Hirano Makito, Samukawa Makoto, Isono Chiharu, Inada Rino, Fukumoto Yuta, Yoshikawa Keisuke, Namura Hitoshi, Sakata Hanami, Hisatomi Takahiro, Michiura Toru, Nakamura Hiroto, Morita Akira, Hoshino Genki, Yamana Kensuke, Terayama Atsushi, Higashimoto Yuji, Mitsui Yoshiyuki, Nagai Yoshitaka
Department of Neurology, Kindai University, Faculty of Medicine, Japan.
Division of Rehabilitation Medicine, Kindai University Hospital, Japan.
Clin Park Relat Disord. 2025 Jul 29;13:100378. doi: 10.1016/j.prdoa.2025.100378. eCollection 2025.
Dysphagia is a potentially fatal symptom of Parkinson's disease (PD) and is characterized by frequent silent aspiration, a known risk factor for aspiration pneumonia. A previous study has reported that the dopamine agonist rotigotine (levodopa equivalent dose of 60 mg/day) delivered via transdermal patch improves swallowing function more effectively than oral levodopa (200 mg/day), highlighting the importance of continuous dopaminergic stimulation (CDS) in managing dysphagia. To achieve CDS, patients with advanced PD may require device-assisted therapies (DATs), including levodopa-carbidopa intestinal gel (LCIG), which have significantly improved swallowing function on some measures. In contrast, swallowing function is an important prognostic factor for patients with PD undergoing LCIG. Continuous subcutaneous infusion of foslevodopa/foscarbidopa (CSCI-FF) is a newly developed DAT; however, its effect on swallowing function remains unknown.
This retrospective open-label evaluator-blinded study included seven patients with PD. Swallowing function was assessed using videofluoroscopic swallow studies (VFSS) conducted before and after initiating CSCI-FF. Evaluations included the Japanese Swallowing Scale, the Dysphagia Outcome and Severity Scale (DOSS), Penetration/Aspiration Scale, oral transit time (OTT), and pharyngeal transit time (PTT).
Following the introduction of CSCI-FF, results of VFSS showed significant improvement in the total score of the Japanese swallowing scale, OTT, and PTT.
This study provides preliminary evidence that CSCI-FF may partially improve swallowing function in patients with advanced PD. Further research with larger cohorts is warranted.
吞咽困难是帕金森病（PD）的一种潜在致命症状，其特征是频繁的隐性误吸，这是吸入性肺炎的一个已知危险因素。先前的一项研究报告称，通过透皮贴剂给药的多巴胺激动剂罗替戈汀（左旋多巴等效剂量为60毫克/天）比口服左旋多巴（200毫克/天）更有效地改善吞咽功能，突出了持续多巴胺能刺激（CDS）在管理吞咽困难中的重要性。为了实现CDS，晚期PD患者可能需要设备辅助治疗（DATs），包括左旋多巴-卡比多巴肠凝胶（LCIG），在某些指标上其显著改善了吞咽功能。相比之下，吞咽功能是接受LCIG治疗的PD患者的一个重要预后因素。持续皮下输注福司左旋多巴/福司卡比多巴（CSCI-FF）是一种新开发的DAT；然而，其对吞咽功能的影响仍然未知。
这项回顾性开放标签评估者盲法研究纳入了7例PD患者。在开始CSCI-FF之前和之后，使用电视荧光吞咽造影检查（VFSS）评估吞咽功能。评估包括日本吞咽量表、吞咽困难结果和严重程度量表（DOSS）、渗透/误吸量表、口腔通过时间（OTT）和咽部通过时间（PTT）。
引入CSCI-FF后，VFSS结果显示日本吞咽量表的总分、OTT和PTT有显著改善。
本研究提供了初步证据，表明CSCI-FF可能部分改善晚期PD患者的吞咽功能。有必要对更大的队列进行进一步研究。
