{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:25:45Z","timestamp":1791318345613,"version":"4.3.1"},"reference-count":11,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2018,3,28]],"date-time":"2018-03-28T00:00:00Z","timestamp":1522195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2018,3,28]],"date-time":"2018-03-28T00:00:00Z","timestamp":1522195200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Case Rep Neurol"],"abstract":"<jats:p>&lt;b&gt;&lt;i&gt;Objective:&lt;\/i&gt;&lt;\/b&gt; The causes of \u201cdelayed-on\u201d and \u201cno-on\u201d phenomena in Parkinson disease (PD) are thought to have some impact on the progress of L-DOPA from the time of ingestion until it reaches the brain and is converted to dopamine. Dysphagia can cause fluctuating symptom expression in L-DOPA therapy for PD. &lt;b&gt;&lt;i&gt;Case Description:&lt;\/i&gt;&lt;\/b&gt; A 69-year-old man with PD presented with \u201cdelayed-on\u201d and \u201cno-on\u201d phenomena. The patient developed a gait disorder at age 60 years, and he began coughing on his food during breakfast at age 64 years. Even though he was independent in daily life, he could not eat because of dysphagia in an \u201coff\u201d state. Videofluoroscopic examination of swallowing in an \u201coff\u201d state revealed bradykinesia of the tongue and the retention of tablets in the epiglottic vallecula. We trained him to keep his tongue in strong contact with the upper incisors before swallowing. After rehabilitation of dysphagia, the frequency of \u201cdelayed-on\u201d and \u201cno-on\u201d phenomena decreased, and his peak L-DOPA plasma concentration was elevated. Additionally, transdermal rotigotine (RTG) was initiated at a maintenance dose of 9.0 mg. The patient reported improvement in swallowing, and the frequency of \u201cno-on\u201d phenomena decreased. &lt;b&gt;&lt;i&gt;Conclusion:&lt;\/i&gt;&lt;\/b&gt; In PD patients, the \u201cno-on\u201d phenomenon can be caused by posterior contractile dysfunction of the tongue, and it can be improved with training of the tongue and transdermal RTG administration.<\/jats:p>","DOI":"10.1159\/000488138","type":"journal-article","created":{"date-parts":[[2018,3,28]],"date-time":"2018-03-28T21:01:24Z","timestamp":1522270884000},"page":"101-107","source":"Crossref","is-referenced-by-count":19,"title":["Dysphagia Causes Symptom Fluctuations after Oral L-DOPA Treatment in a Patient with Parkinson Disease"],"prefix":"10.1159","volume":"10","author":[{"given":"Hiromasa","family":"Sato","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiyuki","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masako","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiko","family":"Furusawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miho","family":"Murata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2018,3,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(03)00307-7"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01271202"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.46.4.1051"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198402233100802"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.5692\/clinicalneurol.49.493"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.2004.00364.x"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016\/S0303-8467(97)00606-9"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-015-9622-5"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s00702-011-0622-9"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.brainres.2010.03.029"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2006.11.002"}],"container-title":["Case Reports in Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/488138","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/488138","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T16:50:04Z","timestamp":1745427004000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000488138"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,28]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,6,7]]}},"URL":"https:\/\/doi.org\/10.1159\/000488138","archive":["Portico"],"relation":{},"ISSN":["1662-680X"],"issn-type":[{"value":"1662-680X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3,28]]}}}