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Swallowing safety in Parkinson's disease after zona incerta Deep Brain Stimulation
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
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2017 (English)In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 7, no 6, e00709Article in journal (Refereed) Published
Abstract [en]

Objectives: The objective of this study was to examine swallowing function in patients with Parkinson's disease before and after caudal zona incerta deep brain (cZI DBS) surgery. The aims were to examine the effect of cZI DBS on swallowing safety regarding liquid and solid food, as well as to identify the effect of cZI DBS on body mass index (BMI) and specific items from part II of the Unified Parkinson's Disease Rating Scale (UPDRS).

Materials and Methods: The median age of the 14 patients was 57 years (range 46–71), with a median disease duration of 6 years (range 2–13). The present sample is an extension of a previous report, into which six additional patients have been added. Fiber endoscopic examinations of swallowing function, measures of BMI, and evaluation of UPDRS part II items were made before and 12 months after surgery, with and without activated DBS.

Results: There were no significant changes due to cZI DBS regarding penetration/aspiration, pharyngeal residue or premature spillage (> .05). Median BMI increased by +1.1 kg/m2 12 months after surgery (= .01, = .50). All reported specific symptoms from the UPDRS part II were slight or mild. A significant improvement regarding handling of utensils was seen 12 months postoperatively (= .03, = −.42).

Conclusions: Caudal zona incerta DBS was found not to have a negative impact on swallowing safety. A significant increase in postoperative weight was observed, and speech seemed to be slightly negatively affected, whereas handling of utensils was improved with cZI DBS.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017. Vol. 7, no 6, e00709
Keyword [en]
body mass index, caudal zona incerta, deep brain stimulation, Parkinson's disease, swallowing function
National Category
Otorhinolaryngology Neurosciences
Research subject
Oto-Rhino-Laryngology
Identifiers
URN: urn:nbn:se:umu:diva-129785DOI: 10.1002/brb3.709ISI: 000403784700017PubMedID: 28638714OAI: oai:DiVA.org:umu-129785DiVA: diva2:1062845
Note

Originally published in thesis in manuscript form.

Available from: 2017-01-09 Created: 2017-01-09 Last updated: 2017-08-08Bibliographically approved
In thesis
1. Swallowing function in patients with Parkinson’s disease and Deep Brain Stimulation
Open this publication in new window or tab >>Swallowing function in patients with Parkinson’s disease and Deep Brain Stimulation
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Sväljningsfunktion hos patienter med Parkinsons sjukdom och djup hjärnstimulering
Abstract [en]

Background

Parkinson’s disease (PD) is one of the most common neurodegenerative diseases in Europe. Besides motor dysfunction, PD is characterized by several non-motor and secondary motor features, such as weight change, sialorrhea, constipation and swallowing problems. Of these, swallowing is one of the most critical, as it is associated with aspiration pneumonia and consequently is the comorbidity with the highest mortality rate. Swallowing problems affect four of every five patients with PD, and even mild swallowing problems have notable psychosocial effects for patients and their caregivers. Consequently, it is essential to find treatment strategies for PD that may alleviate symptoms for patients with swallowing problems and their potential consequences.

Deep Brain Stimulation (DBS) is a surgical treatment option for PD, which improves overall motor function and quality of life, but its effect on swallowing function is not clear.

The purpose of this thesis was to contribute to the understanding of the effect of deep brain stimulation in the subthalamic nucleus (STN DBS) and the caudal zona incerta (cZI DBS) on pharyngeal swallowing function and on swallow-specific quality of life in patients with PD.

The specific aims were to assess longitudinally the effect of STN DBS and cZI DBS on swallowing at 6 and 12 months postoperatively, in order to identify possible effects of the DBS on swallowing function. In addition, the effects of cZI DBS on ratings of swallowing-related non-motor and secondary motor features such as body weight changes, sialorrhea and speech problems were to be assessed.

Methods

Eleven PD patients with STN DBS (Paper I) and seventeen patients with cZI DBS (Paper II-IV) were included in this thesis. All patients were evaluated preoperatively and 6 and 12 months postoperatively. The effect of STN DBS and cZI DBS on swallowing was assessed with Fibreoptic-Endoscopic Evaluation of Swallowing (FEES) according to a predefined protocol including Penetration-Aspiration scale, Secretion Severity scale, preswallow spillage, pharyngeal residue, and pharyngeal clearance. Self-assessments were addressed using a visual analogue scale. The cZI DBS patients also completed the Swallowing Quality of Life (SWAL-QOL) questionnaire. Weight changes measured by Body Mass Index, and specific items from the Unified Parkinson’s Disease Rating Scale were also examined. Nine controls without PD were included in Paper IV, by answering the SWAL-QOL questionnaire.

Results

No clear effect of DBS on swallowing function or swallow-specific quality of life could be observed. There was no effect of DBS on the occurrence of aspiration, secretion, pharyngeal residue or clearance in the study groups with STN DBS or cZI DBS. Patients with STN DBS reported a subjective improvement in swallowing function with DBS stimulation turned on at 6 and 12 months after surgery.

In patients with cZI DBS, the median body mass index was postoperatively increased with 1.1kg/m2 and the median increase in weight were +3.0 kg after 12 months with cZI DBS.

The scores from the SWAL-QOL questionnaire were high overall in the group with cZI DBS, and the scores were unaffected by the cZI DBS surgery and stimulation. The SWAL-QOL total score was not significantly different between the PD patients and the controls, but the scores from the ‘burden’ and the ‘symptom’ subscales were worse in PD patients.

Conclusions

STN DBS or cZI DBS did not have a negative effect on swallowing function or ratings of swallow-specific ‘quality of life’ aspects in this cohort. Patients with STN DBS reported a self-perceived improvement in swallowing function when DBS was turned on. With regard to swallowing, patients with cZI DBS had an overall good quality of life throughout the conduct of the study and their swallow-specific quality of life was not negatively affected by cZI DBS. There seems to be no increased risk for aspiration or penetration due to surgery or stimulation for either the STN DBS or the cZI DBS groups. cZI DBS caused weight gain postoperatively. Since the sample sizes in these cohorts are small, the findings need to be confirmed in larger studies.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2017. 49 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1859
Keyword
Parkinson’s disease, swallowing, deep brain stimulation, subthalamic nucleus, caudal zona incerta, swallowing quality of life
National Category
Otorhinolaryngology
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:umu:diva-127116 (URN)978-91-7601-606-0 (ISBN)
Public defence
2017-02-17, ÖNH föreläsningssal, Byggnad 1B, plan 3, Norrlands universitets sjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-01-27 Created: 2016-10-31 Last updated: 2017-02-01Bibliographically approved

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