From the Guidelines
The treatment of bulbar palsy should focus on a multidisciplinary approach, including speech therapy, nutritional support, and respiratory care, with the goal of managing symptoms and improving quality of life, as recommended by the most recent and highest quality study 1.
Treatment Approach
The treatment of bulbar palsy involves a comprehensive approach that addresses the underlying cause of the condition, as well as its symptoms. This includes:
- Speech therapy to improve communication and swallowing techniques, with specific exercises tailored to strengthen remaining functional muscles 1
- Nutritional support, often requiring dietary modifications to softer foods or thickened liquids, and in severe cases, feeding tubes (nasogastric or percutaneous endoscopic gastrostomy) may be necessary to prevent aspiration and maintain adequate nutrition 2
- Respiratory support, which may include noninvasive ventilation such as BiPAP for sleep-related breathing issues, or in advanced cases, tracheostomy and mechanical ventilation ### Medications and Symptomatic Treatments Medications are prescribed based on the underlying cause of bulbar palsy, such as:
- Immunossuppressants for myasthenia gravis
- Riluzole (50 mg twice daily) for amyotrophic lateral sclerosis to slow disease progression
- Antibiotics for infectious causes Symptomatic treatments include:
- Anticholinergics like glycopyrrolate (1-2 mg three times daily) for excessive secretions
- Pain management as needed ### Multidisciplinary Care A multidisciplinary team, including nurses, physiotherapists, rehabilitation specialists, occupational therapists, speech therapists, and dietitians, is essential for adequate management of complications and improvement of quality of life, as highlighted in the study by 3.
Prognosis and Follow-up
The prognosis varies significantly depending on the underlying cause of bulbar palsy, with some conditions being treatable and others progressive. Regular follow-up with neurologists and other specialists is crucial to monitor disease progression and adjust treatment plans accordingly.
From the Research
Treatment of Bulbar Palsy
The treatment of bulbar palsy involves a multidisciplinary approach, including symptomatic treatment to prevent complications and improve quality of life 4. The following are some key aspects of treatment:
- Symptomatic treatment: This includes management of dysarthria, dysphagia, sialorrhea, and pseudobulbar affective disorder 4.
- Multidisciplinary approach: A team of specialists, including speech-language pathologists, neurologists, otolaryngologists, augmentative alternative communication specialists, dieticians, and electrophysiologists, work together to assess and manage bulbar dysfunction 5.
- Assessment tools: Various clinical tools are used to assess and monitor bulbar dysfunction, including speech, swallowing, and augmentative alternative communication evaluations 5.
- Best practices guidelines: Provisional best practices guidelines have been developed for the evaluation of bulbar dysfunction in amyotrophic lateral sclerosis, including recommendations for speech, augmentative and alternative communication, and swallowing sections 6.
- Medications: Riluzole is a medication that has been shown to slow the course of amyotrophic lateral sclerosis and extend survival, and may be used in the treatment of bulbar palsy 7.
- Management of dysphagia: In children with isolated bulbar palsy, management of dysphagia may include thickened fluids, cooled boiled water, and nasogastric tube feeding 8.