Laboratory for the Study of Upper Airway Dysfunction, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, 32603, USA.
Department of Speech, Language, and Hearing Sciences, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, 32603, USA.
Dysphagia. 2024 Oct;39(5):797-807. doi: 10.1007/s00455-023-10660-4. Epub 2024 Jan 18.
Deep brain stimulation (DBS) is a common treatment for motor symptoms of Parkinson disease (PD), a condition associated with increased risk of dysphagia. The effect of DBS on swallowing function has not been comprehensively evaluated using gold-standard imaging techniques, particularly for globus pallidus internus (GPi) DBS. The objective of this retrospective, cross-sectional study was to identify differences in swallowing safety and timing kinematics among PD subjects with and without GPi DBS. We investigated the effects of unilateral and bilateral GPi DBS as well as the relationship between swallowing safety and DBS stimulation parameters, using retrospective analysis of videofluoroscopy recordings (71 recordings from 36 subjects) from electronic medical records. Outcomes were analyzed by surgical status (pre-surgical, unilateral DBS, bilateral DBS). The primary outcome was percent of thin-liquid bolus trials rated as unsafe, with Penetration-Aspiration Scale scores of 3 or higher. Secondary analyses included swallowing timing measures, relationships between swallowing safety and DBS stimulation parameters, and Dynamic Imaging Grade of Swallowing Toxicity ratings. Most subjects swallowed all boluses safely (19/29 in the pre-surgical, 16/26 in the unilateral DBS, and 10/16 in the bilateral DBS conditions). Swallowing safety impairment did not differ among stimulation groups. There was no main effect of stimulation condition on timing metrics, though main effects were found for sex and bolus type. Stimulation parameters were not correlated with swallowing safety. Swallowing efficiency and overall impairment did not differ among conditions. These results provide evidence that GPi DBS does not affect pharyngeal swallowing function. Further, prospective, investigations are needed.
深部脑刺激（DBS）是治疗帕金森病（PD）运动症状的常用方法，这种疾病与吞咽困难的风险增加有关。使用金标准成像技术（尤其是对苍白球 internus [GPi] DBS）全面评估 DBS 对吞咽功能的影响尚未得到充分评估。本回顾性、横断面研究的目的是确定 PD 患者有无 GPi DBS 之间吞咽安全性和时程运动学的差异。我们通过电子病历中的视频透视记录的回顾性分析（36 名患者的 71 个记录），研究了单侧和双侧 GPi DBS 的影响，以及吞咽安全性与 DBS 刺激参数之间的关系。结果通过手术状态（术前、单侧 DBS、双侧 DBS）进行分析。主要结果是评分 3 或更高的稀薄液滴试验中不安全的百分比，使用渗透-吸入量表评分。次要分析包括吞咽时程测量、吞咽安全性与 DBS 刺激参数之间的关系以及吞咽毒性动态成像分级。大多数患者安全吞咽所有的吞咽物（术前 19/29、单侧 DBS 16/26、双侧 DBS 10/16）。刺激组之间的吞咽安全性受损没有差异。刺激条件对时程指标没有主要影响，但性别和吞咽物类型有主要影响。刺激参数与吞咽安全性无关。吞咽效率和整体损伤在各组之间没有差异。这些结果表明，GPi DBS 不影响咽部吞咽功能。需要进一步进行前瞻性研究。
