van Hooren M R A, Baijens L W J, Voskuilen S, Oosterloo M, Kremer B
Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Parkinsonism Relat Disord. 2014 Aug;20(8):800-7. doi: 10.1016/j.parkreldis.2014.03.026. Epub 2014 Apr 8.
Dysphagia remains a common problem in Parkinson's disease (PD). Previous systematic reviews on therapy effects for oropharyngeal dysphagia in PD have shown a lack of evidence. In the past 5 years several placebo or sham-controlled trials with varying results have been published.
The aim of this systematic literature review is to summarize and qualitatively analyze the published studies on this matter.
METHOD(S): Studies published up to December 2013 were found via a systematic comprehensive electronic database search using PubMed, Embase, and The Cochrane Library. Two reviewers independently assessed the studies using strict inclusion criteria.
RESULT(S): Twelve studies were included and qualitatively analyzed using critical appraisal items. The review includes rehabilitative (exercises, electrical stimulation, bolus modification etc.) and pharmacologic treatment. Some well-designed controlled trials were included. However, none of the included studies fulfilled all criteria for external and internal validity. A meta-analysis was not carried out as most of the studies were not of sufficient quality to warrant doing so.
Expiratory Muscle Strength Training (EMST) and Video-Assisted Swallowing Therapy (VAST) may be effective dysphagia treatments solely or in addition to dopaminergic therapy for PD. However, these preliminary results warrant further investigation concerning their clinical applicability, and further research should be based on randomized sham-controlled trials to determine the effectiveness and long-term effects of different therapies for dysphagia in PD.
吞咽困难仍是帕金森病（PD）中的常见问题。先前关于PD口咽吞咽困难治疗效果的系统评价显示缺乏证据。在过去5年中，已发表了几项结果各异的安慰剂或假对照试验。
本系统文献综述的目的是总结并定性分析关于此问题已发表的研究。
通过使用PubMed、Embase和Cochrane图书馆进行系统全面的电子数据库检索，查找截至2013年12月发表的研究。两名评价者使用严格的纳入标准独立评估这些研究。
纳入12项研究，并使用关键评价项目进行定性分析。该综述包括康复治疗（运动、电刺激、食团改良等）和药物治疗。纳入了一些设计良好的对照试验。然而，纳入的研究均未满足所有外部和内部有效性标准。由于大多数研究质量不足以进行荟萃分析，因此未进行荟萃分析。
呼气肌力量训练（EMST）和视频辅助吞咽治疗（VAST）单独或联合多巴胺能治疗PD时，可能是有效的吞咽困难治疗方法。然而，这些初步结果需要进一步研究其临床适用性，并且进一步的研究应基于随机假对照试验，以确定不同治疗方法对PD吞咽困难的有效性和长期效果。
