The Effect of Levodopa on Swallowing in Parkinson's Disease: are There Benefits in Administration Before Meals?

Parkinson's disease is frequently associated with overt and subclinical swallowing disorders. It is not clear whether these are responsive to levodopa therapy. As levodopa is usually prescribed to be taken after meals, we hypothesised that swallowing at meal time would improve by administration of levodopa one hour prior to meals. Twenty‐one subjects with idiopathic Parkinson's disease treated with levodopa were randomised to receive their levodopa for one week at the same time as their meals (A) or one hour before (B). A modified barium swallow (MBS) was then performed at the usual meal time to assess swallowing function. Subjects were crossed over to the other treatment arm and the study repeated a week later. Subjects were then crossed back to the original randomisation and a third study performed. There were improvements in oropharyngeal transit time when subjects were given levodopa one hour …