Neurologic Disorders, Stroke, Dysphagia

Good nutrition supports the health of the Central Nervous System (CNS) which includes the brain and spinal cord, as well as the Peripheral Nervous System (PNS), the nerves that extend from the spinal cord to the rest of the body.

The nutritional management of the patient with ND (Neurologic Disorders) is complex.

Neurologic diseases of nutritional origin include Pellagra, Pernicious Anaemia, wet Beri-beri, Cretinism and more.

Nutritional considerations are published for many ND, including Guillain-Barre syndrome, Migraine headaches, Multiple sclerosis, spinal cord injury and trauma,  stroke or CVA ( cerebrovascular accident), Wernicke-Korsakoff syndrome, Parkinsons disease and epilepsy.  Neurologic impairments often compromise the mechanisms and cognitive abilities needed for adequate nourishment.

• DYSPHAGIA is associated with many Neurologic Disorders.

Weight loss, dehydration, and anorexia are key concerns with dysphagia.

Active coordination with speech – swallow therapists is important for the dietitian to adjust and improve the patient’s nutritional quality of life. Texture modifications, including fluid modification, dysphagia puree, mechanically altered or selection of advanced (soft  solids), is essential, and nutrient content and density, to fulfil the patient’s requirements is most important.

Aspiration precautions should be maintained in all patients with dysphagia.

• Neurologic Disorder from Trauma includes cerebrovascular accidents (CVA) or stroke.Lifestyle behaviour changes that include diet, are key components to primary prevention of stroke.  The landmark PREDIMED randomized controlled trial showed how a Mediterranean diet supplemented with tree nuts, fish, legumes, fresh fruit and vegetables and olive oil  reduced the incidence of stroke.
• In Head Trauma or Traumatic Brain Injury the intersection with nutrition is complex, and adequate evidence does not exist about best nutritional support.  However the updated Brain Trauma Foundation guidelines (Carney et al 2017) recommend amongst other suggestions, that transgastric jejunal feeding is preferred to reduce the incidence of ventilation-associated pneumonia.
• Neurologic Diseases may include:
• • Dementia and Alzheimer’s disease (see section Psychiatric and Cognitive Disorders)
  • Epilepsy

The classic ketogenic diet , in existence since the 1920’s,  is a well established treatment for epilepsy. The diet is very restrictive and require continued effort, but has been found to reduce seizure frequency by +-50% in about half of the patients. The majority of the diet is composed of fresh meat, eggs, cheese, fish, butter, oil, nuts and seeds. Fresh fruit and vegetables are limited, and multiple vitamin and mineral supplementation is  needed.

• Wernicke-Korsakoff syndrome requires not only total elimination of alcohol, but also thiamine rich foods and supplementation.
• Guillain Barre Syndrome is a rare auto immune disorder that damages the nerves, causing muscle weakness and in severe cases, paralysis. Chest muscles may be affected in 30% of cases, making it difficult to breathe, which could be life threatening, and requires hospitalization. Nasogastric feeding may be required. During the acute stage, metabolic demands may be as high as 40-45kcal/kg, and the patient requires skilled medical nutrition intervention, by an experienced dietitian.
• Multiple Sclerosis is a chronic inflammatory disorder of the CNS. The precise cause remains undetermined. Growing evidence indicates that higher sunlight exposure, and therefore vitamin D production, reduces the risk, as well as a lower saturated fat diet, but smoking, high-salt diet, and obesity in childhood may increase risk.
• Parkinson’s disease is a progressive neurodegenerative disease. The primary focus of nutrition intervention is to optimize dietary intake, particularly to maintain muscle mass for strength.