Electrophysiological patterns of oropharyngeal swallowing in multiple sclerosis E. Alfonsi a,⇑ , R. Bergamaschi b , G. Cosentino c , M. Ponzio d , C. Montomoli d , D.A. Restivo f , F. Brighina c , S. Ravaglia a , P. Prunetti a , G. Bertino e , M. Benazzo e , D. Fontana a , A. Moglia a a Department of Neurophysiopathology, C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy b Multiple Sclerosis Center, C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy c Department of Biomedicine and Clinical Neuroscience (BioNeC), University of Palermo, Italy d Biostatistics and Clinical Epidemiology Section, Department of Public Health, Neuroscience, Experimental and Forensic Medicine, University of Pavia, Italy e Department of Otolaryngology, S. Matteo Hospital, IRCCS, Pavia, Italy f Department of Neurology, Garibaldi Hospital, Catania, Italy article info Article history: Accepted 10 March 2013 Available online 16 April 2013 Keywords: Dysphagia Swallowing Electromyography Multiple sclerosis highlights  Electrophysiological abnormalities of oropharyngeal swallowing are very frequent in MS, and often occur in patients without clinical symptoms of dysphagia.  Prolongation of suprahyoid/submental muscle EMG activity and increase of the interval between onset of this activity and onset of the laryngeal–pharyngeal mechanogram during oropharyngeal swallowing seem to be markers of dysphagia in multiple sclerosis.  The most marked electrophysiological abnormalities of oropharyngeal swallowing are found in sec- ondary progressive multiple sclerosis. abstract Objective: We performed an electrophysiological study of swallowing (EPSS) in multiple sclerosis (MS) to describe oropharyngeal swallowing abnormalities and to analyze their correlations with dysphagia and with overall neurological impairment. Methods: Neurological examinations were quantified using the Kurtzke Functional Systems and the Expanded Disability Status Scale (EDSS). Dysphagia was evaluated using the Dysphagia in Multiple Sclerosis (DYMUS) questionnaire, while fiberoptic endoscopic evaluation of swallowing (FEES) was used to establish the degree of aspiration and penetration, graded using the penetration–aspiration scale (PAS). The EPSS measured the duration of suprahyoid/submental muscle EMG activity (SHEMG-D), the duration of the laryngeal–pharyngeal mechanogram (LPM-D), and the duration of the pause in cricopharyngeal muscle EMG activity (CPEMG-PD); it also measured the interval between onset of the suprahyoid/submental muscle EMG activity (SHEMG) and onset of the laryngeal–pharyngeal mechano- gram(I-SHEMG-LPM). Results: 92% of patients showed at least one electrophysiological abnormality. I-SHEMG-LPM correlated positively with the DYMUS questionnaire. I-SHEMG-LPM, SHEMG-D, and DYMUS correlated positively with the PAS. Moderate to severe bladder sphincter dysfunction was associated with a significant reduction, or absence, of CPEMG-PD. Conclusion: EPSS improves our understanding of the pathophysiology of dysphagia in MS. Significance: This investigation could be useful in MS patients with swallowing abnormalities. Ó 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved. 1388-2457/$36.00 Ó 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.clinph.2013.03.003 Abbreviations: EPSS, electrophysiological study of swallowing; MS, multiple sclerosis; EDSS, Expanded Disability Status Scale; DYMUS, Dysphagia in Multiple Sclerosis; FEES, fiberoptic endoscopic evaluation of swallowing; SHEMG, suprahyoid/submental muscle EMG activity; SHEMG-D, duration of suprahyoid/submental muscle EMG activity; LPM-D, duration of the laryngeal–pharyngeal mechanogram; CP, cricopharyngeal; CPEMG-PD, duration of the pause in cricopharyngeal muscle EMG activity; I- SHEMG-LPM, interval between onset of suprahyoid/submental muscle EMG activity and onset of the laryngeal–pharyngeal mechanogram; UES, upper esophageal sphincter; PAS, penetration–aspiration scale; VFS, videofluoroscopy. ⇑ Corresponding author. Address: C. Mondino National Institute of Neurology Foundation, IRCCS, Via Mondino n. 2, 27100 Pavia, Italy. Tel.: +39 0382 380434; fax: +39 0382 380286. E-mail address: enrico.alfonsi@mondino.it (E. Alfonsi). Clinical Neurophysiology 124 (2013) 1638–1645 Contents lists available at SciVerse ScienceDirect Clinical Neurophysiology journal homepage: www.elsevier.com/locate/clinph