Levodopa responsiveness of dysphagia in advanced Parkinson's disease and reliability testing of the FEES-Levodopa-test

Warnecke, Tobias; Suttrup, Inga; Schröder, Jens Burchard; Osada, Nani; Oelenberg, Stephan; Hamacher, Christina; Suntrup, Sonja; Dziewas, Rainer

doi:10.1016/j.parkreldis.2016.04.034

Cited by 91 publications

(91 citation statements)

References 21 publications

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“…Each parameter is rated on a scale from 0 (normal) to 4 (severe impairment) for each trial and each food consistency, contributing to an overall cumulative score ranging from 0 to 108. The score is described in detail elsewhere and has recently been validated …”

Section: Methodsmentioning

confidence: 99%

“…The score is described in detail elsewhere 29 and has recently been validated. 30 LSR was defined as time period from the beginning of water injection to the beginning of the white-out in FEES. All videos were rated off-line in randomized order with the rater kept blinded to the subject's condition (ie, anesthesia or no anesthesia).…”

Section: Swallowing Assessmentmentioning

confidence: 99%

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FEES‐based assessment of pharyngeal hypesthesia—Proposal and validation of a new test procedure

Labeit

Ogawa

Claus

et al. 2019

Neurogastroenterology Motil

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Background Intact pharyngeal sensation is essential for a physiological swallowing process, and conversely, pharyngeal hypesthesia can cause dysphagia. This study introduces and validates a diagnostic test to quantify pharyngeal hypesthesia. Methods A total of 20 healthy volunteers were included in a prospective study. Flexible endoscopic evaluation of swallowing (FEES) and a sensory test were performed both before and after pharyngeal local anesthesia. To test pharyngeal sensation, a small tube was positioned transnasally in the upper third of the oropharynx with contact to the lateral pharyngeal wall. Increasing volumes of blue‐dyed water were injected through the tube, and the latency of swallowing response (LSR) was determined by two independent raters from the endoscopic video recording. Three trials were performed for each administered volume starting with 0.1 mL and increased by 0.1 mL up to 0.5 mL. Key Results The average LSR without anesthesia was 2.24 ± 0.80 s at 0.1 mL, 1.79 ± 0.84 s at 0.2 mL, 1.29 ± 0.62 s at 0.3 mL, 1.17 ± 0.41 s at 0.4 mL, and 1.19 ± 0.52 s at 0.5 mL. With anesthesia applied, the average LSR was 2.65 ± 0.62 s at 0.1 mL, 2.64 ± 0.49 s at 0.2 mL, 2.44 ± 0.65 s at 0.3 mL, 2.10 ± 0.80 s at 0.4 mL, and 2.18 ± 0.85 s at 0.5 mL. LSR was significantly longer following anesthesia at 0.2 mL (t = −3.82; P = .001), 0.3 mL (t = −4.65; P < .000), 0.4 mL (t = −5.77; P < .000), and 0.5 mL (t = −3.49; P = .005). Conclusion and Inferences Pharyngeal hypesthesia can be quantified with sensory testing using LSR. Suitable volumes to distinguish between normal and impaired pharyngeal sensation are 0.2 mL, 0.3 mL, 0.4 mL and 0.5 mL. Experimentally induced pharyngeal anesthesia represents a valid model of sensory dysphagia.

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Section: Methodsmentioning

confidence: 99%

Section: Swallowing Assessmentmentioning

confidence: 99%

FEES‐based assessment of pharyngeal hypesthesia—Proposal and validation of a new test procedure

Labeit

Ogawa

Claus

et al. 2019

Neurogastroenterology Motil

Self Cite

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“…The primary endpoint was “residues of bread” as they are a characteristic pathology in PD patients 3 . A sample‐size calculation based on the mean values of residues along the 0‐5 residue classification was performed with SD of 0.76, an expected effect size of 1 point, and a P ‐value of 0.05 resulting in a requirement of 11 patients per group to achieve a power of 80 %.…”

