umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Swallowing function in patients with Parkinson’s disease and Deep Brain Stimulation
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Sväljningsfunktion hos patienter med Parkinsons sjukdom och djup hjärnstimulering (Swedish)
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 [en]
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: urn:nbn:se:umu:diva-127116ISBN: 978-91-7601-606-0 (print)OAI: oai:DiVA.org:umu-127116DiVA: diva2:1062857
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
List of papers
1. Deep brain stimulation: effects on swallowing function in Parkinson's disease
Open this publication in new window or tab >>Deep brain stimulation: effects on swallowing function in Parkinson's disease
Show others...
2013 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 127, no 5, 329-336 p.Article in journal (Refereed) Published
Abstract [en]

Objective: In patients with Parkinson’s disease (PD), deep brainstimulation of the subthalamic nucleus (STN DBS) is well recognizedin improving limb function, but the outcome on swallowing functionhas rarely been studied. The aim of this work was to evaluate theeffect of STN DBS on pharyngeal swallowing function in patientswith PD using self-estimation and fiberoptic endoscopic evaluation ofswallowing.

Methods: Eleven patients (aged 41–72, median 61 years)were evaluated preoperatively and at 6 and 12 months after STN DBSsurgery. All patients were evaluated with self-estimation on a visualanalogue scale, and eight of them with a fiberoptic endoscopicexamination with a predefined swallowing protocol includingRosenbek’s Penetration-Aspiration Scale, Secretion Severity Scale,preswallow spillage, pharyngeal residue, and pharyngeal clearance.

Results: The self-assessments of swallowing function revealed asubjective improvement with STN DBS stimulation, whereas the datafrom the swallowing protocol did not show any significant effect ofthe STN DBS treatment itself. The prevalence of aspiration was notaffected by the surgery.

Conclusions: The results show thatswallowing function was not negatively affected by STN DBS and therisk of aspiration did not increase. Self-estimation of swallowingfunction showed a subjective improvement due to stimulation

Place, publisher, year, edition, pages
Wiley and sons: John Wiley & Sons, 2013
Keyword
deep brain stimulation; subthalamic nucleus; dysphagia; Parkinson’s disease; fiberoptic endoscopic evaluation of swallowing; swallowing function; aspiration; L-dopa
National Category
Otorhinolaryngology
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-61453 (URN)10.1111/ane.12019 (DOI)
Projects
Speech, voice and swallowing outcomes after deep brain stimulation (DBS)
Available from: 2013-04-11 Created: 2012-11-14 Last updated: 2017-01-25Bibliographically approved
2. Swallowing function in Parkinson’s patients following Zona Incerta deep brain stimulation
Open this publication in new window or tab >>Swallowing function in Parkinson’s patients following Zona Incerta deep brain stimulation
Show others...
2012 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 126, no 5, 350-356 p.Article in journal (Refereed) Published
Abstract [en]

Objective The purpose of the present study was to examine if there was a negative effect of caudal Zona Incerta deep brain stimulation (cZI DBS) on pharyngeal swallowing function in Parkinson’s patients (PD). There are no former reports on swallowing and cZI DBS.

Methods Eight patients (aged 49 to 71 years; median 62) were evaluated pre- and postoperatively, at six and 12 months after DBS surgery. Evaluation tools were Fiberoptic Endoscopic Evaluation of Swallowing examinations and patients’ self-assessments of the swallowing function including a visual analogue scale and quality of life related questions. The swallowing protocol included Rosenbeck’s Penetration-Aspiration Scale, Secretion Severity Scale and parameters for pre-swallow spillage, pharyngeal residue and pharyngeal clearance.

Results There was no clear-cut effect of neurostimulation postoperatively at six and 12 months on any of the swallowing parameters except for pre-swallow spillage which was slightly worsened in the stimulation on condition 12m postoperatively. The answers to the self assessment questions did not vary significantly.

Conclusions The effect of the stimulation on swallowing function varied among individuals but the overall outcome was that cZI DBS did not seem to have a negative influence on swallowing function in the eight patients studied.

