Objective: Objective: to characterize swallowing in patients with DBS, comparing ON and OFF stimulation state.

Background: Swallowing dysfunction is a frequent complication of Parkinson’s disease (PD), specially seen on long-term follow-up.Besides its negative impact on quality of life, dysphagia is associated with high morbidity and mortality.Deep brain stimulation (DBS) is a recognized treatment for levodopa responsive motor symptoms in PD patients, however its effect on swallowing is poorly known.

Method: Longitudinal Study with 11 with PD (4 males, 7 females), Mean age 59 (±12,73) years , Time PD 16,45 (±5,11) years, Stable in their medications and submitted to DBS treatment, Mean time of surgery 4,55 (±1,29) years. Presenting complaints of swallowing and indication of speech therapy. Evaluated on OFF medication/ON stimulation and OFF medication/OFF stimulation states Videoendoscopy of deglutition using liquid, thin liquid thickened, pasty (5 and 10ml) and solid

Results: Videoendoscopy showed the existence of stasis in pyriform sinuses and valleculae for the sum of all consistencies in 30% of the patients with ON stimulation and 42% on OFF stimulation; there was posterior scape of food in 5% of patients on ON stimulation and 21% on OFF, penetration occurred in 11,6% with ON stimulation and 27% with OFF stimulation. In the OFF stimulation state we observed 8% of silent tracheal aspiration. The pasty and solid presented the highest risk for dysphagia, 45% in ON and 64% in OFF stimulation, 27% of penetration with pasty and 45% in solids with OFF stimulation. The oxyhemoglobin saturation and heart rate did not change during the offers.

Conclusion: The results suggest that DBS continues to be an effective treatment for PD motor symptoms after almost 5 years of surgery. The swallowing is impaired both on ON and OFF conditions of DBS, but tends to be more pronounced in the OFF state of the stimulation. The main dysphagic manifestations were related to the voluntary phases of swallowing and increased consistency of food. Videoendoscopy of swallowing has been shown to be an effective instrument for the diagnosis of oropharyngeal dysphagia in patients with PD and DBS.

References: Lim A, Leow L, Huckabee ML, Frampton C, Anderson T. A pilot study of respiration and swallowing integration in parkinson’s disease: ‘‘On’’ and ‘‘Off’’ levodopa. Dysphagia. 2008;23(1):76-81. Troche MS, Sapienza CM, Rosenbek JC. Effects of bolus consistency on timing and safety of swallow in patients with Parkinson’s disease. Dysphagia. 2008;23(1):26-32. Germano IM. Chronic deep brain stimulation: indications and techniques. In Neurosurgical treatment of movement disorders. Neurosurgical topics of AANS 1998;1:159-168.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/swallowing-videoendoscopy-in-patients-with-parkinsons-disease-with-deep-brain-stimulation/