Zeitschrift für Rheumatologie, Год журнала: 2023, Номер unknown
Опубликована: Ноя. 10, 2023
European Journal of Neurology, Год журнала: 2023, Номер 30(5), С. 1465 - 1480
Опубликована: Фев. 9, 2023
Levodopa is the gold standard for symptomatic treatment of Parkinson's disease (PD). There are well documented motor and non-motor fluctuations, however, that occur almost inevitably once levodopa started after a variable period in people with PD. Whilst brain neurodegenerative processes play part pathogenesis these range barriers across gastrointestinal (GI) tract can alter pharmacokinetics, ultimately contributing to non-optimal response symptoms fluctuations. GI transport absorption include dysphagia, delayed gastric emptying, constipation, Helicobacter pylori infection, small intestinal bacterial overgrowth gut dysbiosis. In addition, protein-rich diet concomitant medication intake further pharmacokinetics. This result unpredictable or sub-optimal response, 'delayed on' 'no phenomena. this narrative review, we provided an overview on plethora obstacles PD their implications pharmacokinetics development management strategies address dysfunction highlighted, including use non-oral therapies bypass tract.
Язык: Английский
Процитировано
51
Neurological Research and Practice, Год журнала: 2024, Номер 6(1)
Опубликована: Май 9, 2024
Abstract Flexible endoscopic evaluation of swallowing (FEES) is one the most important methods for instrumental evaluation. The challenging part examination consists in interpretation various observations encountered during endoscopy and deduction clinical consequences. This review proposes framework an integrated FEES-report that systematically moves from salient findings FEES to more advanced domains such as dysphagia severity, phenotypes impairment pathomechanisms. Validated scales scores are used enhance diagnostic yield. In concluding report, FEES-findings put into perspective context. potential etiology conceivable differential diagnoses considered, further steps proposed, treatment options evaluated, a timeframe re-assessment suggested. designed be adaptable open continuous evolution. Additional items, novel protocols, pathophysiological observations, advancements disease-related knowledge, new options, can easily incorporated. Moreover, there customizing this approach report on structural dysphagia.
Язык: Английский
Процитировано
9
Journal of Neural Transmission, Год журнала: 2025, Номер unknown
Опубликована: Март 22, 2025
Abstract Traditional advanced therapies in Parkinson’s disease (PD) with motor fluctuations and dyskinesias like continuous apomorphine infusion (CSAI), levodopa-carbidopa intestinal gel (LCIG), entacapone (LECIG), or deep brain stimulation (DBS) have played a central role managing therapy-related complications. Recently, subcutaneous foslevodopa/foscarbidopa (CSFLI) has emerged as novel therapeutic option. This manuscript provides insights from one year of real-world experience CSFLI, addressing critical questions that clinicians face when selecting the most appropriate therapy for PD. Our discussion centers on key considerations patient selection, exploring which individuals may benefit more CSFLI compared to other device-aided therapies. We highlight CSFLI’s advantages flexibility ease use but also consider limitations, particularly its side effects, such skin-related issues. Recommendations are presented how prevent manage these adverse effects maximize compliance success. Additionally, paper examines strategies optimizing concurrent oral medications combined providing guidance balancing pump necessary adjunctive treatments.
Язык: Английский
Процитировано
0
GeroScience, Год журнала: 2025, Номер unknown
Опубликована: Апрель 9, 2025
Язык: Английский
Процитировано
0
Movement Disorders Clinical Practice, Год журнала: 2025, Номер unknown
Опубликована: Апрель 21, 2025
Abstract Background Drooling, defined as the involuntary loss of saliva from anterior oral cavity, is potentially problematic for people with Parkinson's disease (PwP). However, there little research on how PwP perceive impact drooling and what factors contribute to it. Objectives The objective was evaluate self‐perceived in without contributing clinical PwP. Methods We conducted a cross‐sectional case‐control study. Participants were clinically examined, primary outcome Sialorrhea Clinical Scale disease. variables compared between control subjects using Mann‐Whitney test, correlations analyzed Spearman's predictors identified linear regression. Results study included 101 sex‐ age‐matched controls. experienced significantly more severe controls across all domains: diurnal nocturnal drooling, severity frequency, social discomfort, speech, eating impairments. greater associated severity, duration, levodopa equivalent daily dose, global impression accumulation (CGI‐S), chewing, swallowing, oromotor, motor non‐motor Significant include higher CGI‐S, facial expression, swallowing Conclusions have controls, affecting several domains. Drooling its should be investigated consultation.
