title: High-dose intravenous steroid regimen for radiation-induced hypoglossal nerve palsy.
abstract: Hypoglossal nerve palsies are infrequent complications of head and neck radiotherapy. Treatments focus on maintaining function and prevention of abnormal airway-related swallowing events.
  
  
  
  A patient with longstanding cranial neuropathies, including bilateral hypoglossal involvement, secondary to chemoradiotherapy for nasopharyngeal carcinoma, experienced repeated episodes of life-threatening complications. Initially, 2 courses of 2 weekly 24-hour intravenous methylprednisolone (IVMP) infusions were administered 2 years apart. We report the results of a third course comprising 5 weekly cycles.
  
  
  
  Patient-reported outcomes revealed significant improvement in swallowing function, speech, and psychosocial status. Airway invasion during swallowing and pharyngeal retention were assessed videofluoroscopically and evaluated using the Penetration-Aspiration Scale (PAS) and a residue rating scale, respectively. PAS ratings after infusions 2 and 5, improved dramatically from baseline and were maintained at 1-year follow-up.
  
  
  
  High doses of IVMP may improve radiation-induced neuropathies. Further testing in similar patients is needed to prove reproducibility. © 2016 Wiley Periodicals, Inc. Head Neck 39: E23-E28, 2017.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lachlan J
authors.initials: LJ
authors.lastname: McDowell
authors.affiliation: Department of Speech-Language Pathology, Oncology Program, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Marlene C
authors.initials: MC
authors.lastname: Jacobson
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Wilfred
authors.initials: W
authors.lastname: Levin
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000175:diagnosis / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000379:methods; D003679:Deglutition / Q000187:drug effects; D003680:Deglutition Disorders / Q000188:drug therapy / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D006801:Humans; D020437:Hypoglossal Nerve Diseases / Q000188:drug therapy* / Q000209:etiology; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D011832:Radiation Injuries / Q000175:diagnosis / Q000188:drug therapy*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D019233:Retreatment; D013065:Speech Intelligibility / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D008775:Methylprednisolone
keywords: deglutition; hypoglossal nerve diseases; radiotherapy; speech; survivorship