Abstract
Background Pharyngeal dysphagia is a common symptom of Parkinson's disease (PD) leading to severe complications. PD-related pharyngeal dysphagia (PDrPD) may significantly improve in up to half of patients following acute oral levodopa challenge. Objective The aim of this study was to investigate the effects of levodopa-carbidopa intestinal gel (LCIG) on PDrPD. Methods Forty-five PD patients under LCIG treatment were available for retrospective analysis. In all patients with PDrPD who underwent flexible endoscopic evaluation of swallowing (FEES) in the clinical “on-state” both before and after implementation of LCIG treatment, FEES videos were systematically reassessed. PDrPD was characterized using a PD-specific FEES score evaluating premature bolus spillage, penetration/aspiration, and pharyngeal residue. Further, the duration of white-out was assessed, as a parameter for pharyngeal bradykinesia. Results Eleven patients with PDrPD (mean age 74.6 ± 4.4 years; mean Hoehn and Yahr stage 3.8 ± 0.6) received FEES both before and after the onset of LCIG treatment. The mean swallowing score improved from 14.9 ± 7.3 to 13.0 ± 6.9 after implementation of LCIG; however, this difference was not significant (p=0.312). Premature bolus spillage decreased significantly (p=0.002) from 5.4 ± 1.1 to 3.6 ± 1.0, and white-out duration decreased significantly (p=0.002) from 984 ± 228 ms to 699 ± 131 ms after implementation of LCIG. Conclusions LCIG may affect PDrPD and reduce premature bolus spillage and pharyngeal bradykinesia. Future studies with larger sample sizes are required to follow-up on these pilot results and identify which factors predict a good response of PDrPD to LCIG treatment.
Highlights
In the advanced stage of Parkinson’s disease (PD), about 40% of patients experience motor fluctuations [1]
Descriptive statistics of the flexible endoscopic evaluation of swallowing (FEES)-L-dopascore and its subdomains, white-out duration, levodopa equivalent daily dose (LEDD), Hoehn and Yahr scale, and functional oral intake score (FOIS) scale as well as the p value for comparison before and after beginning of levodopa-carbidopa intestinal gel (LCIG) are shown in Table 2. e mean FEES-L-dopa score was lower after starting the LCIG therapy compared to before the treatment (14.9 vs. 13.0), but this difference was not statistically significant (p 0.312, t 1.066)
Previous studies with instrumental evaluation have shown that PDrelated pharyngeal dysphagia (PDrPD) may be partly L-dopa responsive by comparing the “on-state” swallowing function after acute levodopa challenge with the “off-state” condition [10, 21]. e results of our study support the finding of an uncontrolled observational study in which up to 60% of PD patients subjectively experienced an improvement of swallowing function and dysphagia during LCIG therapy. [22]
Summary
In the advanced stage of Parkinson’s disease (PD), about 40% of patients experience motor fluctuations [1]. Pharyngeal dysphagia is frequent in patients with PD [7] and causes severe complications in the advanced stage of the disease such as aspiration pneumonia, which is a leading cause of death in this population [8]. PDrelated pharyngeal dysphagia (PDrPD) may significantly improve in up to half of patients following acute oral levodopa challenge. PDrPD was characterized using a PD-specific FEES score evaluating premature bolus spillage, penetration/aspiration, and pharyngeal residue. LCIG may affect PDrPD and reduce premature bolus spillage and pharyngeal bradykinesia. Future studies with larger sample sizes are required to follow-up on these pilot results and identify which factors predict a good response of PDrPD to LCIG treatment
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