A Perspective of the Wearing-off Phenomenon in a Patient with Parkinson’s Disease: A Case Report

Abstract

Dysphagia is a major disability in patients with Parkinson’s disease. Unlike typical motor symptoms, dysphagia is relatively unresponsive to dopaminergic drugs. However, occasionally, swallowing difficulties are much improved by dopaminergic agonists and significantly affected by on/off periods. In such cases, it is difficult to assess the severity of dysphagia accurately if swallowing function evaluation is performed without considering the wearing-off phenomenon in patients with PD. Here, we report a case of dysphagia in a female patient with Parkinson’s disease that was severely affected by the wearing-off phenomenon in response to prolonged use of levodopa. The patient presented with severe oral phase delay with choking symptoms during fluid intake. A videofluoroscopic swallow study performed during an ‘off-period’ showed massive aspiration with severely impaired swallowing function. However, when swallowing evaluation was performed during the ‘on-period’, almost no abnormal function was observed. After adopting an on/off period-tailored diet prescription, sufficient nutrition was possible without aspiration. Consideration of the wearing-off phenomenon is essential when evaluating swallowing function in patients with Parkinson’s disease. Patient-specific swallowing evaluations and diet prescriptions are needed to establish optimal therapeutic strategies.