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Deep brain stimulation: effects on swallowing function in Parkinson's disease
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 Clinical Sciences, Otorhinolaryngology.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
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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. Vol. 127, no 5, 329-336 p.
Keyword [en]
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: urn:nbn:se:umu:diva-61453DOI: 10.1111/ane.12019OAI: oai:DiVA.org:umu-61453DiVA: diva2:615326
Projects
Speech, voice and swallowing outcomes after deep brain stimulation (DBS)
Available from: 2013-04-11 Created: 2012-11-14 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Swallowing and deep brain stimulation: swallowing function in Parkinson's disease after subthalamic nucleus and caudal zona incerta deep brain stimulation
Open this publication in new window or tab >>Swallowing and deep brain stimulation: swallowing function in Parkinson's disease after subthalamic nucleus and caudal zona incerta deep brain stimulation
2014 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Background Swallowing problems are common in Parkinson’s disease, and these affect morbidity and mortality largely due to aspiration-induced pneumonia. Even mild dysphagia affects patient Quality of Life. Deep Brain Stimulation (DBS), a surgical treatment for Parkinson’s disease, improves overall motor function, though the effect of DBS on swallowing function is not clear. The aim of the studies in this thesis was to improve our understanding of the effect from DBS of caudal zona incerta and subthalamic nucleus on pharyngeal swallowing function. Specific aims were to compare DBS effects over time postoperatively (6 & 12 months) for swallowing function, on and off stimulation, with a preoperative baseline assessment in order to identify possible negative swallowing effects of DBS.

Methods Eight patients with DBS in caudal zona incerta and eleven patients with DBS in subthalamic nucleus were included in the two studies. The effect of DBS on swallowing function was evaluated by self-estimation on a visual analogue scale and fiberoptic endoscopic evaluation of swallowing function with a predefined swallowing protocol including Rosenbek’s Penetration/Aspiration Scale, Secretion Severity Scale,preswallow spillage, pharyngeal residue and pharyngeal clearance. The patients with caudal zona incerta DBS also answered questions regarding swallowing-related Quality of Life. All patients received L-dopa treatment during postoperative assessments.

Results There was no clear effect of DBS on swallowing function in the two samples. The occurrence of aspiration, secretions, pharyngeal residue or clearance was not affected by the surgery or the stimulation. In the subthalamic nucleus DBS sample, self-estimations revealed an improvement with stimulation turned on. For the caudal zona incerta DBS patients, no effect of DBS was seen on the results from the swallowing-related QOL questions.

Conclusion Subthalamic nucleus DBS and caudal zona incerta DBS did not appear to have a negative effect on swallowing function in this cohort. Patients with subthalamic nucleus DBS reported a self-perceived improvement in swallowing function after DBS. There appears to be no increased risk for aspiration or penetration due to surgery or stimulation regardless of stimulation site. 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, 2014. 34 p.
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:umu:diva-86133 (URN)978-91-7459-789-9 (ISBN)
Supervisors
Available from: 2014-02-27 Created: 2014-02-18 Last updated: 2014-03-14Bibliographically approved
2. 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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