Язык: Английский
Процитировано
0
Archives of Gerontology and Geriatrics, Год журнала: 2024, Номер 122, С. 105374 - 105374
Опубликована: Фев. 20, 2024
Язык: Английский
Процитировано
3
Nutrients, Год журнала: 2023, Номер 15(12), С. 2662 - 2662
Опубликована: Июнь 7, 2023
Oropharyngeal dysphagia (OD) is a frequent finding in older patients with potentially lethal complications such as aspiration pneumonia, malnutrition, and dehydration. Recent studies describe sarcopenia causative factor for OD, which occasionally referred to “sarcopenic dysphagia” the absence of neurogenic etiology. In most previous on sarcopenic dysphagia, diagnosis was based only clinical assessment. this study, flexible endoscopic evaluation swallowing (FEES) used an objective method evaluate presence its association sarcopenia, pure dysphagia. retrospective cross-sectional 109 acute care geriatric hospital suspected OD received FEES examination bioimpedance analysis (BIA) routine. 95% had at least one neurological disease, 70% fulfilled criteria 45% displayed moderate or severe OD. Although prevalence high, there no significant between sarcopenia. Considering these results, both appear questionable. Further prospective are needed elucidate if merely epiphenomenon disease whether it plays role development
Язык: Английский
Процитировано
8
Journal of Neurology, Год журнала: 2024, Номер 271(6), С. 3554 - 3570
Опубликована: Март 28, 2024
Abstract Background Apomorphine sublingual film (SL-APO) is an on-demand treatment for OFF episodes in patients with Parkinson’s disease (PD). Objective To assess the long-term (≥ 3 years) safety/tolerability and efficacy of SL-APO. Methods Study CTH-301 ( http://www.clinicaltrials.gov NCT02542696; registered 2015-09-03) was a phase 3, multicentre, open-label study SL-APO PD motor fluctuations, comprised dose-titration safety phase. All participants received The primary endpoint (treatment-emergent adverse events [TEAEs]) during Efficacy assessments included Movement Disorder Society-Unified Disease Rating Scale (MDS-UPDRS) part III (motor examination), assessed at weeks 24, 36 48 first year Results 496 were 120 (24.2%) completed Mean duration exposure 294.3 days. TEAEs related to drug experienced by 65.3% (most common: nausea [6.0%], stomatitis [1.8%], lip swelling dizziness [1.6%], oral mucosal erythema mouth ulceration [1.6%]). leading withdrawal 34.0% [5.4%], [4.5%], [2.6%], [2.3%]). A clinically meaningful reduction MDS-UPDRS score observed as soon 15 min following administration SL-APO, peak effects approximately 30 post-dose sustained up 90 post-dose; results consistent over weeks. Conclusions generally well tolerated efficacious long term PD.
Язык: Английский
Процитировано
2
Journal of Clinical Medicine, Год журнала: 2023, Номер 13(1), С. 156 - 156
Опубликована: Дек. 27, 2023
Patients with neurodegenerative disorders (NDDs) often experience functional dysphagia, which may involve dysfunction in a specific phase of swallowing or the entire process. This review outlines approach to dysphagia setting NDDs. Distinguishing etiology can be difficult, and it is important always look out for signs pointing NDD as cause. Thorough diagnostic work-up essential, includes comprehensive history physical examination, alongside function tests, such fiberoptic endoscopic evaluation swallowing, videofluoroscopic study, high-resolution manometry. Management requires multidisciplinary treatment plan tailored each patient. involves dietary guidance, rehabilitation, surgery cases improvement rehabilitation inadequate. Surgery altering certain pharyngolaryngeal structures facilitate reduce risk aspiration (swallowing surgery) separating airway digestive tract while sacrificing laryngeal function, main goal preventing (aspiration prevention surgery). Proper management stems from recognizing impact these on consistently finding ways improve quality life patients.
Язык: Английский
Процитировано
5
Dysphagia, Год журнала: 2023, Номер 39(4), С. 697 - 704
Опубликована: Дек. 22, 2023
Abstract Flexible Endoscopic Evaluation of Swallowing (FEES) is one two diagnostic gold standards for pharyngeal dysphagia in Parkinson's disease (PD), however, validated global outcome measures at the patient level are widely lacking. The Dynamic Imaging Grade Toxicity (DIGEST-FEES) represents such an measure but has been primarily head and neck cancer collectives. objective this study was, therefore, to investigate validity DIGEST-FEES patients with PD. Content was evaluated a modified Delphi expert survey. Subsequently, 66 FEES videos PD were scored DIGEST-FEES. Criterion determined using Spearman's correlation coefficient between Penetration-Aspiration Scale (PAS), Yale-Residue-Rating-Scale, Functional-Oral-Intake-Scale (FOIS), swallowing-related Unified-Parkinson-Disease-Rating-Scale (UPDRS) items. Inter-rater reliability 10 randomly selected FEES-videos examined by second rater. As result, overall DIGEST-FEES-rating exhibited significant correlations Yale-Valleculae-Residue-Scale ( r = 0.84; p < 0.001), Yale-Pyriform-Sinus-Residue-Scale 0.70; FOIS − 0.55, UPDRS-Swallowing-Item-Score 0.42, 0.001). Further, DIGEST-FEES-safety subscore correlated PAS 0.63, high rating (quadratic weighted kappa 0.82). Therefore, valid reliable score evaluate severity Nevertheless, survey identified domains where may need be specifically adapted or neurological collectives future.
Язык: Английский
Процитировано
4