EMST and TMS for Treatment of Dysphagia in Parkinson's Disease

Expiratory Muscle Strength Training (EMST) and Transcranial Magnetic Stimulation (TMS) for Treatment of Swallowing Disorders in Parkinson's Disease

The purpose of the study is to examine the effectiveness of different methods for the treatment of dysphagia in Parkinson's disease (PD). More than 80% of patients suffering from PD develop dysphagia during the course of their disease leading to malnutrition, loss of life quality, weight loss and pneumonia, which is the leading cause of death in these patients. So far, only a few specific treatment approaches have been investigated in PD patients with swallowing disorders. The investigator want to compare a 4-week expiratory muscle strength training (EMST), transcranial magnetic stimulation (TMS), and combination of both with a sham therapy. Dysphagia severity before and after intervention is measured by flexible endoscopic evaluation of swallowing (FEES). For the evaluation of changes in cortical swallowing processing the investigators apply magnetoencephalography (MEG).

Inclusion Criteria:

• Hoehn & Yahr stages II-IV
• Parkinson-related dysphagia
• Oral nutrition
• Ambulant setting
• No change of medication for at least 4 weeks before study inclusion

Exclusion Criteria:

• Other causes for dysphagia
• Other neurological disease potentially causing dysphagia
• Dementia (MMSE<25; Montreal cognitive assessment (MoCA)<26)
• Severe depression (BDI>19)
• Percutaneous endoscopic gastrostomy (PEG)