Modulation of dysarthropneumophonia by low‐frequency STN DBS in advanced Parkinson's disease

Abstract

Chronic treatment with low-frequency STN DBS may have a beneficial impact on dysarthropneumophonia, even in advanced PD patients.

Low-frequency stimulation of STN-DBS reduces aspiration and freezing of gait in patients with PD

“…22,23 Therefore, we hypothesized that lowfrequency stimulation of 60 Hz could similarly produce better swallowing function compared with the routinely used 130 Hz, as seen on other axial symptoms. [15][16][17][18][19] This study could have critical impact on the management of dysphagia, FOG, and other axial symptoms, hence potentially decreasing the morbidity and mortality of these patients.…”

“…STN-DBS might transiently improve the axial symptoms, but could make them worse over the course of 2 to 5 years. [6][7][8][9][10][11][12][13][14][15] The DBS stimulation settings typically used in these studies were high frequency of 130 to 185 Hz.…”

“…Recently, a stimulation frequency of 60 Hz has been found to improve the axial symptoms of freezing of gait (FOG) [16][17][18][19] and dysarthria 15,19 compared with the routinely used 130-Hz stimulation. However, whether or not the stimulation frequency could also affect another axial symptom, swallowing function, remains unknown.…”

“…We tested the hypothesis that swallowing function is better at the low-frequency stimulation of 60 Hz compared with the routinely used 130 Hz in patients with PD undergoing bilateral STN-DBS in the medication-on state. We initially aimed to enroll 8 patients based on the power calculation inferred from the effect of DBS frequency on speech study, 15 because speech and swallowing function are often affected together, 6,24 which allows 80% power to detect 25% improvement on the swallowing function at 60-Hz stimulation compared with 130 Hz at the 2-tailed a level of 0.05. Because we lost one of the key staff members performing the swallowing study after we finished 7 patients, we eliminated enrollment of the last patient to ensure quality of the study, because a substitute might cause inconsistency in swallowing assessment.…”

Postoperative management of deep brain stimulation in Parkinson’s disease

“…Speech impairment is a relevant issue after STN DBS, as a result of lack of sustained and global improvement in, and worsening of, persisting dysarthria Pinto et al, 2005;Tripoliti et al, 2011). An association between speech deterioration and higher stimulation parameters (voltage and frequency) has been found (Tornqvist et al, 2005;Tripoliti et al, 2008Tripoliti et al, , 2011Moreau et al, 2011). Diffusion to the corticospinal tract has been suggested as one explanation for speech deterioration .…”