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Impacts of Deep Brain Stimulation of the Globus Pallidus Internus on Swallowing: A Retrospective, Cross-Sectional Study

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Abstract

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.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Chuck Jacobson, IV, for his assistance with querying the UF INFORM database.

Funding

This research did not receive specific grant funding from any agencies.

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Authors and Affiliations

  1. Laboratory for the Study of Upper Airway Dysfunction, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, 32603, USA

    May Smith-Hublou & Karen Wheeler-Hegland

  2. Department of Speech, Language, and Hearing Sciences, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, 32603, USA

    May Smith-Hublou, Nicole Herndon & Karen Wheeler-Hegland

  3. UF Health Rehab Center at the Norman Fixel Institute for Neurological Diseases, 3009 Williston Road, Gainesville, FL, 32608, USA

    May Smith-Hublou & Nicole Herndon

  4. Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA

    Joshua K. Wong, Adolfo Ramirez-Zamora & Karen Wheeler-Hegland

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  1. May Smith-Hublou
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MSH, NH, and JW. The first draft of the manuscript was written by MSH, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to May Smith-Hublou.

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Smith-Hublou, M., Herndon, N., Wong, J.K. et al. Impacts of Deep Brain Stimulation of the Globus Pallidus Internus on Swallowing: A Retrospective, Cross-Sectional Study. Dysphagia (2024). https://doi.org/10.1007/s00455-023-10660-4

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