Walter Maetzler1,2, Tim W Rattay1,2, Markus A Hobert1,2, Matthis Synofzik1,2, Angela Bader1,3, Daniela Berg1,2, Eva Schaeffer1,2, Natalie Rommel1,3, David Devos4,5, Bastiaan R Bloem6, Benjamin Bender7,8. 1. Center of Neurology Department of Neurodegeneration and Hertie Institute for Clinical Brain Research University of Tübingen Tübingen Germany. 2. DZNE German Center for Neurodegenerative Diseases Tübingen Germany. 3. Therapiezentrum University of Tübingen Tübingen Germany. 4. INSERM U1171 Université Lille Lille France. 5. Pharmacologie Médicale Centre Hospitalier Régional Universitaire Lille France. 6. Department of Neurology Radboud University Medical Center Donders Institute for Brain, Cognition and Behavior Nijmegen The Netherlands. 7. Department of Radiology University Hospital Tübingen Tübingen Germany. 8. Department of Neuroradiology University Hospital Tübingen Tübingen Germany.
Abstract
BACKGROUND: Swallowing deficits and freezing phenomena represent severe parkinsonian features. Freezing as a symptom occurring during swallowing has not been reported on yet. METHODS: We report on 3 patients with probable PSP-parkinsonism (PSP-P) who manifested freezing of swallowing (FOS). RESULTS: All 3 patients experienced severe weight loss in recent months. At examination, 1 patient had freezing of gait. Video fluoroscopy showed nonfunctional trembling movements of the tongue and palate during chewing and volitional swallowing, with a 6- to 8-Hz frequency that is typical for freezing episodes during walking and finger tapping. These freezing episodes were accompanied by impaired oral bolus transportation. The pharyngeal phase was not relevantly affected. CONCLUSIONS: FOS represents a novel disease feature of PSP-P. The feature may have fundamental, but potentially treatable, consequences for patients' health and quality of life and may be considered in patients with degenerative parkinsonism who experience severe and unexplained weight loss.
BACKGROUND: Swallowing deficits and freezing phenomena represent severe parkinsonian features. Freezing as a symptom occurring during swallowing has not been reported on yet. METHODS: We report on 3 patients with probable PSP-parkinsonism (PSP-P) who manifested freezing of swallowing (FOS). RESULTS: All 3 patients experienced severe weight loss in recent months. At examination, 1 patient had freezing of gait. Video fluoroscopy showed nonfunctional trembling movements of the tongue and palate during chewing and volitional swallowing, with a 6- to 8-Hz frequency that is typical for freezing episodes during walking and finger tapping. These freezing episodes were accompanied by impaired oral bolus transportation. The pharyngeal phase was not relevantly affected. CONCLUSIONS: FOS represents a novel disease feature of PSP-P. The feature may have fundamental, but potentially treatable, consequences for patients' health and quality of life and may be considered in patients with degenerative parkinsonism who experience severe and unexplained weight loss.
Entities:
Keywords:
dysphagia; freezing; motor block; parkinsonism; swallowing
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