FOIS level 1 and a DSRS score of 12. The BRS and PAS score of all patients at this stage was 6. The second VFSS was done when patients achieved FOIS level ≥2 and a DSRS score of ≤10. At this stage, BRS was 4 ± 0.8, while PAS improved to 4 at the interval of 8 ± 3 weeks following rehabilitation. Final VFSS was performed at FOIS level ≥4 and DSRS ≤3. BRS and PAS at this stage were ≤2. This was achieved in 20.8 ± 8.3 weeks from the onset of rehabilitation.

Conclusion: Chronic and severe dysphagia in LMS has a favorable recovery prospects. In our study, patients resumed complete oral feeding following dysphagia rehabilitation.