Schlaganfallbedingte Dysphagie – Epidemiologie, Pathophysiologie, Diagnostik und Therapie

 

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Zusammenfassung

Der Schluckakt wird in einem komplexen Zusammenspiel verschiedener Hirnregionen sowohl auf Ebene des Hirnstamms als auch des Großhirns koordiniert. Dementsprechend können Schlaganfälle unterschiedlichster Lokalisationen Schluckstörungen hervorrufen. Bei konsequenter Diagnostik zeigt sich bei bis zu 80 % dieser Patienten eine Einschränkung des Schluckvermögens. Bei ca. 10 – 25 % der Patienten entwickelt sich ein chronisches Störungsbild. Neben einer Beeinträchtigung der Nahrungsaufnahme mit den möglichen Konsequenzen einer Dehydratation und Malnutrition sind die Betroffenen insbesondere von Aspirationspneumonien und von einer signifikant höheren Sterblichkeitsrate bedroht. Einer frühzeitigen klinischen Detektion mit Unterstützung moderner Dysphagiediagnostik, ergänzt durch ein standardisiertes Dysphagiemanagement, kommt daher eine entscheidende Bedeutung zu. Neben einem Aspirationsscreening und einer klinischen Schluckuntersuchung kommen dabei apparative Methoden, wie die Fieberendoskopische Evaluation des Schluckakts (FEES), zum Einsatz. Diese Methoden ermöglichen dem behandelnden multiprofessionellen Team den Pathomechanismus der Schluckstörung zu analysieren, selbst gering ausgeprägte Aspirationen und Risikokonstellationen zu detektieren und einen individualisierten Therapieplan zu entwickeln. Neben etablierten Verfahren wie der Ernährungsmodifikation und der intensivierten logopädischen Therapie werden derzeit verschiedene Verfahren der nicht invasiven Neurostimulation intensiv untersucht.

Abstract

The act of swallowing is coordinated through a complex interface of different brain regions both at the level of the brainstem as well as the cerebrum. Accordingly strokes of different localizations can cause swallowing disorders. Evident results show that up to 80 % of these patients portray a reduction of ability to swallow. A chronic dysfunction is found in approximately 10 – 25 % of these patients. In addition to impaired food intake with the possible consequences of dehydration and malnutrition, those patients are particularly at risk of aspiration pneumonia and a significantly higher mortality rate. An early clinical examination with the support of modern dysphagia diagnostic, supplemented by a standardized dysphagia management, is therefore of crucial importance. In addition to aspiration screening and clinical swallowing examination, the use of apparatus methods like Fibreoptic Endoscopic Evaluation of Swallowing (FEES) plays an important role. These methods allow the therapeutic multi-professional team to analyze the pathogenic mechanism of swallowing disorder, it even enables the detection of small distinct aspirations and to develop an individualized treatment plan for each patient. In addition to established methods, such as diet modification and speech therapy, the use of various non-invasive neurostimulation is currently intensively investigated.

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