[Dysphagia in Parkinsonian Syndromes]

Dysphagia is a clinically relevant problem in Parkinson's disease as well as in atypical Parkinsonian syndromes, such as multiple system atrophy and diseases from the spectrum of 4‑repeat tauopathies, which affect most patients to a varying degree in the course of their disease. This results in relevant restrictions in daily life due to impaired intake of food, fluids, and medication with a subsequent reduction in quality of life. This article not only gives an overview of the pathophysiological causes of dysphagia in the various Parkinson syndromes, but also presents screening, diagnostic and treatment procedures that have been investigated for the different diseases.

Gastrointestinal involvement in Parkinson's disease: pathophysiology, diagnosis, and management

Growing evidence suggests an increasing significance for the extent of gastrointestinal tract (GIT) dysfunction in Parkinson's disease (PD). Most patients suffer from GIT symptoms, including dysphagia, sialorrhea, bloating, nausea, vomiting, gastroparesis, and constipation during the disease course. The underlying pathomechanisms of this α-synucleinopathy play an important role in disease development and progression, i.e., early accumulation of Lewy pathology in the enteric and central nervous systems is implicated in pharyngeal discoordination, esophageal and gastric motility/peristalsis impairment, chronic pain, altered intestinal permeability and autonomic dysfunction of the colon, with subsequent constipation. Severe complications, including malnutrition, dehydration, insufficient drug effects, aspiration pneumonia, intestinal obstruction, and megacolon, frequently result in hospitalization. Sophisticated diagnostic tools are now available that permit more detailed examination of specific GIT impairment patterns. Furthermore, novel treatment approaches have been evaluated, although high-level evidence trials are often missing. Finally, the burgeoning literature devoted to the GIT microbiome reveals its importance for neurologists. We review current knowledge about GIT pathoanatomy, pathophysiology, diagnosis, and treatment in PD and provide recommendations for management in daily practice.

Reliability and main findings of the flexible endoscopic evaluation of swallowing-Tensilon test in patients with myasthenia gravis and dysphagia

BACKGROUND AND PURPOSE

Diagnosis of pharyngeal dysphagia caused by myasthenia gravis (MG) based on clinical examination alone is often challenging. Flexible endoscopic evaluation of swallowing (FEES) combined with Tensilon (edrophonium) application, referred to as the FEES-Tensilon test, was developed to improve diagnostic accuracy and to detect the main symptoms of pharyngeal dysphagia in MG. Here we investigated inter- and intra-rater reliability of the FEES-Tensilon test and analyzed the main endoscopic findings.

METHODS

Four experienced raters reviewed a total of 20 FEES-Tensilon test videos in randomized order. Residue severity was graded at four different pharyngeal spaces before and after Tensilon administration. All interpretations were performed twice per rater, 4 weeks apart (a total of 160 scorings). Intra-rater test-retest reliability and inter-rater reliability levels were calculated.

RESULTS

The most frequent FEES findings in patients with MG before Tensilon application were prominent residues of semi-solids spread all over the hypopharynx in varying locations. The reliability level of the interpretation of the FEES-Tensilon test was excellent regardless of the rater's profession or years of experience with FEES. All four raters showed high inter- and intra-reliability levels in interpreting the FEES-Tensilon test based on residue clearance (kappa = 0.922, 0.981). The degree of residue normalization in the vallecular space after Tensilon application showed the highest inter- and intra-rater reliability level (kappa = 0.863, 0.957) followed by the epiglottis (kappa = 0.813, 0.946) and pyriform sinuses (kappa = 0.836, 0.929).

CONCLUSION

Interpretation of the FEES-Tensilon test based on residue severity and degree of Tensilon clearance, especially in the vallecular space, is consistent and reliable.

Topological oscillations of the magnetoconductance in disordered GaAs layers

Oscillatory variations of the diagonal (Gxx) and Hall (G(xy)) magnetoconductances are discussed in view of topological scaling effects giving rise to the quantum Hall effect. They occur in a field range without oscillations of the density of states due to Landau quantization, and are, therefore, totally different from the Shubnikov-de Haas oscillations. Such oscillations are experimentally observed in disordered GaAs layers in the extreme quantum limit of applied magnetic field with a good description by the unified scaling theory of the integer and fractional quantum Hall effect.

Chaos and fractals in dynamical models of transport and reaction

This paper contains a discussion of dynamical randomness among the different methods of simulation of a fluid and its characterization by the concept of Kolmogorov-Sinai entropy per unit time. Moreover, a renormalization-group method is presented in order to construct the hydrodynamic and reactive modes of relaxation in chaotic models. The renormalization-group construction allows us to obtain the dispersion relation of these modes, i.e. their damping rate versus the wavenumber. Besides, these modes are characterized by a fractal dimension given in terms of a diffusion coefficient and a Lyapunov exponent.

Fractals and dynamical chaos in a two-dimensional Lorentz gas with sinks

We consider a two-dimensional periodic reactive Lorentz gas, in which a moving point particle undergoes elastic collisions on fixed hard disks and annihilates on absorbing disks, called sinks. We present clear evidence of the existence of a fractal repeller in this open system. Moreover, we establish a relation between the reaction rate, describing the macroscopic evolution of the system, and two characteristic quantities of the microscopic chaos: the average Lyapunov exponent and the Hausdorff codimension of the fractal repeller.

Fractality of the hydrodynamic modes of diffusion

Transport by normal diffusion can be decomposed into hydrodynamic modes which relax exponentially toward the equilibrium state. In chaotic systems with 2 degrees of freedom, the fine scale structures of these modes are singular and fractal, characterized by a Hausdorff dimension given in terms of Ruelle's topological pressure. For long-wavelength modes, we relate the Hausdorff dimension to the diffusion coefficient and the Lyapunov exponent. This relationship is tested numerically on two Lorentz gases, one with hard repulsive forces, the other with attractive, Yukawa forces. The agreement with theory is excellent.

Cross-neutralization of thrombin-like enzymes in snake venoms by polyvalent antivenoms

Five polyvalent antivenoms (Crotalidae; Orient, North, Central and South Africa) were tested for their ability to neutralize the thrombin-like activity of snake venoms (Bitis gabonica, Agkistrodon acutus, Bothrops asper, B. atrox, Crotalus adamanteus). Considerable cross-neutralization was observed. Anti-coagulase antibodies were isolated from an antivenom by affinity chromatography using a purified enzyme from Bitis gabonica venom. These antibodies neutralized the activity of most snake venom coagulant enzymes.