Consensus on the treatment of dysphagia in Parkinson's disease

Antonio Schindler¹, Nicole Pizzorni², Emanuele Cereda³, Giuseppe Cosentino⁴, Micol Avenali⁵, Cristina Montomoli⁶, Giovanni Abbruzzese⁷, Angelo Antonini⁸, Filippo Barbiera⁹, Marco Benazzo¹⁰, Eduardo Benarroch¹¹, Giulia Bertino¹⁰, Pere Clavè¹², Pietro Cortelli¹³, Roberto Eleopra¹⁴, Chiara Ferrari¹, Shaheen Hamdy¹⁵, Maggie-Lee Huckabee¹⁶, Leonardo Lopiano¹⁷, Rosario Marchese-Ragona¹⁸, Stefano Masiero¹⁹, Emilia Michou²⁰, Antonio Occhini⁹, Claudio Pacchetti²¹, Ronald F Pfeiffer²², Domenico A Restivo²³, Mariangela Rondanelli²⁴, Giovanni Ruoppolo²⁵, Giorgio Sandrini²⁶, Anthony Schapira²⁷, Fabrizio Stocchi²⁸, Eduardo Tolosa²⁹, Francesca Valentino²¹, Mauro Zamboni³⁰, Roberta Zangaglia²¹, Mario Zappia³¹, Cristina Tassorelli⁵, Enrico Alfonsi³²

Affiliations

¹ Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
² Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy. Electronic address: nicole.pizzorni@unimi.it.
³ Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
⁴ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy.
⁵ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy.
⁶ Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy.
⁷ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa-IRCCS Ospedale Policlinico San Martino, Genova, Italy.
⁸ Parkinson and Movement Disorders Unit, Center for Neurodegenerative Diseases (CENSE), Department of Neuroscience, University of Padua, Padua, Italy.
⁹ Azienda Sanitaria Provinciale Agrigento - UO Complessa Radiologia Distretto Ag 2 Sciacca-Ribera, Presidio Ospedaliero di Sciacca (AG), Sciacca, Agrigento, Italy.
¹⁰ Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
¹¹ Department of Neurology, Mayo Clinic, Rochester, MN, USA.
¹² Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Instituto de Salud Carlos III, Barcelona, Spain.
¹³ IRCCS, Istituto di Scienze Neurologiche di Bologna, Bologna, Italy; DIBINEM, University of Bologna, Italy.
¹⁴ Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
¹⁵ Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Salford Royal Hospital, Salford, UK.
¹⁶ Department of Communication Disorders, Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch, New Zeland.
¹⁷ Department of Neuroscience "Rita Levi Montalcini", University of Torino, Italy.
¹⁸ ENT Department, University of Padova, Padua, Italy.
¹⁹ Rehabilitation Unit, Department of Neuroscience, University of Padova, Padua, Italy.
²⁰ Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece.
²¹ Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy.
²² Department of Neurology, Oregon Health and Science University, Portland, OR, USA.
²³ Department of Neurology, Garibaldi Hospital, Catania, Italy.
²⁴ Department of Public Health, Experimental and Forensic Medicine, Unit of Human and Clinical Nutrition, University of Pavia, Pavia, Italy; IRCCS Mondino Foundation, Pavia, Italy.
²⁵ Department of Sense Organs, Sapienza University of Rome, Rome, Italy.
²⁶ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
²⁷ Department of Clinical and Movement Neurosciences, UCL, Queen Square Institute of Neurology, London, UK.
²⁸ University and Institute for Research and Medical Care IRCCS San Raffaele, Rome, Italy.
²⁹ Parkinson disease and Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII) Barcelona, Spain.
³⁰ Department of Medicine, Division of Geriatrics, Healthy Aging Center, University of Verona, Italy.
³¹ Department GF Ingrassia, University of Catania, Catania, Italy.
³² Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy.

PMID: 34624796
DOI: 10.1016/j.jns.2021.120008

Free article

Consensus on the treatment of dysphagia in Parkinson's disease

Antonio Schindler et al. J Neurol Sci. 2021.

