Consensus on the treatment of dysphagia in Parkinson's disease

Dysphagia is common in Parkinson's disease (PD). The effects of antiparkinsonian drugs on dysphagia are controversial. Several treatments for dysphagia are available but there is no consensus on their efficacy in PD. To conduct a systematic review of the literature and to define consensus statements on the treatment of dysphagia in PD and related nutritional management. A multinational group of experts in the field of neurogenic dysphagia and/or Parkinson's disease conducted a systematic evaluation of the literature and reported the results according to PRISMA guidelines. The evidence from the retrieved studies was analyzed and discussed in a consensus conference organized in Pavia, Italy, and the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus. The literature review retrieved 64 papers on treatment and nutrition of patients with PD and dysphagia, mainly of Class IV quality. Based on the literature and expert opinion in cases where the evidence was limited or lacking, 26 statements were developed. The statements developed by the Consensus panel provide a guidance for a multi-disciplinary treatment of dysphagia in patients with PD, involving neurologists, otorhinolaryngologists, gastroenterologists, phoniatricians, speech-language pathologists, dieticians, and clinical nutritionists. •PD treatments should be optimized to minimize the impact on swallowing function•Treatment of dysphagia should be guided by an instrumental assessment of swallowing•There is insufficient evidence to support the use of neuromodulation techniques•Botulinum toxin is an option for isolated upper esophageal sphincter impairment•PEG feeding must be considered on an individual basis, but not in case of dementia