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Swallowing Outcomes Following Unilateral STN vs. GPi Surgery: A Retrospective Analysis

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Abstract

The adverse effects of deep brain stimulation (DBS) surgery on swallowing could potentially exacerbate the natural deterioration of airway protection associated with Parkinson’s disease (PD) degeneration and increase the incidence of aspiration pneumonia and associated death. There are no studies that compare swallowing outcomes associated with subthalamic nucleus (STN) versus globus pallidus interna (GPi) DBS surgery; therefore, we completed a retrospective study comparing swallowing outcomes in a cohort of patients with PD who underwent unilateral DBS surgery in either the STN or GPi. A chart review was completed to identify all patients with a diagnosis of PD who received videofluoroscopic swallowing evaluations before DBS and after unilateral DBS in the STN or GPi. The retrospective search yielded 33 patients (STN = 14, GPi = 19) with idiopathic PD who met the inclusion criteria. Mean penetration–aspiration (PA) scores did not change significantly for participants who underwent GPi surgery (z = –.181, p = .857), but mean PA scores significantly worsened for participants who underwent STN DBS (z = –2.682, p = .007). There was a significant improvement in Unified PD Rating Scale (UPDRS) scores off medication before surgery, to off medication and on stimulation after surgery for both groups (F = 23.667, p < .001). Despite the limitations of a retrospective analysis, this preliminary study suggests that unilateral STN DBS may have an adverse effect on swallowing function, while unilateral GPi DBS does not appear to have a similar deleterious effect. This study and other future studies should help to elucidate the mechanisms underpinning the effects of DBS on swallowing function.

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References

  1. Zahodne LB, Okun MS, Foote KD, Fernandez HH, Rodriguez RL, Kirsch-Darrow L, et al. Cognitive declines one year after unilateral deep brain stimulation surgery in Parkinson’s disease: a controlled study using reliable change. Clin Neuropsychol. 2009;23:385–405.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Anderson VC, Burchiel KJ, Hogarth P, Favre J, Hammerstad JP. Pallidal vs subthalamic nucleus deep brain stimulation in Parkinson disease. Arch Neurol. 2005;62:554–60.

    Article  PubMed  Google Scholar 

  3. Okun MS, Gallo BV, Mandybur G, et al. Subthalamic deep brain stimulation with a constant-current device in Parkinson’s disease: an open-label randomised controlled trial. Lancet Neurol. 2012;11:140–9.

    Article  PubMed  Google Scholar 

  4. Follett KA, Weaver FM, Stern M, Hur K, Harris CL, Luo P, et al. Pallidal versus subthalamic deep-brain stimulation for Parkinson’s disease. N Engl J Med. 2010;362:2077–91.

    Article  CAS  PubMed  Google Scholar 

  5. Hariz MI, Rehncrona S, Quinn NP, Speelman JD, Wensing C, et al. Multicenter study on deep brain stimulation in Parkinson’s disease: an independent assessment of reported adverse events at 4 years. Mov Disord. 2008;23:416–21.

    Article  PubMed  Google Scholar 

  6. Rocchi L, Carlson-Kuhta P, Chiari L, Burchiel KJ, Hogarth P, Horak FB. Effects of deep brain stimulation in the subthalamic nucleus or globus pallidus internus on step initiation in Parkinson disease: laboratory investigation. J Neurosurg. 2012;117:1141–9.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Rodrigues JP, Walters SE, Watson P, Stell R, Mastaglia FL. Globus pallidus stimulation improves both motor and nonmotor aspects of quality of life in advanced Parkinson’s disease. Mov Disord. 2007;22:1866–70.

    Article  PubMed  Google Scholar 

  8. Zahodne LB, Okun MS, Foote KD, Fernandez HH, Rodriguez RL, Wu SS, et al. Greater improvement in quality of life following unilateral deep brain stimulation surgery in the globus pallidus as compared to the subthalamic nucleus. J Neurol. 2009;256:1321–9.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Videnovic A, Metman LV. Deep brain stimulation for Parkinson’s disease: prevalence of adverse events and need for standardized reporting. Mov Disord. 2008;23:343–9.

    Article  PubMed  Google Scholar 

  10. Drapier D, Drapier S, Sauleau P, Haegelen C, Raoul S, Biseul I, et al. Does subthalamic nucleus stimulation induce apathy in Parkinson’s disease? J Neurol. 2006;253:1083–91.

