Sato Hiromasa, Yamamoto Toshiyuki, Sato Masako, Furusawa Yoshihiko, Murata Miho
Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
Department of Rehabilitation Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
Case Rep Neurol. 2018 Mar 28;10(1):101-107. doi: 10.1159/000488138. eCollection 2018 Jan-Apr.
The 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.
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.
In 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.
帕金森病（PD）中“起效延迟”和“无起效”现象的原因被认为对左旋多巴从摄入到进入大脑并转化为多巴胺的过程有一定影响。吞咽困难可导致PD患者左旋多巴治疗中症状表现波动。
一名69岁的PD男性患者出现“起效延迟”和“无起效”现象。该患者60岁时出现步态障碍，64岁时早餐进食时开始出现食物呛咳。尽管他日常生活能够自理，但在“关”期因吞咽困难无法进食。对其“关”期吞咽进行视频透视检查发现舌运动迟缓以及片剂滞留在会厌谷。我们训练他在吞咽前让舌头用力抵住上切牙。吞咽困难康复后，“起效延迟”和“无起效”现象的发生频率降低，且其左旋多巴血浆峰值浓度升高。此外，开始使用维持剂量为9.0 mg的透皮罗替戈汀（RTG）。患者报告吞咽情况改善，“无起效”现象的发生频率降低。
在PD患者中，“无起效”现象可能由舌后部收缩功能障碍引起，通过舌部训练和透皮给予RTG可使其得到改善。
