[Dysphagia] MELAS

[mbhauser at velocity.net (Mary Hauser)]

I am writing for one of my school-based SLP friends.  (Sorry for the length)

She has been having many neurological symptoms since last April, which  have increased dramatically since November.  Some symptoms have included sudden weakness on left side, numbness and tingling, eye twitching,  and now dysphagia symptoms (will describe later). This resolves after a few hours, but her legs still feel weak and "heavy" and her arm feels numb at times. 

She has been going through numerous Dr. visits/tests and they have a "possible" diagnosis of "MELAS":  mitochondrial encephalomyopathy with lactic acidosis, and stroke-like Syndrome.  But  they have not ruled out MS, Sjogren's (sp) or something else unknown as yet.  I checked out MELAS, and it doesn't sound like something you'd want to develop, and the prognosis is poor. There was no mention of dysphagia as symptoms. 

She is 55 years of age, slightly overweight, and less than 5 feet tall.   She takes lotensin for high blood pressure and synthroid for multinodual goiter. ( All blood tests show thyroid levels are WNL. ) She uses a CPAP at night for sleep apnea.

Dysphagia symptoms  (intermittent and can start mid-meal): 
Throat, back of tongue, tongue base, and velum will start to  "thighten" "ache" and "feel tired" making swallowing very difficult.  She does not feel food sticking at laryngeal level or lower. But it is difficult for her to manipulate the bolus and start to swallow. It happens with all textures, and even some liquids.   In addition, her mouth is usually dry, until she eats then she has excess saliva and starts to drool on her left side of her mouth.  

 She states that she has always had some difficulty swallowing things like pills and says she has "excessive" tissue in her pharynx including large tonsils, uvula and a big tongue  ( I didn't look). 

I suggested small bites, alternate with liquids,  & trying lemon ice to help with the sticking.  But since I've never come across MELAS or simlar symptoms, I'm not sure this is the best for her. 

Has anyone had a patient with MELAS, or similar symptoms?  Is there something else I can do to help her?

Thanks!
mary