Objective: To identify the impact of DBS on airway protection in patient’s post-VIM lead implantation.

Background: Deep brain stimulation (DBS) targeting the ventral intermediate nucleus of the thalamus (VIM) is utilized for medically refractory tremors in patients with various movement disorders. Speech abnormalities and dysphagia have been sparsely mentioned as side effects of this neuromodulatory therapy. There is however a gap in knowledge in regards to the impact of VIM DBS in swallowing function and airway protection due to the lack of studies systematically designed to answer this question.

Methods: This study consisted of a retrospective chart review of patients with the diagnosis of Essential tremor without other neurodegenerative or swallowing conditions seen at the UF Movement Disorder Center who had undergone unilateral and or bilateral VIM DBS surgery. We evaluated the potential impact of DBS on airway protection and swallowing safety by comparing pre and post penetration-aspiration score (PAS) utilizing a paired T-test. The mean differences between the pre and post DBS states were compared within the same group.

Results: The cohort included 43 patients, with a mean age of 71.9 ± 7.4 years, and 37.5% males. Thirty three patients underwent unilateral DBS placement while 10 received bilateral leads. There was no difference between pre-DBS PA scores between patients who received unilateral versus bilateral DBS (p=0.55). There was not a statistically significant difference between PA scores pre- and post-unilateral DBS (2.8±2.0 and 3.1±1.8, respectively, p=0.34). However, in patients who received bilateral leads, there was a significant difference between PA scores pre- and post- DBS (3.4±2.5 and 5.1±3.1 respectively, p=0.02).

Conclusions: Despite our small sample size, unilateral VIM lead placement in ET patients does not appear to affect swallowing. However, bilateral VIM lead placement seems to impair airway protection as identified through screening via PAS swallow assessments. Further studies should be pursued to include a more detailed understanding of dysphagia in patients with unilateral versus bilateral VIM and the impact on quality of life post neuromodulation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/does-vim-deep-brain-stimulation-affect-swallowing/