Deep-brain-stimulation does not impair deglutition in Parkinson's disease |
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| Authors: | Lengerer Sabrina Kipping Judy Rommel Natalie Weiss Daniel Breit Sorin Gasser Thomas Plewnia Christian Krüger Rejko Wächter Tobias |
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| Institution: | 1. German Centre for Neurodegenerative Diseases (DZNE), Otfried-Müller-Straße 27, 72076 Tübingen, Germany;2. Department for Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany;3. Max Planck Institute for Human Cognitive and Brain Sciences, Department of Neurology, Stephanstraße 1A, 04103 Leipzig, Germany;4. Therapiezentrum, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany;5. Department for Psychiatry and Psychotherapy, University of Tübingen, Calwerstr. 14, 72076 Tübingen, Germany;1. Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain;2. Hospital Monte Naranco, Oviedo, Asturias, Spain;3. Hospital Universitario Sant Joan d’Alacant, Sant Joan d’Alacant, Alicante, Spain;4. Complejo Hospitalario Torrecárdenas, Almería, Spain;5. Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain;6. Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPaz), Madrid, Spain;7. Hospital Universitario de Cabueñes, Gijón, Asturias, Spain;8. Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí I3PT, UAB, Sabadell, Barcelona, Spain;9. Hospital Virgen de la Salud, Toledo, Spain;10. Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain;11. Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain;12. Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain;13. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain;14. Hospital Universitari Vall d’Hebron, Barcelona, Spain;15. Instituto de Salud Musculoesquelética, Madrid, Spain;1. Department of Human Biology, University of Toronto, Toronto, ON, Canada;2. Neurological Rehabilitation Unit, Cirineo Group, Unicolciencias, Bogota, Colombia;3. Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA;4. Unit of Parkinson Disease and Movement Disorders, Mediciencias, Unicolciencias/Universidad Nacional, Bogota, Colombia;1. Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain;2. Unitat d’Exploracions Funcionals Digestives, Laboratori de Fisiologia Digestiva CIBERehd CSdM-UAB, Hospital de Mataró, Barcelona, Spain;3. Fundació Institut d’Investigació Germans Trias i Pujol, Badalona, Spain;2. The Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD;1. The University of Texas Medical Branch, Department of Pathology, Galveston, TX 77555-0609, USA;2. Texas Tech University, Department of Biological Sciences, Lubbock, TX 79409-3131, USA |
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| Abstract: | ObjectiveA large proportion of patients with Parkinson's disease develop dysphagia during the course of the disease. Dysphagia in Parkinson's disease affects different phases of deglutition, has a strong impact on quality of life and may cause severe complications, i.e. aspirational pneumonia. So far, little is known on how deep-brain-stimulation of the subthalamic nucleus influences deglutition in PD.MethodsVideofluoroscopic swallowing studies on 18 patients with Parkinson's disease, which had been performed preoperatively, and postoperatively with deep-brain-stimulation-on and deep-brain-stimulation-off, were analyzed retrospectively. The patients were examined in each condition with three consistencies (viscous, fluid and solid). The ‘New Zealand Index for Multidisciplinary Evaluation of Swallowing (NZIMES) Subscale One’ for qualitative and ‘Logemann-MBS-Parameters’ for quantitative evaluation were assessed.ResultsPreoperatively, none of the patients presented with clinically relevant signs of dysphagia. While postoperatively, the mean daily levodopa equivalent dosage was reduced by 50% and deep-brain-stimulation led to a 50% improvement in motor symptoms measured by the UPDRS III, no clinically relevant influence of deep-brain-stimulation-on swallowing was observed using qualitative parameters (NZIMES). However quantitative parameters (Logemann scale) found significant changes of pharyngeal parameters with deep-brain-stimulation-on as compared to preoperative condition and deep-brain-stimulation-off mostly with fluid consistency.ConclusionIn Parkinson patients without dysphagia deep-brain-stimulation of the subthalamic nucleus modulates the pharyngeal deglutition phase but has no clinically relevant influence on deglutition. Further studies are needed to test if deep-brain-stimulation is a therapeutic option for patients with swallowing disorders. |
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