Guideline of the German Society for Nutritional Medicine (DGEM) in cooperation with the GESKES, the AKE, the DGN and the DGGE81

Purpose: Neurologic diseases can lead to swallowing disorders. This may cause aspiration during oral intake of food and fluid and involves a higher risk for malnutrition. The present guideline is supposed to give evidence-based recommendations for clinical nutrition in neurology. Acute stroke, Parkinson's disease, Chorea Huntington and Multiple Sclerosis were chosen because here nutrition can become an import issue. Methods: A systematic literature search about nutrition and the mentioned disease patterns was conducted. The results were discussed in an interdisciplinary working group that consisted of neurologists and physicians with expertise for nutritional medicine. On this basis the working group developed recommendations, which were presented, discussed and partly modified at the consensus conference on September 14th, 2011. The revised form of these recommendations was passed at a second consensus conference on June 16th, 2012. Results: The guideline includes 75 recommendations for patients with neurologic diseases. If the existing disease leads to dysphagia, screening and assessment of dysphagia should be performed early. Nutritional intervention has to be adapted according to medical findings. This ranges from texture modification and tube feeding to necessity for parenteral nutrition. Patients with Morbus Parkinson and Chorea Huntington have a higher risk for malnutrition already in early stages of disease. Regular screening, assessment and, if needed, nutritional interventions are recommended to avoid malnutrition. When using L-Dopa-containing medication the interactions with food proteins have to be taken into account. There is no adequate scientific evidence for the application of specific diets or nutritional supplements in Multiple Sclerosis, therefore such interventions cannot be recommended in general. Conclusion: Nutrition for patients with neurologic diseases can be optimized by early screening and assessment of dysphagia and malnutrition. The texture modification of food and drinks, oral nutritional supplements, nutrition through a nasogastric tube, PEG tube, PEJ tube and parenteral nutrition are possible nutritional medical interventions. All indicated interventions shoud be introduced early.