Document Type
Article
Publication Date
5-19-2023
Publication Title
Annals of Clinical and Transitional Neurology
ISSN
2328-9503
Volume
10
Issue/No.
8
First Page
1296
Last Page
1304
Abstract
OBJECTIVE: No efficacious treatments exist to improve or prolong bulbar functions of speech and swallowing in persons with amyotrophic lateral sclerosis (pALS). This study evaluated the short-term impact of dextromethorphan/quinidine (DMQ) treatment on speech and swallowing function in pALS.
METHODS: This was a cohort trial conducted between August 2019 to August 2021 in pALS with a confirmed diagnosis of probable-definite ALS (El-Escorial Criteria-revisited) and bulbar impairment (ALS Functional Rating Scale score ≤ 10 and speaking rate ≤ 140 words per minute) who were DMQ naïve. Efficacy of DMQ was assessed via pre-post change in the ALS Functional Rating Scale-Revised bulbar subscale and validated speech and swallowing outcomes. Paired t-tests, Fisher's exact, and χ
RESULTS: Twenty-eight pALS enrolled, and 24 participants completed the 28-day trial of DMQ. A significant increase in ALSFRS-R bulbar subscale score pre- (7.47 ± 1.98) to post- (8.39 ± 1.79) treatment was observed (mean difference: 0.92, 95% CI: 0.46-1.36, p < 0.001). Functional swallowing outcomes improved, with a reduction in unsafe (75% vs. 44%, p = 0.003) and inefficient swallowing (67% vs. 58%, p = 0.002); the relative speech event duration in a standard reading passage increased, indicating a greater duration of uninterrupted speech (mean difference: 0.33 s, 95% CI: 0.02-0.65, p = 0.035). No differences in diadochokinetic rate or speech intelligibility were observed (p > 0.05).
INTERPRETATION: Results of this study provide preliminary evidence that DMQ pharmacologic intervention may have the potential to improve or maintain bulbar function in pALS.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
NSUWorks Citation
Tabor Gray, Lauren; Locatelli, Eduardo; Vasilopoulos, Terrie; Wymer, James; and Plowman, Emily K., "Dextromethorphan/quinidine for the treatment of bulbar impairment in amyotrophic lateral sclerosis." (2023). HPD Articles. 493.
https://nsuworks.nova.edu/hpd_facarticles/493
ORCID ID
DOI
10.1002/acn3.51821
Copyright
ª 2023 The Authors.
Comments
Acknowledgments Thank you to the pALS and their caregivers for participating in the study and to the ALS Association for awarding the Clinical Management Grant to complete this study