Comparison of dysphagia before and after deep brain stimulation in Parkinson's disease

Abstract

Although dysphagia is a common problem for many Parkinson's disease (PD) patients, the effect of deep brain stimulation (DBS) on swallowing is unclear. Fourteen subjects with advanced PD underwent videofluorographic swallowing studies prior to bilateral DBS of the subthalamic nucleus (STN) and at 3 and 12 months postprocedure. They were tested under several stimulation and medication conditions. Subjects completed the Dysphagia Handicap Index at each time. There was a strong trend toward improved swallowing response for solid intake in the medication-free condition with the stimulator on compared with the stimulator off (P = .0107). Also, there was a trend toward improved oral preparation of thin liquids (P = .0368) in the medication-free condition when the stimulator was on versus off 12 months later. The remaining swallowing parameters showed no change or worsening of swallowing function regardless of stimulator or medication status. Results of the Dysphagia Handicap Index revealed significant improvement in subject self-perception of swallowing 3 and 12 months following the procedure compared with baseline on the functional subscale (P = .020 and P = .010, respectively), the emotional subscale (P = .013 and P = .003, respectively), and the total score (P = .025 and P = .003, respectively). These data suggest that bilateral STN-DBS does not substantively impair swallowing in PD. In addition, it may improve motor sequencing of the oropharyngeal swallow for solid consistencies (which are known to provide increased sensory feedback to assist motor planning of the oropharyngeal swallow). Subjects with advanced PD who are undergoing DBS may perceive significant improvement in swallowing ability despite the lack of objective improvements in swallowing function.

The safety issues and hardware-related complications of deep brain stimulation therapy: a single-center retrospective analysis of 478 patients with Parkinson’s disease

“…Among the 39 deaths in this study group, the 15 cases of pneumonia, seven cases of asphyxia, and three cases of multiple-organ failure were all associated with swallowing impairments. These swallowing-related disorders are likely the result of stereotyped movement and motor impairment of the epiglottis and throat muscles 23,24. Kanna and Bhanu also reported a high prevalence of swallowing-related diseases in patients with PD, the severity of which was associated with the duration and severity of PD 25.…”

Rheological aspects of dysphagia-oriented food products: A mini review

“…A thicker bolus will help protect airway in comparison to thin-liquid boluses through one or more of several mechanisms, including increased sensory feedback, increased bolus cohesiveness and/or slowing bolus flow through the oropharynx [41,52]. An important feature of these studies is better hydration and positive effects on patients' quality of life through inhibition from aspiration [2].…”

Management of Dysphagia and Drooling in Patients With Parkinson’s Disease

“…In cases where drug treatment is complicated by incapacitating response fluctuations, deep brain stimulation is required -a surgical approach where electrodes are placed in the basal ganglia, most often in the subthalamic nucleus. With the exception of one case study, in which symptoms of stridor, dysphagia and aspiration were resolved when the subthalamic nucleus stimulator was switched off [58], studies have either reported no clinically relevant changes in deglutition after subthalamic nucleus deep brain stimulation [59] or an improvement of dysphagia in the 'on' condition [60][61][62], in particular in the pharyngeal stages of swallowing [63].…”