    Article  CAS  PubMed  Google Scholar 

  11. Funkiewiez A, Ardouin C, Caputo E, Krack P, Fraix V, Klinger H, et al. Long term effects of bilateral subthalamic nucleus stimulation on cognitive function, mood, and behaviour in Parkinson’s disease. J Neurol Neurosurg Psychiatr. 2004;75:834–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Troche MS, Brandimore AE, Foote KD, Okun MS. Swallowing and deep brain stimulation in Parkinson’s disease: a systematic review. Parkinsonism Relat Disord. 2013;19:783–8.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Chung SJ, Jeon SR, Kim SR, Sung YH, Lee MC. Bilateral effects of unilateral subthalamic nucleus deep brain stimulation in advanced Parkinson’s disease. Eur Neurol. 2006;56:127–32.

    Article  PubMed  Google Scholar 

  14. Taba HA, Wu SS, Foote KD, Hass CJ, Fernandez HH, Malaty IA, et al. A closer look at unilateral versus bilateral deep brain stimulation: results of the National Institutes of Health COMPARE cohort. J Neurosurg. 2010;113:1224–9.

    Article  PubMed  Google Scholar 

  15. Alberts JL, Hass CJ, Vitek JL, Okun MS. Are two leads always better than one: an emerging case for unilateral subthalamic deep brain stimulation in Parkinson’s disease. Exp Neurol. 2008;214:1–5.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood J. A penetration–aspiration scale. Dysphagia. 1996;11:93–8.

    Article  CAS  PubMed  Google Scholar 

  17. McHorney CA, Robbins J, Lomax K, Rosenbek JC, Chignell K, Kramer AE, et al. The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia. 2002;17:97–114.

    Article  PubMed  Google Scholar 

  18. Bronstein JM, Tagliati M, Alterman RL, Lozano AM, Volkmann J, Stefani A, et al. Deep brain stimulation for Parkinson disease: an expert consensus and review of key issues. Arch Neurol. 2011;68:165.

    Article  PubMed  Google Scholar 

  19. Gorell JM, Johnson CC, Rybicki BA. Parkinson’s disease and its comorbid disorders: an analysis of Michigan mortality data, 1970 to 1990. Neurology. 1994;44:1865–8.

    Article  CAS  PubMed  Google Scholar 

  20. Ciucci MR, Barkmeier-Kraemer JM, Sherman SJ. Subthalamic nucleus deep brain stimulation improves deglutition in Parkinson’s disease. Mov Disord. 2008;23:676–83.

    Article  PubMed  Google Scholar 

  21. Silbergleit AK, Lewitt P, Junn F, Schultz LR, Collins D, Beardsley T, et al. Comparison of dysphagia before and after deep brain stimulation in Parkinson’s disease. Mov Disord. 2012;27:1763–8.

    Article  PubMed  Google Scholar 

  22. Kulneff L, Sundstedt S, Olofsson K, van Doorn J, Linder J, Nordh E, et al. Deep brain stimulation—effects on swallowing function in Parkinson’s disease. Acta Neurol Scand. 2012;127:329–36.

    Article  PubMed  Google Scholar 

  23. Lengerer S, Kipping J, Rommel N, Weiss D, Breit S, Gasser T, et al. Deep-brain-stimulation does not impair deglutition in Parkinson’s disease. Parkinsonism Relat Disord. 2012;18:847–53.

    Article  PubMed  Google Scholar 

  24. Wolz M, Hauschild J, Fauser M, Klingelhofer L, Reichmann H, Storch A. Immediate effects of deep brain stimulation of the subthalamic nucleus on nonmotor symptoms in Parkinson’s disease. Parkinsonism Relat Disord. 2012;18:994–7.

    Article  PubMed  Google Scholar 

  25. Kitashima A, Umemoto G, Tsuboi Y, Higuchi MA, Baba Y, Kikuta T. Effects of subthalamic nucleus deep brain stimulation on the swallowing function of patients with Parkinson’s disease. Parkinsonism Relat Disord. 2013;19:480–2.

