Evaluation of oropharyngeal deglutitive pressure dynamics in patients with Parkinson's disease.

In Parkinson's disease (PD), oropharyngeal dysphagia is common and clinically relevant. The neurophysiology of dysphagia in PD is complex and incompletely understood. The aim of the study was to determine the changes in oropharyngeal deglutitive pressure dynamics in PD and to correlate these with clinical characteristics including dysphagia and PD severity. In prospective consecutive series of 64 patients with PD [mean age: 66.9 ± 8.3 (SD)], we evaluated dysphagia severity clinically as well as with Sydney Swallow Questionnaire (SSQ) and Swallow Quality-of-Life Questionnaire (SWAL-QOL). PD severity was assessed with Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). We used high-resolution pharyngeal impedance manometry (HRPIM) to objectively evaluate swallow function and compared data from 23 age-matched healthy controls [mean age 62.3 ± 9.1 (SD)]. Metrics assessed were upper esophageal sphincter (UES), integrated relaxation pressure (IRP), relaxation time (RT), maximum opening (MaxAdm), and pharyngeal intrabolus pressure (IBP) and pharyngeal contractility (PhCI). Mean MDS-UPDRS score was positively associated with dysphagia severity on SSQ and SWAL-QOL. HRPIM in PD compared with controls showed impaired UES relaxation parameters, with shorter RT, and elevated IRP and IBP. MaxAdm was not affected. The overall pharyngeal contractility was significantly higher in PD. Only the IBP and IRP were associated with PD severity and only IBP was significantly associated with dysphagia severity. UES dysfunction leading to increased flow resistance is common in patients with PD and correlates with dysphagia severity. Increased flow resistance may suggest impaired UES relaxation and/or impaired neuromodulation to bolus volume.NEW & NOTEWORTHY In Parkinson's disease, objective assessment of swallow function with high-resolution impedance manometry identifies upper esophageal sphincter dysfunction leading to increased flow resistance.

The Relationships Between Radiation Dosage and Long-term Swallowing Kinematics and Timing in Nasopharyngeal Carcinoma Survivors.

This study aimed to investigate the relationship between intensity-modulated radiation therapy (IMRT) dosimetry and swallowing kinematic and timing measures. Thirteen kinematic and timing measures of swallowing from videofluoroscopic analysis were used as outcome measures to reflect swallowing function. IMRT dosimetry was accessed for thirteen swallowing-related structures. A cohort of 44 nasopharyngeal carcinoma (NPC) survivors at least 3 years post-IMRT were recruited. The cohort had a mean age of 53.2 ± 11.9 years, 77.3% of whom were male. There was an average of 68.24 ± 14.15 months since end of IMRT; 41 (93.2%) had undergone concurrent chemotherapy. For displacement measures, female sex and higher doses to the cricopharyngeus, glottic larynx, and base of tongue were associated with reduced hyolaryngeal excursion and pharyngeal constriction, and more residue. For timing measures, higher dose to the genioglossus was associated with reduced processing time at all stages of the swallow. The inferior pharyngeal constrictor emerged with a distinctly different pattern of association with mean radiation dosage compared to other structures. Greater changes to swallowing kinematics and timing were observed for pudding thick consistency than thin liquid. Increasing radiation dosage to swallowing-related structures is associated with reduced swallowing kinematics. However, not all structures are affected the same way, therefore organ sparing during treatment planning for IMRT needs to consider function rather than focusing on select muscles. Dose-response relationships should be investigated with a comprehensive set of swallowing structures to capture the holistic process of swallowing.

Prognostic indicators of subacute combined degeneration from B12 deficiency: A systematic review.

OBJECTIVE: A systematic review was conducted on published data of subacute combined degeneration (SCD) from B12 deficiency to investigate potential prognostic indicators of final ambulatory function in affected patients. TYPE: Systematic review. LITERATURE SURVEY: Records published from 1999 through 2018 were searched on the electronic databases MEDLINE, PUBMED, and SCOPUS. The publication language was restricted to English and French. METHODOLOGY: Records that described cases of SCD from B12 deficiency in patients ≥16 years of age at onset were included. From a final total of 66 cases of SCD identified, ambulation scores were assigned based on the clinical descriptions reported. Patient characteristics, clinical manifestations, and ambulatory function were reported descriptively. Subanalyses on potential prognostic indicators were performed. SYNTHESIS: Greater ambulatory function at diagnosis was associated with recovery of normal ambulatory function at follow-up (P < .001). Nearly 90% of patients walking unsupported at diagnosis made a complete recovery regardless of etiology. For patients initially walking with support, 22% of cases from impaired B12 digestion/absorption made a complete recovery compared with ≥50% of cases from other etiologies. For patients initially requiring a wheelchair, 33% of cases from impaired digestion/absorption were able to walk with support compared with ≥50% of cases from other etiologies. The total B12 administered over the course of treatment was correlated with improved ambulation (P = .024) for all patients, with a higher B12 replacement regimen associated with better outcomes in patients who were unable to walk unsupported at diagnosis (number needed to treat = 4). CONCLUSIONS: Initial ambulatory function may be a useful clinical marker of the severity of spinal cord dysfunction and final functional outcome. Etiological risk factors influenced both clinical manifestations and final walking ability in SCD, suggesting a distinct pathophysiological mechanism among the causes. In addition, a more intensive B12 replacement regimen may improve ultimate ambulatory function in advanced cases of SCD.