NW Center for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA.
NW Center for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA.
Clin Neurol Neurosurg. 2021 Apr;203:106587. doi: 10.1016/j.clineuro.2021.106587. Epub 2021 Mar 2.
Swallowing problems are common in Parkinson's Disease (PD) and aspiration pneumonia is the leading cause of death. Deep brain stimulation (DBS) surgery can successfully manage the motor symptoms of PD when pharmacological management begins to fail. Before DBS it is important to identify baseline dysfunction, but no consensus regarding swallowing screening exists.
This study was undertaken to: 1) identify the prevalence of dysphagia prior to DBS; and 2) determine if screening measures or other characteristics were predictive for reduced airway protection.
A standardized protocol was performed for 137 consecutive patients with idiopathic PD and no confounding medical conditions, including those referred for work-up of dysphagia (n = 57) and those prior to DBS (n = 80). Three validated screening measures were completed before videofluoroscopic evaluation.
On videofluoroscopy, there were significant differences in reduced airway protection by group (dysphagia group: 44 %; pre-DBS group: 21 %). Aspiration also differed by group (dysphagia group: 18 %; pre-DBS group: 8 %) although not significantly. Although there were significant between-group differences, none of the screening measures was predictive of reduced airway protection or aspiration in the sample overall. Male gender, previous videofluoroscopic evaluation, history of pneumonia, and previous DBS surgery were associated with increased aspiration-risk. Age also showed a modest correlation.
Dysphagia is not uncommon prior to DBS. No screening measure accurately predicted reduced airway protection on videofluoroscopy. Abnormal findings on clinical assessment prior to DBS, particularly in patients that are older, male, or have a history of pneumonia, may identify individuals requiring an objective dysphagia evaluation.
吞咽问题在帕金森病（PD）中很常见，吸入性肺炎是导致死亡的主要原因。当药物治疗开始失效时，深部脑刺激（DBS）手术可以成功治疗 PD 的运动症状。在进行 DBS 之前，识别基线功能障碍很重要，但目前尚无关于吞咽筛查的共识。
本研究旨在：1）确定 DBS 前吞咽困难的患病率；2）确定筛查措施或其他特征是否与气道保护能力降低相关。
对 137 例无混杂医学条件的特发性 PD 患者（包括因吞咽困难而接受评估的患者[n = 57]和 DBS 前的患者[n = 80]）进行了标准化的方案。在视频透视检查前完成了三种经过验证的筛查措施。
在视频透视检查中，两组患者的气道保护能力存在显著差异（吞咽困难组：44%；DBS 前组：21%）。两组的吸入情况也存在差异（吞咽困难组：18%；DBS 前组：8%），但无统计学意义。虽然两组间存在显著差异，但没有一种筛查措施可以预测整个样本中气道保护能力或吸入的情况。男性、先前的视频透视评估、肺炎病史和先前的 DBS 手术与吸入风险增加相关。年龄也显示出适度的相关性。
在 DBS 之前，吞咽困难并不罕见。没有任何筛查措施可以准确预测视频透视检查中的气道保护能力降低。在 DBS 前的临床评估中出现异常发现，特别是在年龄较大、男性或有肺炎病史的患者中，可能会识别出需要进行客观吞咽评估的个体。
