ABSTRACT
We sought to determine whether hyposialorrhea is an early manifestation of Parkinson disease (PD). We measured basal and citric acid stimulated secretion of whole saliva in 20 patients with early stage (Hoehn-Yahr I-II) PD who had motor symptoms for less than 1 year and were on no medication and 11 age matched controls. Compared to controls, PD patients had significant reduction of both basal (0.0964+/-0.08 vs 0.293+/-0.112 ml/min, p<0.001) and reflex (0.263+/-0.213 vs 0.537+/-0.313 ml/min, p<0.001) salivary secretion. Our findings confirm that hyposialorrhea is an early autonomic manifestation of PD.
Subject(s)
Parkinson Disease/diagnosis , Parkinson Disease/physiopathology , Salivation/physiology , Secretory Rate/physiology , Adult , Aged , Aged, 80 and over , Case-Control Studies , Citric Acid/pharmacology , Female , Humans , Male , Middle Aged , Reflex, Abnormal/drug effects , Reflex, Abnormal/physiology , Salivation/drug effects , Secretory Rate/drug effectsABSTRACT
We examined basal and reflex salivary flow rate and composition in 46 patients with Parkinson's disease (PD), both in off and on conditions, compared to 13 age-matched controls without underlying disease or treatment affecting autonomic function. Whole saliva was collected 12 hours after withdrawal of dopaminergic drugs and at the peak of levodopa-induced motor improvement. Twenty-three of the 46 PD patients had received domperidone a week before the study. Basal salivary flow rate was significantly lower in PD patients in the off state compared to controls (P<0.005). Levodopa increased salivary flow rate (P<0.05) both in the domperidone-pretreated and untreated groups. Citric acid stimulated salivary flow rate in both the off and on states in PD patients. This effect was higher in the domperidone-pretreated patients. Salivary concentration of sodium, chloride, and amylase was higher in PD patients than in controls and was not affected by levodopa or domperidone treatment. Levodopa stimulates both basal and reflex salivary flow rate in PD. The mechanism appears to be central, as the effect is not blocked by domperidone. Domperidone may have a peripheral effect that potentiates reflex salivary secretion. Salivary composition is abnormal in PD and is not affected by levodopa treatment.
Subject(s)
Parkinson Disease/physiopathology , Salivation/physiology , Secretory Rate/physiology , Adult , Aged , Aged, 80 and over , Amylases/metabolism , Analysis of Variance , Antiparkinson Agents/blood , Antiparkinson Agents/therapeutic use , Case-Control Studies , Domperidone/administration & dosage , Dopamine Antagonists/administration & dosage , Female , Humans , Levodopa/blood , Levodopa/therapeutic use , Male , Middle Aged , Parkinson Disease/drug therapy , Rest/physiology , Secretory Rate/drug effectsABSTRACT
El blefaroespasmo es una distonía focal caracterizada por el cierre involuntario de los ojos debido a la contracción anormal de los músculos orbiculares de los párpados. Cuando el blefaroespasmo se asocia a la presencia de movimientos involuntarios oromandibulares se denomina síndrome de Meige. El objetivo de este estudio fue investigar la presencia de alteraciones deglutorias en pacientes con blefaroespasmo y síndrome de Meige. Se incluyeron 20 pacientes consecutivos que fueron estudiados mediante vídeo fluoroscopia con técnica de bario. Se investigaron las 4 etapas de la deglución. El 90% de los pacientes (18 casos) presentó trastornos en la deglución. Las alteraciones más comúnmente halladas fueron caída prematura del alimento, 15 casos (83%) y resíduos valeculares, 14 casos (78%). El 67% de anormalidades se observó en la tercera etapa de la deglución. El 89% de los pacientes (16) presentó más de un trastorno deglutorio. Se observó una correlación positiva y estadísticamente significativa entre el número de hallazgos patológicos y la edad de los pacientes y la duración de la enfermedad. De acuerdo a lo publicado, la prevalencia de desórdenes de la deglución en pacientes sanos de edad avanzada es del 44%. En nuestra serie alcanzó el 90%, lo cual sugiere que nuestros hallazgos podrían estar relacionados no sólo con la edad, sino también con la posibilidad de que el compromiso distónico en pacientes con blefaroespasmo sea mayor de lo que se aprecia clínicamente extendiéndose más allá de los músculos orofaciales. (AU)
Subject(s)
Adult , Middle Aged , Aged , Aged, 80 and over , Humans , Male , Female , Deglutition Disorders/complications , Blepharospasm/complications , Meige Syndrome/complicationsABSTRACT
El blefaroespasmo es una distonía focal caracterizada por el cierre involuntario de los ojos debido a la contracción anormal de los músculos orbiculares de los párpados. Cuando el blefaroespasmo se asocia a la presencia de movimientos involuntarios oromandibulares se denomina síndrome de Meige. El objetivo de este estudio fue investigar la presencia de alteraciones deglutorias en pacientes con blefaroespasmo y síndrome de Meige. Se incluyeron 20 pacientes consecutivos que fueron estudiados mediante vídeo fluoroscopia con técnica de bario. Se investigaron las 4 etapas de la deglución. El 90% de los pacientes (18 casos) presentó trastornos en la deglución. Las alteraciones más comúnmente halladas fueron caída prematura del alimento, 15 casos (83%) y resíduos valeculares, 14 casos (78%). El 67% de anormalidades se observó en la tercera etapa de la deglución. El 89% de los pacientes (16) presentó más de un trastorno deglutorio. Se observó una correlación positiva y estadísticamente significativa entre el número de hallazgos patológicos y la edad de los pacientes y la duración de la enfermedad. De acuerdo a lo publicado, la prevalencia de desórdenes de la deglución en pacientes sanos de edad avanzada es del 44%. En nuestra serie alcanzó el 90%, lo cual sugiere que nuestros hallazgos podrían estar relacionados no sólo con la edad, sino también con la posibilidad de que el compromiso distónico en pacientes con blefaroespasmo sea mayor de lo que se aprecia clínicamente extendiéndose más allá de los músculos orofaciales.