Place, publisher, year, edition, pages
John Wiley & Sons, 2012
Keyword
Deep brain stimulation, caudal Zona Incerta, Dysphagia, Parkinson's disease, FEES, aspiration, swallowing function, L-dopa, complications
National Category
Otorhinolaryngology Surgery Neurology
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:umu:diva-55468 (URN)10.1111/j.1600-0404.2012.01658.x (DOI)000309400300009 ()
Available from: 2012-05-22 Created: 2012-05-16 Last updated: 2017-01-25Bibliographically approved
3. Swallowing safety in Parkinson's disease after zona incerta Deep Brain Stimulation
Open this publication in new window or tab >>Swallowing safety in Parkinson's disease after zona incerta Deep Brain Stimulation
Show others...
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
Keyword
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:nbn:se:umu:diva-129785 (URN)10.1002/brb3.709 (DOI)000403784700017 ()28638714 (PubMedID)
Note

Originally published in thesis in manuscript form.

Available from: 2017-01-09 Created: 2017-01-09 Last updated: 2017-08-08Bibliographically approved
4. ­­Swallowing quality of life after zona incerta Deep brain stimulation
Open this publication in new window or tab >>­­Swallowing quality of life after zona incerta Deep brain stimulation
Show others...
2017 (English)In: Annals of Otology, Rhinology and Laryngology, ISSN 0003-4894, E-ISSN 1943-572X, Vol. 126, no 2, 110-116 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The management of Parkinson’s disease (PD) has been improved, but management of features like swallowing problems is still challenging. Deep Brain Stimulation (DBS) alleviates the cardinal motor symptoms and improves quality of life, but its effect on swallowing is not fully explored. The purpose of this study was to examine self-reported swallowing specific quality of life, before and after caudal zona incerta DBS (cZI DBS), in comparison with a control group.

Methods: Nine PD patients (2 women and 7 men) completed the self-report Swallowing Quality of Life questionnaire (SWAL-QOL) before and 12 months after cZI DBS surgery. The postoperative data were compared to nine controls. Median ages were 53 years (range 40-70) for patients and 54 years (range 42-72) for controls.

Results: No significant differences were found between the pre-, or postoperative scores. The SWAL-QOL total scores did not differ significantly between PD patients and controls. PD patients reported significantly lower scores in the 'burden' subscale and in the 'symptom' scale.

Conclusions: PD patients selected for cZI DBS showed a good self-reported swallowing specific quality of life, in many aspects equal to controls. CZI DBS did not negatively affect swallowing specific quality of life in this study.

Keyword
caudal zona incerta, Deep Brain Stimulation, Dysphagia, Parkinson’s disease, Swallowing quality of life
National Category
Otorhinolaryngology
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:umu:diva-127115 (URN)10.1177/0003489416675874 (DOI)000397728500004 ()27831516 (PubMedID)
Available from: 2016-11-21 Created: 2016-10-31 Last updated: 2017-05-11Bibliographically approved

Open Access in DiVA

fulltext(1210 kB)75 downloads
File information
File name FULLTEXT03.pdfFile size 1210 kBChecksum SHA-512
ae6e19f6c3f27e9fbf4f37600755f3fc4911ca5d43a0286df72f526535f526a40d74bad068db3101531107ee926552b7ecf53e2ea2a8f336a21f0e8aeeb01875
Type fulltextMimetype application/pdf
spikblad(116 kB)13 downloads
File information
File name SPIKBLAD01.pdfFile size 116 kBChecksum SHA-512
f5ba91ed75c8b271981e165abe7f29623551b1dc68f3afd07664948871ec621905d4ff964fa056265c2d14c0e747b62149932ae63014b4d332751f7264164bf2
Type spikbladMimetype application/pdf

Search in DiVA

By author/editor
Sundstedt, Stina
By organisation
Otorhinolaryngology
Otorhinolaryngology

Search outside of DiVA

GoogleGoogle Scholar
Total: 75 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Total: 826 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf