Article
Deep brain stimulation-improvement of dysphagia in patients with Parkinson's disease
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Authors
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Wilma Vorwerk
- universitätsklinik für HNO-Heilkunde, Magdeburg, Germany
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Imke Galazky
- Universitätsklinik für Neurologie, Magdeburg, Germany
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Christoph Arens
- Universitätsklinik für HNO-Heilkunde, Magdeburg, Germany
| Published: | July 6, 2010 |
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Outline
Text
Dysphagia and hypersalivation are common axial symptoms of Parkinson’s disease (PD). Complications are pharyngeal retentions and aspiration that can make oral nutrition impossible. Dysphagia in PD may persist in spite of improvement of motor symptoms by medication or surgical treatment with deep brain stimulation (DBS). However recent radiographic swallow studies could show an improvement of dysphagia by subthalamic nucleus DBS.
Background: All phases of swallowing have been shown to be impaired in PD. Laryngoskopic studies allow more detailed informations about the pharyngeal phase which is important regarding retention and aspiration. This study aimed in the evaluation of qualitative and quantitative variations of swallowing in PD by DBS.
Methods: Seven patients with PD underwent stereotactic surgery for treatment with subthalamic nucleus DBS. Patients were evaluated for dysphagia in medication off state, before surgery and during DBS. The anatomy of orofacial structures were examined by an otolaryngologist. A videotaped laryngoskopy was performed including a qualitative and quantitative assessment of retention, penetration, aspiration a leaking regarding solid, mashed and liquid food.
Results: Before surgery as well as during DBS 5 patients complained dysphagia. All of them reported a feeling of tacked bolus, 2 patients additionally reported aspiration. Two patients were free of symptoms. Before surgery retention of solid food was found in all 5 symptomatic patients and in one patient without complaints, leaking was detected in 4 patients. Aspiration was not observed. Penetration was normal in all patients. During DBS retention improved in 3 of 5 patients. All patients with leaking showed an improvement during DBS.
Conclusion: Based on laryngoskopic criteria dysphagia in Parkinsonian patients was improved to a variable extent during DBS of the subthalamic nucleus. The decrease of retentions is supposed to be related to a harmonization of motor activity. It is not clear yet if leaking was caused by an impaired laryngeal sensitivity or an impaired fine motor tuning or both. Since DBS seems to be effective on swallowing disturbance in PD the interaction of the motor and sensory parts in swallowing could give an explanation for the varability of improvement in individual patients.
