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Can Sinemet cause a severe speech impairment?


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#1 NicoleZ

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Posted 21 November 2012 - 11:43 PM

Last night I met a man, a psychiatrist (former), who is now 48 years old, diagnosed at the Mayo Clinic 10 years ago with PD. 5 years ago he was about to have DBS, but decided against it....only taking Sinemet now. He has been on disability for 4 years because in his off times he has such severe gait issues that he sometimes uses a wheelchair....when in an on time he walks pretty well. BUT, when he is in an on time, he has a severe speech impairment - like so mumbled that his words are indecipherable and he communicates by typing on an IPad! Have you heard of this as a side effect of Sinemet? He does not have the impairment in off times/skips doses. He usually takes the meds so he is mobile, sacrificing his speech. He had tried many, well really all, the other PD meds and they either caused worse side effects (intractable nausea, hallucinations, etc) or didn't help much at all with symptoms.

I myself am 39 yo with YOPD, and I was shocked at how severely debilitated this man was from either PD itself or medication side effects.... It made me very sad for him, and worried for me!

#2 Dr. Mahler

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Posted 30 November 2012 - 10:29 AM

You are bringing up an important question about speech communication in people with young onset PD. I have been practicing as a speech-language pathologist for over 30 years and I have not had the experience of Sinemet having a significant negative or positive impact on the speech of someone with PD. I am also not aware of published research stating this. The best recommendation for improving communication is based on the literature identifying the benefits of exercise for people with PD. The consensus is that the impact of medications (and deep brain stimulation surgery) on speech is not as positive as it is for limb motor movement. Therefore, I recommend early referral for evaluation of communication skills and early initiation of the appropriate treatment. LSVT LOUD has been shown to improve the speech of people with idiopathic PD at all ages. (Ramig et al., 2001, Sapir et al., 2011). Please write again if I can answer any more specific questions about communication or swallowing or cognitive changes associated with PD.

Sincerely,
Leslie Mahler, PhD, CCC-SLP
Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island

#3 miracleseeker

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Posted 30 January 2013 - 09:06 AM

Hello,

My mom has always been on Stalevo. When she stopped swallowing it whole her doctor switched her to plain Sinemet. As a result she stopped speaking entirely until I took her off and back on Stalevo once again. Granted due to her dementia she doesn't really talk much so mostly mumbles but when she was on Sinemet she was completely silent.

#4 Dr. Mahler

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Posted 30 January 2013 - 01:59 PM

I am sorry to hear that your Mom is having such difficulty with speech and swallowing. I am not familiar with any studies that have found Sinemet to be detrimental to speech. Typically, the PD drugs that can be helpful for limb movement and mobility do not have as significant an impact on the muscles of speech and swallowing. That is why behavioral speech and swallowing exercise treatments are so important. There may be other effects of switching medications that have an indirect influence on communication.

If you haven't done so already, please consult a speech-language pathologist for safe swallow recommendations. Difficulty swallowing pills is usually accompanied by difficulty swallowing during meals. You want to find out if there is a risk of aspiration (some food or liquid going into the lungs instead of the stomach). If there is a problem with aspiration, then it is critical to learn what can be done to minimize the risk and maximize safety and efficiency of swallowing.

Please write again if you have any further questions.

Sincerely,

Leslie Mahler, PhD, CCC-SLP
Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island

#5 miracleseeker

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Posted 30 January 2013 - 04:10 PM

Thank you for your concern. My mom swallows just fine. She just won't swallow her medication unless they are chewed up first. The 6 months of trial and error time I spent trying to train her to do it has partially contributed to a lot of broken teeth. She even chews on the cherry bits and pieces in yogurt. You can say my mom is a very thorough eater or.... just terrified of choking even in her limited state of mind.

#6 Dr. Mahler

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Posted 31 January 2013 - 01:36 PM

This sounds like an interesting combination of behaviors that might have a solution if she were seen for an evaluation. I recommend you speak to her doctor about a referral to a speech-language pathologist. What happens when you put her pill in yogurt or something of that consistency that she enjoys eating??

Leslie Mahler
Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island

#7 miracleseeker

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Posted 31 January 2013 - 02:48 PM

My mom cannot follow directions or answer a question unless she wants to. If I put a pill in the yogurt she will chew first like always. She feels everything with her tongue. She's very good with tiny fish bones too.

#8 Dr. Mahler

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Posted 13 February 2013 - 01:21 PM

There are several possible explanations about why someone doesn't follow directions or answer questions. It would be important to find out why your Mom doesn't follow directions or answer questions because that information would make a difference in terms of strategies for communicating with her. It could be a motor speech problem, a language problem, or a cognitive problem or a combination. If your Mom hasn't seen a speech-language pathologist already, it seems appropriate that she she see one now to help you understand the communication and swallowing changes.

