PARKINSONIAN MEDICATION ONE-HOUR BEFORE MEALS IMPROVES SYMPTOMATIC SWALLOWING - A CASE-STUDY

Dysphagia has been reported in 15%-50% of patients with Parkinson's disease with abnormalities on barium swallow being demonstrated in up to 95% of cases [1-3]. More recently, the barium swallow has been modified (known as the Dysphagia Motility Study or DMS) to allow visualization of the more important oral, pharyngeal, and upper esophageal components of the swallowing reflex. This has demonstrated abnormalities in Parkinson's disease including lingual tremor, repetitive tongue humping, and prolonged ramp-like posturing of the tongue [2,3]. The response of these swallowing abnormalities to treatment with levodopa (L-dopa) is less clear [4]. It is likely that the striated muscle of the voluntary component of swallowing is under extrapyramidal influence, hence responsiveness to levodopa could be expected [1]. A recent study demonstrated improvement in DMS-documented swallowing disorders with introduction of levodopa, however, only small numbers were involved [5]. Described below is a case study of an elderly parkinsonian man with dysphagia who improved with adjustment of timing of his medication.