Is Dysphagia in Multiple System Atrophy Responsive to Levodopa? Results from a Retrospective Study

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

To systematically assess levodopa-responsiveness of dysphagia in MSA.

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.

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.

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.