Pharyngo-Esophageal Dysphagia in Parkinson's Disease

Leopold, Norman A.; Kagel, Marion C.

doi:10.1007/pl00009512

Cited by 190 publications

(118 citation statements)

References 57 publications

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“…However, in an earlier study it was shown that aspiration is evident mainly in the later stages of the disease (29), and the latency of the onset of dysphagia might be up to 130 months (10 yrs) after onset of PD (30). The patients in the present study were on the verge of this latency time, and hence may not yet have manifested such problems as aspiration.…”

Section: Discussionmentioning

confidence: 45%

Swallowing function in Parkinson's patients following Zona Incerta deep brain stimulation

et al. 2012

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ObjectiveThe purpose of the present study was to examine if there was a negative effect of caudal Zona Incerta deep brain stimulation (cZI DBS) on pharyngeal swallowing function in Parkinson's patients (PD). There are no former reports on swallowing and cZI DBS. MethodsEight patients (aged 49 to 71 years; median 62) were evaluated pre-and postoperatively, at six and 12 months after DBS surgery. Evaluation tools were Fiberoptic Endoscopic Evaluation of Swallowing examinations and patients' self-assessments of the swallowing function including a visual analogue scale and quality of life related questions. The swallowing protocol included Rosenbeck's Penetration-Aspiration Scale, Secretion Severity Scale and parameters for pre-swallow spillage, pharyngeal residue and pharyngeal clearance. ResultsThere was no clear-cut effect of neurostimulation postoperatively at six and 12 months on any of the swallowing parameters except for pre-swallow spillage which was slightly worsened in the stimulation on condition 12m postoperatively. The answers to the self assessment questions did not vary significantly. ConclusionsThe effect of the stimulation on swallowing function varied among individuals but the overall outcome was that cZI DBS did not seem to have a negative influence on swallowing function in the eight patients studied.

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Section: Discussionmentioning

confidence: 45%

Swallowing function in Parkinson's patients following Zona Incerta deep brain stimulation

et al. 2012

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“…Swallowing dysfunction in PD patients covers the clinical area from mild dysphagia to life threatening aspiration-induced pneumonias (7)(8)(9). The cause of swallowing dysfunction is often not known for PD patients, but a dysfunctional regulation pattern in the medulla oblongata (10) has been speculated (11).…”

Section: Introductionmentioning

confidence: 99%

Deep brain stimulation - effects on swallowing function in Parkinson's disease

et al. 2012

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ObjectiveIn patients with Parkinson's disease (PD), deep brain stimulation of the subthalamic nucleus (STN DBS) is well recognized in improving limb function, but the outcome on swallowing function has rarely been studied. The aim of this work was to evaluate the effect of STN DBS on pharyngeal swallowing function in PD patients using self-estimation and fiberoptic endoscopic evaluation of swallowing. MethodsEleven patients (aged 41-72, median 61 years) were evaluated preoperatively and at 6 and 12 months after STN DBS surgery. All patients were evaluated with self-estimation on a visual analogue scale and eight of them with a fiberoptic endoscopic examination with a predefined swallowing protocol including Rosenbek's Penetration-Aspiration Scale, Secretion Severity Scale, preswallow spillage, pharyngeal residue and pharyngeal clearance. ResultsThe self-assessments of swallowing function revealed a swallowing improvement with STN DBS stimulation whereas the data from the swallowing protocol did not show any significant effect of the STN DBS treatment itself. The prevalence of aspiration was not affected by the surgery. ConclusionsThe results show that swallowing function was neither improved nor negatively affected by STN DBS and the risk of aspiration did not increase. Self-estimation of swallowing function showed an improvement due to stimulation.

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“…The nasal cavity (in humans) is divided in to two symmetrical halves by a septum with each cavity sub-dived into four areas namely vestibules, atrium, respiratory region and olfactory regions. With a surface area of 150 cm 2 , total volume of 15-20 mL the nasal cavity provides an optimal absorption area for drugs into the systemic circulations which would inevitably enhance the bioavailability of the therapeutic agent, particularly those which demonstrate poor oral absorption (intestinal permeation) or significant first-pass metabolism (extra-hepatic and hepatic) 5,6 . Although originally exploited for the delivery of locally acting agents (allergic of infections rhinitis, nasal pluposos and sinusitis) the highly vascularised nature of the nasal cavity has provided a portal for systemic delivery of small molecules and biomolecules 7 .…”

Section: Introductionmentioning

confidence: 99%

Development and Evaluation of a Novel Intranasal Spray for the Delivery of Amantadine

Lungare

Bowen

Badhan

2016

Journal of Pharmaceutical Sciences

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The aim of this study was to develop and characterise an intranasal delivery system for amantadine (AMT). Optimal formulations (F) consisted of a thermosensitive polymer Pluronic ® 127 (P127) and either carboxy methyl cellulose (CMC) or chitosan (CS) which demonstrated gel-transition at nasal cavity temperatures (34 °C ± 1 °C). Rheologically, the loss tangent (Tan δ) confirmed a three-stage gelation phenomena at 34 °C ± 1 °C and nonNewtonian behaviour. Storage of FCMC and FCS at 4 °C for 8 weeks resulted in repeatable release profiles at 34 °C when sampled, with a Fickian mechanism earlier on but moving towards anomalous transport by week 8. Polymers (P127, CMC and CS) demonstrated no significant cellular toxicity to human nasal epithelial cells up to 4 mg/mL and up to 1 mM for AMT (IC50: 4.5 mM ± 0.05 mM). FCMC and FCS demonstrated slower release across an in-vitro human nasal airway model (43-44 % vs 79 % ± 4.58 % for AMT). Using a human nasal cast model, deposition into the olfactory regions (potential nose-to-brain) was demonstrated upon nozzle insertion (5 mm) whereas tilting of the head forward (15°) resulted in greater deposition in the bulk of the nasal cavity. KEYWORDSParkinson's disease; rheology; nasal; RPMI 2650; nose to brain; thermoresponsive; 3 INTRODUCTION Parkinson's disease (PD) is an ageing associated progressive neurological disorder and affects 1.5 % of the population over 65-years of age 1 , with age-adjusted prevalence rates thought to be around 150 per 100,000 with a suggested mean onset in the 70's 1 . Ageing is the largest single risk factor for the development of PD and the pathogenesis of PD is composed of a range of events leading towards neuronal apoptosis, primarily of degradation of dopamine neurones in the sustantia nigra. The mainstay of clinical drug therapy focuses on increases the levels of dopamine (DA) in the brain, with oral dosing of levodopa being the most commonly used to pharmacological intervention treatment to reverse the symptoms of PD. It is also common to use adjunct therapies in conjunction with levodopa, such as the weak NMDA-type receptor antagonist amantadine, which can aid in blocking dopamine reuptake.

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Pharyngo-Esophageal Dysphagia in Parkinson's Disease

Cited by 190 publications

References 57 publications

Swallowing function in Parkinson's patients following Zona Incerta deep brain stimulation

Swallowing function in Parkinson's patients following Zona Incerta deep brain stimulation

Deep brain stimulation - effects on swallowing function in Parkinson's disease

Development and Evaluation of a Novel Intranasal Spray for the Delivery of Amantadine

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