Subject(s)
Adult , Middle Aged , Aged, 80 and over , Humans , Male , Female , Blepharospasm/complications , Deglutition Disorders/complications , Meige Syndrome/complicationsABSTRACT
The development of dyskinesias is a common side effect during chronic levodopa therapy in parkinsonian patients. Recent reports suggest that amantadine, a drug with well known antiparkinsonian activity, is effective in the treatment of this complication. In order to evaluate its usefulness we conducted an open label, prospective and longitudinal study in 26 patients with Parkinson's disease (PD) on chronic levodopa therapy who presented peaks of dose dyskinesias. After 3 weeks' treatment dyskinesia severity was reduced by 70% (p < 0.0001) on the I SAPD scale and by 68.8% (p < 0.0002) on the UPDRS IV subscale. Patients were later evaluated every 45 days showing persistent drug benefit during follow-up ranging from 2 to 11 months (mean 6.5 months). One third of our series presented unwanted effects which were only severe enough in 2 cases to discontinue treatment. In the others, side effects were transient or readily abated with amantadine dose reduction. Our findings support amantadine as a safe and useful drug to treat levodopa-induced dyskinesias which on occasion prove as disabling as PD itself. Treatment with amantadine should routinely be considered before indicating pallidotomy for levodopa-induced dyskinesias.
Subject(s)
Amantadine/therapeutic use , Antiparkinson Agents/therapeutic use , Dyskinesia, Drug-Induced/drug therapy , Levodopa/adverse effects , Parkinson Disease/drug therapy , Adult , Aged , Aged, 80 and over , Antiparkinson Agents/adverse effects , Female , Humans , Longitudinal Studies , Male , Middle Aged , Prospective Studies , Severity of Illness Index , Statistics, NonparametricSubject(s)
Albuterol/adverse effects , Asthma/drug therapy , Bronchodilator Agents/adverse effects , Myoclonus/chemically induced , Respiratory Insufficiency/drug therapy , Aged , Aged, 80 and over , Albuterol/administration & dosage , Bronchodilator Agents/administration & dosage , Dose-Response Relationship, Drug , Electromyography/drug effects , Humans , Male , Middle Aged , Myoclonus/diagnosisABSTRACT
The development of dyskinesias is a common side effect during chronic levodopa therapy in parkinsonian patients. Recent reports suggest that amantadine, a drug with well known antiparkinsonian activity, is effective in the treatment of this complication. In order to evaluate its usefulness we conducted an open label, prospective and longitudinal study in 26 patients with Parkinsons disease (PD) on chronic levodopa therapy who presented peaks of dose dyskinesias. After 3 weeks treatment dyskinesia severity was reduced by 70
(p < 0.0001) on the I SAPD scale and by 68.8
(p < 0.0002) on the UPDRS IV subscale. Patients were later evaluated every 45 days showing persistent drug benefit during follow-up ranging from 2 to 11 months (mean 6.5 months). One third of our series presented unwanted effects which were only severe enough in 2 cases to discontinue treatment. In the others, side effects were transient or readily abated with amantadine dose reduction. Our findings support amantadine as a safe and useful drug to treat levodopa-induced dyskinesias which on occasion prove as disabling as PD itself. Treatment with amantadine should routinely be considered before indicating pallidotomy for levodopa-induced dyskinesias.