    Article  PubMed  Google Scholar 

  26. Ramig LO, Fox C, Sapir S. Parkinson’s disease: speech and voice disorders and their treatment with the Lee Silverman Voice Treatment. Semin Speech Lang. 2004;25:169–80.

    Article  PubMed  Google Scholar 

  27. Mena-Segovia J, Bolam JP, Magill PJ. Pedunculopontine nucleus and basal ganglia: distant relatives or part of the same family? Trends Neurosci. 2004;27:585–8.

    Article  CAS  PubMed  Google Scholar 

  28. Benarroch EE. Pedunculopontine nucleus: functional organization and clinical implications. Neurology. 2013;80:1148–55.

    Article  PubMed  Google Scholar 

  29. Carpenter MB. Core text of neuroanatomy. 3rd ed. Baltimore: Williams & Wilkins; 1985.

    Google Scholar 

  30. St George RJ, Carlson-Kuhta P, Burchiel KJ, Hogarth P, Frank N, Horak FB. The effects of subthalamic and pallidal deep brain stimulation on postural responses in patients with Parkinson disease. J Neurosurg. 2012;116:1347–56.

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

The authors thank the participants and their families. This work was funded in part by an National Institutes of Health (NCATS) CTSA through the University of Florida (UL1TR000064 and KL2TR000065).

Disclosures

Dr. Troche’s work is supported in part by an NIH (NCATS) CTSA through the University of Florida (UL1TR000064 and KL2TR000065). Ms. Brandimore’s work is supported in part by a predoctoral fellowship through the Department of Veterans Affairs. Dr. Morishita has been supported by Japan Society for Promotion of Science and St. Luke Life Science Institute. He has received honoraria from Otsuka pharmaceutical as a consultant within the past 12 months. Dr. Hegland’s work is supported in part by the American Heart Association and BAE defense systems. Dr. Okun serves as a consultant for the National Parkinson Foundation and has received research grants from NIH, NPF, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. Dr. Okun has previously received honoraria, but in the past >36 months has received no support from industry. Dr. Okun has received royalties for publications with Demos, Manson, Amazon, and Cambridge (movement disorders books). Dr. Okun is an associate editor for New England Journal of Medicine Journal Watch Neurology. Dr. Okun has participated in CME activities on movement disorders in the last 36 months sponsored by PeerView, Prime, and Vanderbilt University. The institution and not Dr. Okun receives grants from Medtronic and ANS/St. Jude and has no financial interest in these grants. Dr. Okun has participated as a site primary investigator and/or coinvestigator for several NIH-, foundation-, and industry-sponsored trials over the years but has not received honoraria. Dr. Foote and Mr. Chen have no disclosures to report.

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Authors and Affiliations

  1. Department of Speech, Language, and Hearing Sciences, University of Florida, PO Box 117420, Gainesville, FL, 32611, USA

    Michelle S. Troche, Alexandra E. Brandimore & Karen W. Hegland

  2. Department of Neurosurgery, University of Florida, 1600 SW Archer Rd, Gainesville, FL, 32610, USA

    Kelly D. Foote & Takashi Morishita

  3. Department of Neurology, University of Florida, 2000 SW Archer Rd, Gainesville, FL, 32610, USA

    Michael S. Okun

  4. Center for Movement Disorders and Neurorestoration, University of Florida, 3450 Hull Rd, Gainesville, FL, 32607, USA

    Michelle S. Troche, Alexandra E. Brandimore, Kelly D. Foote, Takashi Morishita, Dennis Chen, Karen W. Hegland & Michael S. Okun

  5. Brain Rehabilitation Research Center, Malcom Randall VA, 1601 SW Archer Rd, Gainesville, FL, 32608, USA

    Alexandra E. Brandimore

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  1. Michelle S. Troche
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  2. Alexandra E. Brandimore
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  3. Kelly D. Foote
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  4. Takashi Morishita
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  5. Dennis Chen
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  6. Karen W. Hegland
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  7. Michael S. Okun
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Correspondence to Michelle S. Troche.

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Troche, M.S., Brandimore, A.E., Foote, K.D. et al. Swallowing Outcomes Following Unilateral STN vs. GPi Surgery: A Retrospective Analysis. Dysphagia 29, 425–431 (2014). https://doi.org/10.1007/s00455-014-9522-0

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  • DOI: https://doi.org/10.1007/s00455-014-9522-0

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