PMC5903165_01
Brain magnetic resonance imaging results. T2-weighted magnetic resonance imaging (axial image of the pons at the level of the medial longitudinal fasciculus) was normal in this patient.
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F1
There were no abnormalities in the general blood tests or on head magnetic resonance imaging (Fig. 1).
Videofluoroscopic examination of the swallowing process. a Four tablets covered with a water-soluble film were administered orally in 10 mL of jelly containing barium. Tablets remained in the epiglottic vallecula (white frame). b Enlarged view of the epiglottic vallecula. The tablets remaining in the epiglottic vallecula are seen as filling defects (asterisks).
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F2
The backward movement of the tongue root was very limited, and the tablets remained in the epiglottic vallecula (Fig. 2).
Results of the L-DOPA test. One ground L-DOPA 100 mg/carbidopa 10 mg tablet was administered orally on an empty stomach after waking in the morning, and the L-DOPA blood concentration was measured seven times from before the tablet was administered to 240 min after ingestion. Prior to rehabilitative intervention, the tablet was ineffective (a "no-on" state), parkinsonian signs did not improve, and the maximum blood L-DOPA concentration was 0.78 nmol/mL (solid line). After dysphagia rehabilitation, the patient was able to swallow the tablets quickly, his parkinsonism symptoms improved within 30 min after administration, and his maximum blood L-DOPA concentration was 9.99 nmol/mL (dashed line).
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F3
There was no improvement in parkinsonian symptoms even 4 h after administration, and the blood L-DOPA level only rose to 0.78 nmol/mL (Fig. 3). The highest blood level of the drug was 9.99 nmol/mL 30 min after administration (Fig. 3).