Section: Methodsmentioning

confidence: 99%

“…Dysphagia is a well‐known problem in Parkinson´s disease (PD) with a prevalence of 11 to 95% in PD patients 1,2 . The most common endoscopic pathologies are pharyngeal residues of firm consistencies followed by the aspiration of water 2,3 . Self‐perception of swallowing is poor in many PD patients and even severe dysphagia is often not realized 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Impact of simultaneous subthalamic and nigral stimulation on dysphagia in Parkinson’s disease

Pflug

Nienstedt

Gulberti

et al. 2020

Ann Clin Transl Neurol

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Objectives: Dysphagia is a frequent and highly relevant symptom in Parkinson's disease (PD) due to high associated morbidity and mortality. To compare the effect of simultaneous stimulation of the subthalamic nucleus (STN) and substantia nigra (SNr) with conventional STN-stimulation on swallowing function in Parkinson's disease. Methods: In this controlled, randomized, doubleblind, cross-over clinical trial, 15 PD patients were assessed with DBS switched off (STIM OFF), STN-DBS, STN + SNr-DBS. Patients and 32 age-matched healthy controls were examined clinically and by flexible-endoscopic evaluation of swallowing (FEES) to evaluate the swallowing function. The primary endpoint was the assessment of residues, secondary endpoints were penetration/ aspiration, leakage, retained pharyngeal secretions, drooling, and assessments of the patient's self-perception of swallowing on a visual analog scale. Results: Compared with healthy controls PD patients showed significantly more pharyngeal residues in STIM OFF and both DBS modes. Residues or aspiration events were found in 80% of the patients under STN-stimulation. Simultaneous STN + SNr-stimulation had no additional positive effect on objective dysphagia and self-reported swallowing function compared to STN-DBS. Interpretation: Simultaneous STN + SNr-stimulation seems to have no additional beneficial effects on dysphagia when compared with conventional STN-stimulation, but did not deteriorate the swallowing function. If STN + SNr-stimulation is planned to be applied for the improvement of axial symptoms and gait disorders in PD patients, it can be considered safe in terms of dysphagia. 628

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“…Whether dysphagia in PD responds to levodopa therapy remains controversial. 67,68 Cricopharyngeal dysfunction may be successfully treated with either myotomy or botulinum toxin injections. 69,70 Behavioral therapy that teaches safe swallowing maneuvers and techniques is still the standard treatment approach for parkinsonian dysphagia.…”

Section: Dysphagiamentioning

confidence: 99%

Management of Autonomic Dysfunction in Parkinson's Disease

Pfeiffer

2017

Semin Neurol

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Autonomic dysfunction is a frequent and important nonmotor feature of Parkinson's disease (PD). Autonomic dysfunction in PD spans a broad clinical spectrum. Cardiovascular dysfunction is characterized most prominently by orthostatic hypotension. Gastrointestinal dysfunction can involve virtually all levels of the gastrointestinal tract. Urinary dysfunction can entail either too frequent voiding or difficulty voiding. Sexual dysfunction is frequent and frustrating for both the patient and the partner. Alterations in sweating and body temperature are not widely recognized, but often are present. The presence of effective treatment for at least some aspects of autonomic dysfunction makes it vitally important that the assessment of autonomic dysfunction be a regular component of the neurologic history and examination for individuals with PD.

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Levodopa responsiveness of dysphagia in advanced Parkinson's disease and reliability testing of the FEES-Levodopa-test

Cited by 91 publications

References 21 publications

FEES‐based assessment of pharyngeal hypesthesia—Proposal and validation of a new test procedure

FEES‐based assessment of pharyngeal hypesthesia—Proposal and validation of a new test procedure

Impact of simultaneous subthalamic and nigral stimulation on dysphagia in Parkinson’s disease

Management of Autonomic Dysfunction in Parkinson's Disease

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