Levodopa responsiveness of dysphagia in advanced Parkinson's disease and reliability testing of the FEES-Levodopa-test

Background: It is still controversially discussed whether central dopaminergic stimulation improves swallowing ability in Parkinson's disease (PD). We evaluated the effect of oral levodopa application on dysphagia in advanced PD patients with motor fluctuations. Methods: In 15 PD patients (mean age 71.93 +/- 8.29 years, mean disease duration 14.33 +/- 5.94 years) with oropharyngeal dysphagia and motor fluctuations endoscopic swallowing evaluation was performed in the off state and on state condition following a specifically developed protocol (FEES-levodopa-test). The respective dysphagia score covered three salient parameters, i.e. premature spillage, penetration/aspiration events and residues, each tested with liquid as well as semisolid and solid food consistencies. An improvement of >30% in this score indicated levodopa responsiveness of dysphagia. Measures were compared between the off-and on-state condition by using the Wilcoxon Test and marginal homogeneity test. Inter- and intrarater reliability was also investigated. Results: Severity of swallowing dysfunction in the off state varied widely. The lowest dysphagia score was 15 points (dysphagia without any aspiration risk). The highest dysphagia score was 84 points (dysphagia with aspiration of all consistencies). Seven patients showed a marked improvement of dysphagia in the on state condition. Eight PD patients did not respond. Inter- and intrarater reliability was excellent for all three subscales in the off state and on state conditions. Conclusions: A significant proportion of advanced PD patients with motor fluctuations and mild to moderate oropharyngeal dysphagia may demonstrate a clinically relevant improvement of swallowing after levodopa challenge. The FEES-levodopa-test is a reliable and sensitive tool to differentiate these responders from non-responders. (C) 2016 Elsevier Ltd. All rights reserved.