Core messages
Many Parkinson’s patients develop swallowing disorders caused by their neurodegenerative disease over time. A possible consequence of dysphagia can be life-threatening aspiration pneumonia. Privatdozentin Dr. med. habil. Inga Claus (University Hospital Münster, ParkinsonZentrum Münster/Osnabrück) and Professor Dr. med. Tobias Warnecke (Department of Neurology and Neurological Early Rehabilitation
Klinikum Osnabrück, ParkinsonZentrum Münster/Osnabrück) explain in a recent how these dysphagia patients can be treated.
Dysphagia is a common and often underestimated problem in patients with neurological diseases.It is not just a symptom, but a multietiological syndrome. A few figures underline the clinical significance of dysphagia in patients with neurological diseases. According to the DGN (German Society of Neurology), 20 to 30 percent of dementia patients suffer from swallowing disorders and initially about 50 percent of all patients with stroke. In patients with severe traumatic brain injuries, the figure is about 60 percent, and after prolonged mechanical ventilation, as many as 70-80 percent are affected (but mostly transient). The symptom is also relatively common in Parkinson’s syndromes and multiple sclerosis. The incidence of dysphagia symptoms is particularly noticeable in 30–40% of all elderly people who still lead independent lives, as well as in more than 50% of nursing home residents and approximately 70% of all geriatric patients in clinics.
Activating therapies
According to Inga Claus and Tobias Warnecke, speech therapy has a central position in the treatment of Parkinson’s-related swallowing disorders.Restituting procedures (e.g. sensory stimulation), compensatory methods (e.g. vigorous swallowing) or dietary adjustment (e.g. by thickening liquids) would be used.
For some years now, further innovative therapies have been developed, the authors explain. The best data is currently available for a four-week intensive exhalation training (Expiratory muscle strength training). In patients with mild to moderate dysphagia, studies have shown that appropriate training with this special exhalation trainer (EMST150 Aspire Products) could significantly improve swallowing safety and also swallowing efficiency. The training lasts. four weeks and find in home environment; the daily time required is about 10 to 15 minutes. In the meantime, the training device is also available with two different intensity levels, so that even more severely affected people, for example with atypical Parkinson’s syndromes, can train with it.
According to the neurologists, before starting speech therapy exercises, it should first be checked whether the drug therapy for Parkinson’s disease needs to be optimized, since pharyngeal bradykinesia can also be the result of insufficient dopaminergic medication in some patients.»In this case, an endoscopic swallowing examination with assessment of dysphagia in both the OFF and ON states is helpful in order to be able to reliably assess the potential benefit of modifying the dopaminergic medication,» Claus and Warnecke write. On the basis of a specific score (0-108), a potential change in swallowing function could be made in a comparison of the two studies. An improvement of> 30% is considered significant.
In the case of atypical Parkinson’s syndromes, an attempt to optimize dopaminergic medication could also be helpful, although the positive effects are usually less than in idiopathic Parkinson’s syndrome, similar to motor skills. However, the optimization of dopaminergic medication has a positive influence on pharyngeal residuals, which generally have less of an impact on the oral phase of the swallowing act that is often prevalent in atypical Parkinson’s syndromes.
According to the authors, other potential therapies include substance P, which interacts with the pharyngeal mucosa and, as a neurotransmitter, exerts a positive influence on the triggering of the swallowing and coughing reflexes.Pilot studies would also have a positive effect of Capsaicin has been shown to increase the concentration of substance P as well as oropharyngeal swallowing disorders in geriatric patients, including Parkinson’s patients.
In the case of persistent penetration or aspiration events for one or more consistencies, it may be necessary to adjust the diet of oral nutrition, depending on the findings of the examination.
If the swallowing disorder persists despite optimized therapy, especially in the case of atypical Parkinson’s syndromes, the possibility of a PEG system to ensure food, fluid and medication intake should be discussed with the patients and relatives at an early stage.
Increased salivation
Many patients with Parkinson’s syndromes also suffer from chronic sialorrhea; As a rule, the cause of this is not an increased saliva production, but a reduced swallowing frequency due to pharyngeal bradykinesia, the neurologists explain. Drug therapy attempts for chronic sialorrhea are often inadequate and also have side effects.Chewing gum or sucking sage sweets, on the other hand, leads to at least a passagaric reduction in salivation. Training with a «swallowing alarm clock» could also be useful: Here, those affected train 2×15 minutes a day to swallow at a frequency of once per minute by reminding them to swallow once a minute by the swallowing alarm clock. Here, too, regular training leads to an overall reduction in salivation.
Another promising therapeutic approach is the injection of botulinum toxin into the parotid glandle and/or the submandibular gland. This therapy has been used effectively for many years, and in 2019 approval was granted in Germany for the indication «chronic sialorrhea» for the preparation «IncobotulinumtoxinA», so that the costs for the treatment would have to be regularly covered by all health insurance companies.
Detailed recommendations for the care of patients with swallowing disorders can be found in the 2020 publication Guideline on neurogenic dysphagia
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Source — https://www.univadis.de/viewarticle/schluckst%25C3%25B6rungen-bei-parkinson-syndromen-wie-behandeln-2023a10009vo