Response of parkinsonian swallowing dysfunction to dopaminergic stimulation.
OBJECTIVE
To determine the degree of dopaminergic response of swallowing dysfunction in Parkinson's disease.


METHODS
Fifteen patients with idiopathic Parkinson's disease and symptomatic dysphagia were studied. All had motor fluctuations in response to long term levodopa therapy. On two separate days, after overnight withdrawal of all antiparkinsonian medication, a modified barium swallow using cinefluoroscopy and different food consistencies was performed before and after administration of oral levodopa and subcutaneous apomorphine.


RESULTS
Despite all patients having an unequivocal motor response to both agents, there were few significant responses in any of the quantitative or qualitative criteria of swallowing dysfunction assessed. The oral preparatory phase, generally considered a more voluntary component of swallowing, showed a response, but not with all consistencies. In a subgroup of patients the pharyngeal phase time also improved.


CONCLUSIONS
These findings suggest that parkinsonian swallowing dysfunction is not solely related to nigrostriatal dopamine deficiency and may be due to an additional non-dopamine related disturbance of the central pattern generator for swallowing in the pedunculopontine nucleus or related structures in the medulla.
Hunter
P C
PC
Department of Aged Care Services, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia.
Crameri
J
J
Austin
S
S
Woodward
M C
MC
Hughes
A J
AJ
D000368:Aged; D001058:Apomorphine / Q000627:therapeutic use*; D001464:Barium; D003680:Deglutition Disorders / Q000150:complications / Q000175:diagnosis*; D018491:Dopamine Agonists / Q000627:therapeutic use*; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy*; D012720:Severity of Illness Index; D013997:Time Factors
D018491:Dopamine Agonists; D001464:Barium; D007980:Levodopa; D001058:Apomorphine