Swallowing outcomes following unilateral STN vs. GPi surgery: a retrospective analysis

Abstract

The adverse effects of deep brain stimulation (DBS) surgery on swallowing could potentially exacerbate the natural deterioration of airway protection associated with Parkinson's disease (PD) degeneration and increase the incidence of aspiration pneumonia and associated death. There are no studies that compare swallowing outcomes associated with subthalamic nucleus (STN) versus globus pallidus interna (GPi) DBS surgery; therefore, we completed a retrospective study comparing swallowing outcomes in a cohort of patients with PD who underwent unilateral DBS surgery in either the STN or GPi. A chart review was completed to identify all patients with a diagnosis of PD who received videofluoroscopic swallowing evaluations before DBS and after unilateral DBS in the STN or GPi. The retrospective search yielded 33 patients (STN = 14, GPi = 19) with idiopathic PD who met the inclusion criteria. Mean penetration-aspiration (PA) scores did not change significantly for participants who underwent GPi surgery (z = -.181, p = .857), but mean PA scores significantly worsened for participants who underwent STN DBS (z = -2.682, p = .007). There was a significant improvement in Unified PD Rating Scale (UPDRS) scores off medication before surgery, to off medication and on stimulation after surgery for both groups (F = 23.667, p < .001). Despite the limitations of a retrospective analysis, this preliminary study suggests that unilateral STN DBS may have an adverse effect on swallowing function, while unilateral GPi DBS does not appear to have a similar deleterious effect. This study and other future studies should help to elucidate the mechanisms underpinning the effects of DBS on swallowing function.

Fig. 1

The repeated-measures ANOVA identified a statistically significant interaction revealing that penetration–aspiration scores differed significantly between time points by surgery type, with mean penetration–aspiration scores not changing significantly for participants who received GPi surgery (dotted line), but mean penetration–aspiration scores significantly worsening for participants who received STN DBS (solid line)