From the Guidelines
Swallowing problems, or dysphagia, are primarily caused by neurological disorders such as stroke, Parkinson's disease, multiple sclerosis, and ALS, which impair nerve signals controlling swallowing muscles, as well as by structural issues and age-related muscle weakening. The most recent and highest quality study, 1, published in 2025, highlights the importance of addressing dysphagia in stroke patients, emphasizing that unmitigated poststroke dysphagia may cause malnutrition, dehydration, infection, and death. Key factors contributing to dysphagia include:
- Neurological disorders affecting nerve signals
- Structural issues physically obstructing the passage of food
- Age-related muscle weakening
- Dental problems
- Certain medications causing dry mouth Treatment depends on the underlying cause and may include swallowing therapy exercises, dietary modifications, medications to reduce acid reflux, or surgery for structural problems. It is crucial to seek medical attention promptly if experiencing persistent swallowing problems to prevent complications like malnutrition, dehydration, or aspiration pneumonia, as proper swallowing requires coordinated action of over 50 pairs of muscles and nerves, and disruption at any point can result in dysphagia, as noted in 1 and 1. Additionally, evidence from 1 and 1 supports the use of specific interventions such as chin tuck against resistance and respiratory muscle strength training to improve oropharyngeal swallow function and reduce aspiration in patients with poststroke dysphagia. Overall, the management of dysphagia should be tailored to the individual patient's needs, taking into account the underlying cause and the potential risks and benefits of different treatment options, as discussed in 1 and 1.
From the FDA Drug Label
Treatment with botulinum toxin products, including JEUVEAU, can result in swallowing or breathing difficulties. Patients with preexisting swallowing or breathing difficulties may be more susceptible to these complications In most cases, this has been a consequence of weakening of muscles in the area of injection that are involved in breathing or oropharyngeal muscles that control swallowing or breathing Dysphagia may persist for several months, and require use of a feeding tube to maintain adequate nutrition and hydration. Aspiration may result from severe dysphagia and is a particular risk when treating patients in whom swallowing or respiratory function is already compromised
Causes of swallowing problems include:
- Weakening of muscles in the area of injection involved in breathing or oropharyngeal muscles that control swallowing or breathing
- Pre-existing swallowing or breathing difficulties
- Treatment with botulinum toxin products, including JEUVEAU 2
From the Research
Causes of Swallowing Problems
- Neurological disorders, such as stroke, Parkinson's disease, and dementia, can cause swallowing problems, also known as dysphagia 3, 4, 5
- Traumatic brain injury, chronic obstructive pulmonary disease, head and neck cancer, and cervical spine injury can also lead to dysphagia 4
- Multiple sclerosis is another condition that can cause dysphagia, with swallowing disturbances present at all stages of the disease 6
- Parkinson's disease is a common cause of dysphagia, with more than 80% of patients developing swallowing problems during the course of their disease 7
Pathophysiology of Dysphagia
- Dysphagia is often caused by a disruption of the sophisticated, integrated sensorimotor swallowing system 3
- The pathophysiology of dysphagia in multiple sclerosis is likely due to a combination of factors, including the involvement of corticobulbar tracts, the cerebellum, and the brainstem 6
- In Parkinson's disease, dopaminergic and non-dopaminergic mechanisms are involved in the development of dysphagia 7
Symptoms and Complications of Dysphagia
- Symptoms of dysphagia include difficulty initiating swallowing, nasal regurgitation, difficulty managing secretions, choke/cough episodes while feeding, and food sticking in the throat 5
- Dysphagia can lead to malnutrition, dehydration, aspiration pneumonia, and airway obstruction 4
- If left untreated, dysphagia can result in significant morbidity and mortality, particularly in patients with underlying neurological disorders 3, 5