Session Time: 1:45pm-3:15pm
Location: Exhibit Hall C
Objective: We report on three consecutive patients with Parkinson’s disease, in whom myasthenia gravis turned out responsible for progressive dysphagia.
Background: Swallowing dysfunction is common in Parkinson’s disease. However, other etiologies have to be considered.
Methods: Case series
Results: A 82-year old man with a 6 year history of parkinson’s disease presented with gait difficulties and progressive dysphagia since 2 years. Neurological exam showed an untypical bulbar dysarthria. Edrophoniumchlorid-test was strikingly positive. Anti-acetylcholinreceptor (AChR) -antibodies were elevated: 0.55 nmol/l (normal: <0.39). Pyridostigmine (240 mg/d) showed no clear improvement and higher dosages were not tolerated due to abdominal discomfort. Due to severe dysphagia the patient received IVIG (5 days each 0.4g/kg) and prednisolone (20 mg/d) under which symptoms improved considerably. Additionally a treatment with azathioprin was started.
A 95-year old man with a 5 year history of parkinsons’s disease presented with dysphagia, frequent choking und sometimes nasal regurgitation since one year. Neurological exam showed dysphagia during water swallowing test. Edrophoniumchlorid-test was not performed due to cardiopulmonal diseases. Anti-AChR-antibodies were elevated: 2.01 nmol/l. Pyridostigmine (330 mg/d) and prednisolone (20 mg/d) led to improvement of dysphagia.
A 83-year old man with a 5 year history of parkinsons’s disease presented with swallowing difficulties for solids and liquids and sialorrhea worsening in the evening since a few months. Neurological exam showed hypophonia and dysphagia worsening when eating. Oral pyridostigmine test was positive. Anti-AChR-antibodies were elevated: 0.54 nmol/l. Pyridostigmine (120 mg/d) and prednisolone (20 mg/d) improved dysphagia considerably.
In all patients 3-Hz-stimulation of nasal and trapezius muscles showed no decrement and thorax-CT excluded thymoma.
Conclusions: In all patients progressive dysphagia was initially related to parkinson’s disease. Indicative for myasthenia gravis was either the Parkinson untypical bulbar dysarthria or some fluctuation of dysphagia. Diagnosis was established by positive anti-AChR-antibodies and responding on symptomatic and immunosuppressive treatment.
To cite this abstract in AMA style:P. Urban. Parkinson’s disease and progressive dysphagia – consider myasthenia gravis [abstract]. Mov Disord. 2017; 32 (suppl 2). https://www.mdsabstracts.org/abstract/parkinsons-disease-and-progressive-dysphagia-consider-myasthenia-gravis/. Accessed December 3, 2023.
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