Tison F, Wiart L, Guatterie M, Fouillet N, Lozano V, Henry P, Barat M
Département de Neurologie, Hôpital Pellegrin, CHU de Bordeaux, France.
Mov Disord. 1996 Nov;11(6):729-32. doi: 10.1002/mds.870110622.
Swallowing disorders are common in Parkinson's disease but are of obscure and complex nature and pathophysiology. The effect of central dopaminergic stimulation on disordered swallowing is not well known. We studied the effects of apomorphine (in combination with domperidone) on buccolinguofacial motoricity and on various swallowing stages by using videofluoroscopy in eight patients with dysphagia. Swallowing abnormalities more frequently encountered were vallecular stasis (n = 7), fragmentation of the bolus (n = 7), and buccal stagnation of the bolus. Apomorphine improved vallecular stasis and fragmentation in about half the cases and improved buccal stagnation in all cases. Direct laryngeal penetration was found in three cases and improved in two of them. The total swallowing duration was improved by apomorphine in a subset of patients (n = 5). This improvement correlated with an improvement of the buccolinguofacial motoricity and was combined with an improvement of pharyngeal transit time. Thus central dopaminergic stimulation by apomorphine improved swallowing in a subgroup of patients, mainly in its early stages.
吞咽障碍在帕金森病中很常见，但性质和病理生理机制不明且复杂。中枢多巴胺能刺激对吞咽障碍的影响尚不清楚。我们通过视频荧光吞咽造影术研究了阿扑吗啡（联合多潘立酮）对8例吞咽困难患者颊舌面部运动功能及各个吞咽阶段的影响。更常见的吞咽异常表现为会厌谷淤滞（7例）、食团破碎（7例）和食团颊部停滞。阿扑吗啡在约半数病例中改善了会厌谷淤滞和食团破碎，在所有病例中均改善了食团颊部停滞。3例出现直接喉穿透，其中2例有所改善。阿扑吗啡使部分患者（5例）的总吞咽时间缩短。这种改善与颊舌面部运动功能的改善相关，并伴有咽部通过时间的改善。因此，阿扑吗啡引起的中枢多巴胺能刺激改善了部分患者的吞咽功能，主要是在早期阶段。
