Category: Surgical Therapy: Parkinson's Disease
Objective: The primary goal of this study is to objectively assess changes in swallowing following Deep Brain Stimulation (DBS) surgery for patients with Parkinson’s disease (PD).
Background: There are few studies addressing the effect of DBS on swallowing in PD. Some have used a questionnaire – response to UPDRS Part II questions and some are case reports. We have employed the “gold standard” video fluoroscopy (VFS) by our Speech pathologist (KM) to assess swallowing function pre-DBS and then 6 months post-DBS to give an accurate comparison of swallowing function after the patient has been stabilized on PD meds and DBS settings.
Method: Our study participants underwent pre- and post-DBS VFS (6 months later). We have converted penetration and aspiration events into an objective scale based on a previously validated conversion scoring system. Higher scores denote more severe dysphagia and normal swallowing as 0. Since the data is highly skewed, we used non-parametric test (Wilcoxon signed rank test) to test if the difference between post- and pre-DBS swallow score is significantly different from 0.
Results: We had a total of 56 PD patients with completed pre- and post-DBS completed evaluations. We present demographics, clinical characteristics and medication use (pre- and post-DBS) summary in Table 1. Twenty-five patients had bilateral GPi DBS (44.6%) and 29 had bilateral STN DBS (51.8%), rest had unilateral implants. The results are summarized in Table 2. The mean (SD) post-DBS swallow score is 1.9 (2.0) and pre-DBS swallow score is 1.6 (1.4). The difference is not significantly different from 0 (p=0.32). In our study, majority of the patients’ (40 out of 56) swallow scores did not change after DBS regardless of lead location. Seven (12.5%) PD patients had post-DBS swallow score decrease on average by 1.4 (SD: 1.1) points. Nine (16.1%) patients had post-DBS swallow score increase on average by 2.7 (SD: 2.3) points.
Conclusion: In our study of 56 PD patients, we did not see a significant change in the swallow scores pre-and 6 months post-DBS with VFS, regardless of the site of bilateral lead implantation (STN vs GPi). Hence, we believe that DBS does not improve or reduce swallow function in a clinically meaningful way in PD.
To cite this abstract in AMA style:K. Henry, R. Singh, N. Zhang, K. Mcnett, M. Lyons, S. Mehta. Effect of DBS on Swallowing function in Parkinson’s disease as assessed by Video fluoroscopy [abstract]. Mov Disord. 2021; 36 (suppl 1). https://www.mdsabstracts.org/abstract/effect-of-dbs-on-swallowing-function-in-parkinsons-disease-as-assessed-by-video-fluoroscopy/. Accessed December 7, 2023.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-dbs-on-swallowing-function-in-parkinsons-disease-as-assessed-by-video-fluoroscopy/