Sincerely,
Leslie Mahler, PhD, CCC-SLP
Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island

#9 Curt Bates

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Posted 15 May 2015 - 11:57 AM

Dr. Mahler,

 

I have been having a great deal of swallowing and speaking issues.  It doesnt matter what I am trying to eat or drink, I can only take small amounts at one time and very rarely can I finish whatever I am drinking. My speech also becomes very slurred and nasaly throughout the day and by the end of the day, it is hard for my family to understand what I am saying.  I am scheduled to see neuro next week to reaffirm PD diagnosis due to tremor, bradykinesia, micrographia, gait issues, etc.  My swallowing has gotten considerably worse over the last week.  I have not started simenet regiment as of yet, but he will begin it at next appt.  I realize that therapy is in my future, but will simenet help in any way for the swallwing and/or speech issues?

Thanks for all you do!



#10 Dr. Mahler

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Posted 01 October 2015 - 03:05 PM

Dear Curt,

This is a really good question and I'm glad that you asked.  The situation you describe is a little unusual in that I would not expect swallowing ability to change rapidly if the cause is Parkinson disease only.  This emphasizes the importance for you to have an evaluation soon.  Changes in swallowing are frequently found in people with PD.  It has been reported that as many as 95% of people with PD have dysphagia (Bird, Woodward, Gibson, Phyland, & Fonda, 1994; Logemann, Blonsky & Boshes, 1975; Potulska, Friedman, Krolicki & Spychala, 2003).  When dysphagia is present it has a negative impact on quality of life by interfering with the ability to take medications, maintain hydration and nutrition, and may result in aspiration pneumonia.  Pneumonia is one of the leading causes of death in PD (Beyer, Herlofson, Arsland, & Larson, 2001; D’Amelio, Ragonese, Morgante, Reggio, Callari, Salemi & Savettieri, 2006).  Even when there are no difficulties with swallowing, mealtimes can be effortful for people with PD possible causing them to fatigue easily and eat less.

 

Muscle rigidity, weakness and bradykinesia that are present in the limbs can also affect all phases of swallowing (Robbins et al. 1986; Labuszewski & Lidsky, 1979).   In addition, sensorimotor abnormalities may reduce the person’s awareness of symptoms of dysphagia.

 

Some Symptoms of swallowing disorders called, “dysphagia” may include:

  • Frequent coughing during meals
  • Coughing while drinking liquids or taking pills
  • A wet gurgly sounding voice quality
  • Recent unexplained weight loss
  • Recent diagnosis of pneumonia
  • Difficulty making the food “go down”

 

There are a number of reasons why swallowing can be "difficult" for a person with PD.  The reason you need to get a referral for an evaluation with a speech- language pathologist (SLP) is so that they can identify the unique causes of the swallowing difficulty for you as an individual. The evaluation usually consists of an examination of the muscles for chewing and swallowing and then possibly a modified barium swallow study if the SLP suspects a problem in the pharyngeal stage of the swallow, which is more difficult to observe directly. When the evaluation is done the SLP should be able to describe your swallowing problems, the underlying physiology causing the problems, your risk for aspiration, and treatment strategies that appropriately address the cause of the problems.
 

Although people with PD share a common etiology there may still be heterogeneity within the population regarding the cause of swallow problems.  There are a number of reasons why swallowing can be "difficult" for a person with PD and it is important for the health care team to understand these issues.  Appropriate treatment techniques to address swallowing disorders in PD need to address the motor and sensory components.  Common treatment approaches for swallowing deficits in PD include:

  • Modifying bolus flow with postures
  • Maneuvers to improve airway protection or airway clearance
  • Alterations in diet consistency
  • Sensory stimulation
  • Exercises to improve swallow function
  • Alterations in feeding environment

I recommend that you get a referral for a swallowing evaluation with a speech-language pathologist who has experience with Parkinson disease to learn what can be done to maximize swallow safety and oral intake in addition to consulting about specific diet recommendations.

 

Sinemet is a combination of drugs to replace lost dopamine and help the synthetic dopamine stay in the system to help improve symptoms of PD.  Sinemet has been documented to help with axial limb symptoms more than speech or swallowing symptoms although the response of specific individuals to the drug can not be predicted.  It is more likely that exercise will be a key variable to improving the safety and efficiency of your swallow.

 

Please write again if you have any additional questions. 

 

Sincerely,

 

Leslie Mahler, PhD, CCC-SLP


Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island




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