Objective: To evaluate the effects of deep brain stimulation (DBS) on dysphagia in  Parkinson’s disease (PD) patients.

Background: Although DBS in the subthalamic nucleus (STN) or globus pallidus internus (GPi) has proven to be an effective treatment for PD, the potential adverse effect in deglutition can exacerbate the worsening of airway protection associated with PD degeneration and increase the aspiration pneumonia incidence¹.

Method: We conducted a systematic review searching in the PubMed database using the terms ‘dysphagia’, ‘deglutition disorders’, ‘deep brain stimulation’ and ‘Parkinson’s disease’. Two reviewers independently evaluated the titles and abstracts of studies published before March 2023. Studies with subjective dysphagia evaluation methods, studies that were not in English, reviews, pilot studies, and case reports were excluded.

Results: 50 potential articles were identified; 11 met the inclusion criteria. Sample sizes varied from 10 to 132 participants. Among the nine studies evaluating only DBS in STN, a Randomized Controlled Trial (RCT)² suggested that it improves the pharyngeal phase time of swallowing and does not change the oral phase time. Two retrospective^3,7 and two prospective^8,9 studies indicate that STN-DBS does not increase the risk of dysphagia, possibly improving the oropharyngeal phase of swallowing for solid consistencies⁸. A retrospective cohort of 30 years⁶ hypothesizes that advanced age in STN-DBS worsens dysphagia. One RCT¹⁰ demonstrated that 60 Hz STN-DBS, compared to 130 Hz, reduced the aspiration frequency by 79%. Among the two studies comparing DBS sites, an RCT with a sample of 54 patients⁴ concluded that the STN group had impaired voluntary jaw velocity, while the GPi group showed a slight improvement after 6 months. However, a retrospective study with 54 patients¹¹ demonstrated no difference between GPi and STN groups before and after 6 months of DBS.

Conclusion: The lack of consensus across studies probably results from methodological differences. Thus, to assess the possible damage caused by DBS in dysphagia, it is necessary further RCT with large samples, objective dysphagia evaluation methods, and uniform distribution of patients’ age at undergoing DBS. Furthermore, further research comparing the sites of DBS and stimulation frequency is needed to clarify the optimal DBS target.

References: [1] Suttrup I, Warnecke T. Dysphagia in Parkinson’s Disease. Dysphagia. 2016;31(1):24–32.

[2] Ciucci MR, Barkmeier-Kraemer JM, Sherman SJ. Subthalamic nucleus deep brain stimulation improves deglutition in Parkinson’s disease. Movement Disorders. 2007 Dec 28;23(5):676–83.

[3] Bove F, Genovese D, Petracca M, Tufo T, Pisani D, Lo Monaco MR, et al. STN-DBS does not increase the risk of sialorrhea in patients with advanced Parkinson’s disease. npj Parkinson’s Disease [Internet]. 2022 Jun 29;8(1):1–3.

[4] Robertson, Lee T.; St George, Rebecca J.; Carlson-Kuhta, Patricia; Hogarth, Penelope; Burchiel, Kim J.; Horak, Fay B. (2011). Site of deep brain stimulation and jaw velocity in Parkinson disease. Journal of Neurosurgery, 115(5), 985–994.

[5] Ong JNA, Shin JH, Jeon S, Lee CY, Kim HJ, Paek SH, Jeon B. Development of Clinical Milestones in Parkinson’s Disease After Bilateral Subthalamic Deep Brain Stimulation. J Mov Disord. 2022;15(2):124-131.

[6] Merola A, Zibetti M, Angrisano S, Rizzi L, Ricchi V, Artusi CA, Lanotte M, Rizzone MG, Lopiano L. Parkinson’s disease progression at 30 years: a study of subthalamic deep brain-stimulated patients. Brain. 2011 Jul;134(Pt 7):2074-84.

[7] Lengerer S, Kipping J, Rommel N, Weiss D, Breit S, Gasser T, et al. Deep-brain-stimulation does not impair deglutition in Parkinson’s disease. Park Relat Disord. 2012 Aug;18(7):847–53.

[8] Silbergleit AK, LeWitt P, Junn F, Schultz LR, Collins D, Beardsley T, et al. Comparison of dysphagia before and after deep brain stimulation in Parkinson’s disease. Movement Disorders [Internet]. 2012 Oct 31 [cited 2019 Dec 13];27(14):1763–8.

[9] Olchik MR, Ghisi M, Ayres A, Schuh AFS, Oppitz PP, Rieder CR de M, et al. The Impact of Deep Brain Stimulation on the Quality of Life and Swallowing in Individuals with Parkinson’s Disease. International Archives of Otorhinolaryngology [Internet]. 2018 Jun 1 [cited 2020 Feb 21];22(2):125–9.

[10] Xie T, Bloom L, Padmanaban M, Bertacchi B, Kang W, MacCracken E, et al. Long-term effect of low frequency stimulation of STN on dysphagia, freezing of gait and other motor symptoms in PD. Journal of Neurology, Neurosurgery, and Psychiatry [Internet]. 2018 Sep 1 [cited 2022 Mar 22];89(9):989–94.

[11] Henry KA, Singh R, Zhang N, Lyons MK, McNett K, Neal MT, Mehta SH. Effect of STN/GPi DBS on swallowing function in Parkinson’s disease as assessed by Video fluoroscopy: A retrospective study. Parkinsonism Relat Disord. 2022 Oct;103:136-140.

[12] Fabbri M, Zibetti M, Rizzone MG, Giannini G, Borellini L, Stefani A, et al. Should We Consider Deep Brain Stimulation Discontinuation in Late-Stage Parkinson’s Disease? Mov Disord. 2020;35(8):1379–87.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-deep-brain-stimulation-on-dysphagia-in-parkinsons-disease-a-systematic-review/