Free article

. 2021 Nov 15:430:120008.

doi: 10.1016/j.jns.2021.120008. Epub 2021 Sep 27.

Authors

Affiliations

¹ Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
² Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy. Electronic address: nicole.pizzorni@unimi.it.
³ Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
⁴ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy.
⁵ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy.
⁶ Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy.
⁷ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa-IRCCS Ospedale Policlinico San Martino, Genova, Italy.
⁸ Parkinson and Movement Disorders Unit, Center for Neurodegenerative Diseases (CENSE), Department of Neuroscience, University of Padua, Padua, Italy.
⁹ Azienda Sanitaria Provinciale Agrigento - UO Complessa Radiologia Distretto Ag 2 Sciacca-Ribera, Presidio Ospedaliero di Sciacca (AG), Sciacca, Agrigento, Italy.
¹⁰ Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
¹¹ Department of Neurology, Mayo Clinic, Rochester, MN, USA.
¹² Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Instituto de Salud Carlos III, Barcelona, Spain.
¹³ IRCCS, Istituto di Scienze Neurologiche di Bologna, Bologna, Italy; DIBINEM, University of Bologna, Italy.
¹⁴ Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
¹⁵ Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Salford Royal Hospital, Salford, UK.
¹⁶ Department of Communication Disorders, Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch, New Zeland.
¹⁷ Department of Neuroscience "Rita Levi Montalcini", University of Torino, Italy.
¹⁸ ENT Department, University of Padova, Padua, Italy.
¹⁹ Rehabilitation Unit, Department of Neuroscience, University of Padova, Padua, Italy.
²⁰ Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece.
²¹ Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy.
²² Department of Neurology, Oregon Health and Science University, Portland, OR, USA.
²³ Department of Neurology, Garibaldi Hospital, Catania, Italy.
²⁴ Department of Public Health, Experimental and Forensic Medicine, Unit of Human and Clinical Nutrition, University of Pavia, Pavia, Italy; IRCCS Mondino Foundation, Pavia, Italy.
²⁵ Department of Sense Organs, Sapienza University of Rome, Rome, Italy.
²⁶ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
²⁷ Department of Clinical and Movement Neurosciences, UCL, Queen Square Institute of Neurology, London, UK.
²⁸ University and Institute for Research and Medical Care IRCCS San Raffaele, Rome, Italy.
²⁹ Parkinson disease and Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII) Barcelona, Spain.
³⁰ Department of Medicine, Division of Geriatrics, Healthy Aging Center, University of Verona, Italy.
³¹ Department GF Ingrassia, University of Catania, Catania, Italy.
³² Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy.

PMID: 34624796
DOI: 10.1016/j.jns.2021.120008

Abstract

Background: Dysphagia is common in Parkinson's disease (PD). The effects of antiparkinsonian drugs on dysphagia are controversial. Several treatments for dysphagia are available but there is no consensus on their efficacy in PD.

Objective: To conduct a systematic review of the literature and to define consensus statements on the treatment of dysphagia in PD and related nutritional management.

Methods: A multinational group of experts in the field of neurogenic dysphagia and/or Parkinson's disease conducted a systematic evaluation of the literature and reported the results according to PRISMA guidelines. The evidence from the retrieved studies was analyzed and discussed in a consensus conference organized in Pavia, Italy, and the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus.

Results: The literature review retrieved 64 papers on treatment and nutrition of patients with PD and dysphagia, mainly of Class IV quality. Based on the literature and expert opinion in cases where the evidence was limited or lacking, 26 statements were developed.

Conclusions: The statements developed by the Consensus panel provide a guidance for a multi-disciplinary treatment of dysphagia in patients with PD, involving neurologists, otorhinolaryngologists, gastroenterologists, phoniatricians, speech-language pathologists, dieticians, and clinical nutritionists.

Keywords: Consensus development conference; Deglutition disorders; Nutrition; Parkinson's disease; Rehabilitation.

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Consensus on the treatment of dysphagia in Parkinson's disease

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Consensus on the treatment of dysphagia in Parkinson's disease

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