ArticleCase reports in neurology
Dysphagia Causes Symptom Fluctuations after Oral L-DOPA Treatment in a Patient with Parkinson Disease.
Article in Case reports in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 15 citations in OpenAlex.
- Parkinson's Disease: Conventional Pharmacotherapy, Drug Delivery Innovations, and Emerging Therapeutic Targets.Brain sciences · 2026Review
- The Effect of Dopaminergic Therapies in Parkinson's Disease on Non-Motor Symptoms.International journal of molecular sciences · 2025Review
- Discontinuation or acute unplanned cessation of oral dopaminergic medications in persons with Parkinson's disease: A practice review.Journal of Parkinson's disease · 2025Review
- Effectiveness of Continuous Dopaminergic Therapies in Parkinson's Disease: A Review of L-DOPA Pharmacokinetics/Pharmacodynamics.Journal of Parkinson's disease · 2024Review
- Dysphagia for medication in Parkinson's disease.NPJ Parkinson's disease · 2022Article
- Management of dysphagia and gastroparesis in Parkinson's disease in real-world clinical practice - Balancing pharmacological and non-pharmacological approaches.Frontiers in aging neuroscience · 2022Review
- Gastrointestinal dysfunction in the synucleinopathies.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2021Review
- Gastrointestinal Dysfunction in Parkinson's Disease.Current treatment options in neurology · 2018Review
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe causes of "delayed-on" and "no-on" phenomena in Parkinson disease (PD) are thought to have some impact on the progress of L-DOPA from the time of ingestion until it reaches the brain and is converted to dopamine. Dysphagia can cause fluctuating symptom expression in L-DOPA therapy for PD. CASE DESCRIPTION: A 69-year-old man with PD presented with "delayed-on" and "no-on" phenomena. The patient developed a gait disorder at age 60 years, and he began coughing on his food during breakfast at age 64 years. Even though he was independent in daily life, he could not eat because of dysphagia in an "off" state. Videofluoroscopic examination of swallowing in an "off" state revealed bradykinesia of the tongue and the retention of tablets in the epiglottic vallecula. We trained him to keep his tongue in strong contact with the upper incisors before swallowing. After rehabilitation of dysphagia, the frequency of "delayed-on" and "no-on" phenomena decreased, and his peak L-DOPA plasma concentration was elevated. Additionally, transdermal rotigotine (RTG) was initiated at a maintenance dose of 9.0 mg. The patient reported improvement in swallowing, and the frequency of "no-on" phenomena decreased.
conclusionIn PD patients, the "no-on" phenomenon can be caused by posterior contractile dysfunction of the tongue, and it can be improved with training of the tongue and transdermal RTG administration.
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