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

Dysphagia has been reported in 15%-50% of patients with Parkinson's di sease with abnormalities on barium swallow being demonstrated in up to 95% of cases [1-3]. More recently, the barium swallow has been modifi ed (known as the Dysphagia Motility Study or DMS) to allow visualizati on of the more important oral, pharyngeal, and upper esophageal compon ents of the swallowing reflex. This has demonstrated abnormalities in Parkinson's disease including lingual tremor, repetitive tongue humpin g, 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 volun tary component of swallowing is under extrapyramidal influence, hence responsiveness to levodopa could be expected [1]. A recent study demon strated improvement in DMS-documented swallowing disorders with introd uction of levodopa, however, only small numbers were involved [5]. Des cribed below is a case study of an elderly parkinsonian man with dysph agia who improved with adjustment of timing of his medication.