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Swallowing and deep brain stimulation: swallowing function in Parkinson's disease after subthalamic nucleus and caudal zona incerta deep brain stimulation
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
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: urn:nbn:se:umu:diva-86133ISBN: 978-91-7459-789-9 (print)OAI: oai:DiVA.org:umu-86133DiVA: diva2:697597
Supervisors
Available from: 2014-02-27 Created: 2014-02-18 Last updated: 2014-03-14Bibliographically approved
List of papers
1. 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
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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: 2017-12-07Bibliographically approved
2. 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
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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
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: 2017-12-06Bibliographically approved

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