Endoscopic characteristics and levodopa responsiveness of swallowing function in progressive supranuclear palsy

Abstract

Dysphagia is a frequent and early symptom in progressive supranuclear palsy (PSP) predisposing patients to aspiration pneumonia. Fiberoptic endoscopic evaluation of swallowing (FEES) has emerged as a valuable apparative tool for objective evaluation of neurogenic dysphagia. This is the first study using FEES to investigate the nature of swallowing impairment in PSP. Eighteen consecutive PSP patients (mean age 69.7 +/- 9.0 years) were included. The salient findings of FEES in PSP patients were compared with those of 15 patients with Parkinson's disease (PD). In 7 PSP patients, a standardized FEES protocol was performed to explore levodopa (L-dopa) responsiveness of dysphagia. Most frequent abnormalities detected by FEES were bolus leakage, delayed swallowing reflex, and residues in valleculae and piriformes. Aspiration events with at least one food consistency occurred in nearly 30% of PSP patients. Significant pharyngeal saliva pooling was observed in 4 PSP patients. We found no difference of salient endoscopic findings between PSP and PD patients. Endoscopic dysphagia severity in PSP correlated positively with disease duration, clinical disability, and cognitive impairment. No correlation was found with dysarthria severity. In early PSP patients, swallowing dysfunction was solely characterized by liquid leakage with the risk of predeglutitive aspiration during the oral phase of swallowing. Two PSP patients showed relevant improvement of swallowing function after L-dopa challenge. Chin tuck-maneuver, hard swallow, and modification of food consistency were identified as the most effective therapeutic interventions. In conclusion, FEES assessment can deliver important findings for the diagnosis and refined therapy of dysphagia in PSP patients.

Deglutição e consistências alimentares pastosas e sólidas: revisão crítica de literatura

“…To assess swallowing, studies variously use videofluoroscopy exams (5)(6)(7)11,14,18,19) , digital acoustic analysis of swallowing sounds (9,21) and surface electromyography (11) . The use of control groups and participants' ages also varied among the reviewed studies.…”

“…The use of control groups and participants' ages also varied among the reviewed studies. Studies were performed with healthy subjects to obtain baseline data (6,12,14,16) and with patients with specific pathologies (5,13,17) . Studies of specific pathologies had well-formed research groups but did not always include control groups.…”

“…An experimental study (5) assessed the use of Levodopa and the swallowing performance observed with various food consistencies in patients with progressive supranuclear palsy (PSP) and Parkinson's disease (PD). The study did not include control cases and was conducted with subjects who were diagnosed with probable PSP or PD.…”

A Review: Mealtime Difficulties following Frontotemporal Lobar Degeneration

“…The degree of cognitive impairment positively correlates to both individual reports of difficulty and clinician-observed swallow impairment [20, 83]. Aberrant eating behaviors – namely, impulsive eating – are reported in PSP [79, 81, 84].…”

“…Levodopa, commonly prescribed to treat dysphagia in individuals with Parkinson’s disease, is ineffective in treating the bradykinesia-related swallow impairments of PSP [79, 81, 82]. Postural modification in combination with modified diet texture presents the best current treatment option for managing dysphagia [79, 83]. …”