title: Deep-brain-stimulation does not impair deglutition in Parkinson's disease.
abstract: OBJECTIVE
  A large proportion of patients with Parkinson's disease develop dysphagia during the course of the disease. Dysphagia in Parkinson's disease affects different phases of deglutition, has a strong impact on quality of life and may cause severe complications, i.e., aspirational pneumonia. So far, little is known on how deep-brain-stimulation of the subthalamic nucleus influences deglutition in PD.
  
  
  METHODS
  Videofluoroscopic swallowing studies on 18 patients with Parkinson's disease, which had been performed preoperatively, and postoperatively with deep-brain-stimulation-on and deep-brain-stimulation-off, were analyzed retrospectively. The patients were examined in each condition with three consistencies (viscous, fluid and solid). The 'New Zealand index for multidisciplinary evaluation of swallowing (NZIMES) Subscale One' for qualitative and 'Logemann-MBS-Parameters' for quantitative evaluation were assessed.
  
  
  RESULTS
  Preoperatively, none of the patients presented with clinically relevant signs of dysphagia. While postoperatively, the mean daily levodopa equivalent dosage was reduced by 50% and deep-brain-stimulation led to a 50% improvement in motor symptoms measured by the UPDRS III, no clinically relevant influence of deep-brain-stimulation-on swallowing was observed using qualitative parameters (NZIMES). However quantitative parameters (Logemann scale) found significant changes of pharyngeal parameters with deep-brain-stimulation-on as compared to preoperative condition and deep-brain-stimulation-off mostly with fluid consistency.
  
  
  CONCLUSIONS
  In Parkinson patients without dysphagia deep-brain-stimulation of the subthalamic nucleus modulates the pharyngeal deglutition phase but has no clinically relevant influence on deglutition. Further studies are needed to test if deep-brain-stimulation is a therapeutic option for patients with swallowing disorders.
authors.affiliation: Department for Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Lengerer
authors.forename: Judy
authors.initials: J
authors.lastname: Kipping
authors.forename: Natalie
authors.initials: N
authors.lastname: Rommel
authors.forename: Daniel
authors.initials: D
authors.lastname: Weiss
authors.forename: Sorin
authors.initials: S
authors.lastname: Breit
authors.forename: Thomas
authors.initials: T
authors.lastname: Gasser
authors.forename: Christian
authors.initials: C
authors.lastname: Plewnia
authors.forename: Rejko
authors.initials: R
authors.lastname: Krüger
authors.forename: Tobias
authors.initials: T
authors.lastname: Wächter
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D046690:Deep Brain Stimulation; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000150:complications / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D016896:Treatment Outcome