KMID : 1024320230130010059
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Journal of the Korean Dysphagia Society 2023 Volume.13 No. 1 p.59 ~ p.64
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A Perspective of the Wearing-off Phenomenon in a Patient with Parkinson¡¯s Disease: A Case Report
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Park Chul-Min
Kim Kyoung-Tae
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Abstract
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Dysphagia is a major disability in patients with Parkinson¡¯s disease. Unlike typical motor symptoms, dysphagia is relatively unresponsive to dopaminergic drugs. However, occasionally, swallowing difficulties are much improved by dopaminergic agonists and significantly affected by on/off periods. In such cases, it is difficult to assess the severity of dysphagia accurately if swallowing function evaluation is performed without considering the wearing-off phenomenon in patients with PD. Here, we report a case of dysphagia in a female patient with Parkinson¡¯s disease that was severely affected by the wearing-off phenomenon in response to prolonged use of levodopa. The patient presented with severe oral phase delay with choking symptoms during fluid intake. A videofluoroscopic swallow study performed during an ¡®off-period¡¯ showed massive aspiration with severely impaired swallowing function. However, when swallowing evaluation was performed during the ¡®on-period¡¯, almost no abnormal function was observed. After adopting an on/off period-tailored diet prescription, sufficient nutrition was possible without aspiration. Consideration of the wearing-off phenomenon is essential when evaluating swallowing function in patients with Parkinson¡¯s disease. Patient-specific swallowing evaluations and diet prescriptions are needed to establish optimal therapeutic strategies.
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KEYWORD
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Parkinson¡¯s disease, Dysphagia, Levodopa, Videofluoroscopic swallow study
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