title: 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.
authors.affiliation: Department of Neurology, University Hospital of Münster, Münster, Germany. tobias.warnecke@ukmuenster.de
authors.forename: Tobias
authors.initials: T
authors.lastname: Warnecke
authors.forename: Stephan
authors.initials: S
authors.lastname: Oelenberg
authors.forename: Inga
authors.initials: I
authors.lastname: Teismann
authors.forename: Christina
authors.initials: C
authors.lastname: Hamacher
authors.forename: Hubertus
authors.initials: H
authors.lastname: Lohmann
authors.forename: Erich Bernd
authors.initials: EB
authors.lastname: Ringelstein
authors.forename: Rainer
authors.initials: R
authors.lastname: Dziewas
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D003680:Deglutition Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D013494:Supranuclear Palsy, Progressive / Q000150:complications / Q000188:drug therapy
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa