title: Impact of deep brain stimulation on pharyngo-esophageal motility: a randomized cross-over study.
abstract: BACKGROUND
  Bilateral subthalamic nucleus (STN) stimulation is used to alleviate Parkinson's disease (PD) motor symptoms. Recently, it has been shown that this therapeutic also increased gut cholinergic contractions. We therefore investigated the effect of STN stimulation on esophageal motility in an interventional randomized study.
  
  
  METHODS
  Sixteen humans PD patients (4 women, 12 men; age: 62.4 ± 9.3-years old) who underwent STN stimulation for at least 6 months were randomly evaluated with either stimulator turned OFF then ON, or inversely. Esophageal high resolution manometry was performed at the end of each ON and OFF period, with a 5 min resting period followed by ten swallows of 5 mL.
  
  
  RESULTS
  During the ON, an increase in the distal contractility index was found (OFF: 1750 ± 629 vs ON: 2171 ± 755 mmHg/cm/s; p = 0.03), with no difference in the distal front velocity. A decrease in the integrative relaxation pressure of the lower esophageal sphincter (LES) was noted (OFF: 11.1 ± 1.8 mmHg vs ON: 7.2 ± 1.8 mmHg; p < 0.05) in ON. The LES resting pressure remained unchanged during the two periods. This resulted in a decrease in the intrabolus pressure (p = 0.03). No difference was observed for the upper esophageal sphincter, nor the pharyngeal contraction amplitude and velocity.
  
  
  CONCLUSIONS
  In conclusion, STN stimulation in PD patients increased esophageal body contractions and enhanced the LES opening. This suggests that the nigrostriatal-striatonigral loop is involved in the control of esophageal motility.
authors.affiliation: Nutrition, Gut & Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.|Department of Neurosurgery, Rouen University Hospital, University of Rouen, Rouen, France.
authors.forename: S
authors.initials: S
authors.lastname: Derrey
authors.affiliation: Nutrition, Gut & Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.|Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France.
authors.forename: N
authors.initials: N
authors.lastname: Chastan
authors.affiliation: Department of Neurology, Rouen University Hospital, University of Rouen, Rouen, France.
authors.forename: D
authors.initials: D
authors.lastname: Maltete
authors.affiliation: Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France.
authors.forename: E
authors.initials: E
authors.lastname: Verin
authors.affiliation: Nutrition, Gut & Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.
authors.forename: P
authors.initials: P
authors.lastname: Dechelotte
authors.affiliation: Department of Neurology, Rouen University Hospital, University of Rouen, Rouen, France.
authors.forename: R
authors.initials: R
authors.lastname: Lefaucheur
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, University of Rouen, Rouen, France.
authors.forename: F
authors.initials: F
authors.lastname: Proust
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, University of Rouen, Rouen, France.
authors.forename: P
authors.initials: P
authors.lastname: Freger
authors.affiliation: Nutrition, Gut & Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.|Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France.
authors.forename: A M
authors.initials: AM
authors.lastname: Leroi
authors.affiliation: Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France.|Clinical Investigation Centre INSERM 0204, Rouen University Hospital, University of Rouen, Rouen, France.
authors.forename: J
authors.initials: J
authors.lastname: Weber
authors.affiliation: Nutrition, Gut & Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.|Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France.
authors.forename: G
authors.initials: G
authors.lastname: Gourcerol
mesh_terms: D000368:Aged; D018592:Cross-Over Studies; D046690:Deep Brain Stimulation; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D010614:Pharynx / Q000503:physiopathology*; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D016896:Treatment Outcome
keywords: Parkinson's disease; deep brain stimulation; gut motility; high resolution manometry; subthalamic nucleus