Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany.
Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany.
Ann Clin Transl Neurol. 2020 May;7(5):628-638. doi: 10.1002/acn3.51027. Epub 2020 Apr 8.
Dysphagia is a frequent and highly relevant symptom in Parkinson's disease (PD) due to high associated morbidity and mortality. To compare the effect of simultaneous stimulation of the subthalamic nucleus (STN) and substantia nigra (SNr) with conventional STN-stimulation on swallowing function in Parkinson's disease.
In this controlled, randomized, double-blind, cross-over clinical trial, 15 PD patients were assessed with DBS switched off (STIM OFF), STN-DBS, STN + SNr-DBS. Patients and 32 age-matched healthy controls were examined clinically and by flexible-endoscopic evaluation of swallowing (FEES) to evaluate the swallowing function. The primary endpoint was the assessment of residues, secondary endpoints were penetration/aspiration, leakage, retained pharyngeal secretions, drooling, and assessments of the patient's self-perception of swallowing on a visual analog scale.
Compared with healthy controls PD patients showed significantly more pharyngeal residues in STIM OFF and both DBS modes. Residues or aspiration events were found in 80% of the patients under STN-stimulation. Simultaneous STN + SNr-stimulation had no additional positive effect on objective dysphagia and self-reported swallowing function compared to STN-DBS.
Simultaneous STN + SNr-stimulation seems to have no additional beneficial effects on dysphagia when compared with conventional STN-stimulation, but did not deteriorate the swallowing function. If STN + SNr-stimulation is planned to be applied for the improvement of axial symptoms and gait disorders in PD patients, it can be considered safe in terms of dysphagia.
吞咽困难是帕金森病（PD）的常见且高度相关的症状，因为其具有较高的相关发病率和死亡率。本研究旨在比较丘脑底核（STN）与黑质（SNr）同时刺激与常规 STN 刺激对帕金森病吞咽功能的影响。
在这项对照、随机、双盲、交叉临床试验中，15 例 PD 患者接受了 DBS 关闭（STIM OFF）、STN-DBS 和 STN+SNr-DBS 治疗。对患者和 32 名年龄匹配的健康对照者进行了临床和吞咽功能的纤维内镜评估（FEES），以评估吞咽功能。主要终点是评估残留量，次要终点是渗透/吸入、泄漏、咽潴留分泌物、流涎以及患者对吞咽的自我感知的视觉模拟量表评估。
与健康对照组相比，PD 患者在 STIM OFF 和两种 DBS 模式下均表现出明显更多的咽部残留。在 STN 刺激下，80%的患者出现残留或吸入事件。与 STN-DBS 相比，同时进行 STN+SNr 刺激对客观吞咽困难和自我报告的吞咽功能没有额外的积极影响。
与常规 STN 刺激相比，同时进行 STN+SNr 刺激似乎对吞咽困难没有额外的益处，但不会恶化吞咽功能。如果计划对 PD 患者进行 STN+SNr 刺激以改善轴性症状和步态障碍，那么从吞咽困难的角度来看，该刺激是安全的。
