Is dysphagia in multiple system atrophy responsive to levodopa? Results from a retrospective study

Background: Dysphagia remains a major clinical concern in multiple system atrophy (MSA), and so far, lacks relevant treatment options.

Objective: To systematically assess levodopa-responsiveness of dysphagia in MSA.

Methods: 19 MSA-patients underwent endoscopic swallowing evaluation in Off- and On-state, following an adapted FEES-levodopa-test-protocol. Findings were compared between states and correlated to disease-specific and demographic factors.

Results: All 19 MSA-patients 70 [66–72] years, 15/4 MSA-P/ C, 10 women exhibited dysphagia. Levodopa-responsiveness of motor-impairment was poor (UPDRS-3 Off 46 [34–52] vs On 43 [40–48], P = 0.31). Dysphagia severity varied greatly. Sum-scores ranged between 9–21 in Off and 6–20 in On. MSA-P-patients were more likely to have higher sum-scores (rpb 0.41, P = 0.01). Sum-scores otherwise were independent of disease-specific and demographic factors. 3/19 MSA-patients showed marked score-improvement by ≥30% through reduced leaking and aspiration but remained unchanged for the majority. Scores worsened in 2/19 patients. In the group analysis, the median dysphagia-score remained unchanged (2 [1, 2], P = 0.28). The occurrence of leaking, pharyngeal residue, penetration, and aspiration was not changed (P = 0.13–0.19). Severity of leaking was reduced (3 [2–4] vs. 0[0.5–1], P < 0.0001), while severity of pharyngeal residue, penetration, and aspiration remained unchanged (P = 0.29–0.53). Liquids were more often associated with leaking (P < 0.05) and aspiration (P < 0.005). All patients exhibited laryngeal movement disorders, with irregular arytenoid cartilage movements (iACM) being observed in all patients, regardless of levodopa-state.

Conclusion: The levodopa-response in MSA-related dysphagia varies greatly. Some patients might improve markedly, necessitating individual assessments to tailor patient-specific therapies. Non-pharmacological measures should be investigated to address dysphagia in MSA. IACM again proved to be highly prevalent in MSA.