Effects of Deep Brain Stimulation on Swallow Physiology in Patients with Parkinson Disease
Item
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Title
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Effects of Deep Brain Stimulation on Swallow Physiology in Patients with Parkinson Disease
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Identifier
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d_2009_2013:b7fefd72d692:11350
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identifier
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11807
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Creator
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Riquelme, Luis F.,
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Contributor
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Joyce F. West
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Date
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2012
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Language
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English
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Publisher
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City University of New York.
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Subject
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Health sciences | Neurosciences | Physiology | dysphagia | isometric tongue pressures | oropharyngeal swallow | subthalamic nucleus | swallow apnea | UPDRS
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Abstract
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The effect of neurosurgical intervention for patients who present with oropharyngeal dysphagia secondary to idiopathic Parkinson Disease is not well understood. Deep brain stimulation of the subthalamic nucleus (DBS-STN) is an effective treatment for the improvement of limb movements, but its effect on speech and swallowing is less predictable. DBS is a reversible therapeutic surgical procedure that uses small electrical pulses to disrupt the brain signals that cause tremor and rigidity. It involves implanting a thin insulated wire (lead) with electrodes into the STN of the brain. To date, the literature that has addressed the effects of DBS-STN on speech has not demonstrated statistically or clinically significant gains. Studies of this nature looking at the effects of DBS-STN on swallow physiology are limited. The present study, sought to: (1) quantify the temporal and physiological changes in specific aspects of swallow physiology when comparing the DBS "on" to the DBS "off" condition; and (2) to determine benefits/contraindications to DBS placement in patients with oropharyngeal dysphagia. Participants were examined during the DBS "on" condition and subsequently with the equipment turned off for 24 hours so as to complete the DBS "off" condition examination.;It was hypothesized that negative changes in swallow physiology would result during the DBS "on" condition when compared to the DBS "off" condition. Namely, quantifiable changes in bolus flow through the oropharynx to the cervical esophagus would be observed. Six adult participants were included in this preliminary study. No statistically significant differences were found for oropharyngeal swallow efficiency (OPSE), swallow apnea duration (SAD), tongue pressure changes or scores on the United Parkinson's Disease Rating Scale (UPDRS) when comparing the DBS "on" condition (day #1) to the DBS "off" condition (day #2). Of note, although not statistically significant, was the observation that for bolus consistencies of liquid form (5cc thin liquid and "sips" thin liquid), there was an improvement in OPSE score from day #1 to day #2; whereas for the pudding and cookie consistencies there was a decline in the mean OPSE score. Furthermore, analysis of UPDRS scores attained in the area of speech (question #5) and swallowing (question #7) denoted a non-statistically significant trend towards worsening speech production and swallow function on day #2 (DBS in off condition). Three of the six participants completed tongue pressure measurements and two of these demonstrated an increase in isometric pressure on day #2. Additional participants need be tested in order to gain greater insight into changes in swallow physiology using this particular surgical approach for the treatment of Parkinson Disease.
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Type
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dissertation
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Source
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2009_2013.csv
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degree
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Ph.D.
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Program
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Speech and Hearing Sciences
