Swallowing Quality of Life After Zona Incerta Deep Brain Stimulation

Abstract

Objectives: The management of Parkinson’s disease (PD) has been improved, but management of signs like swallowing problems is still challenging. Deep brain stimulation (DBS) alleviates the cardinal motor symptoms and improves quality of life, but its effect on swallowing is not fully explored. The purpose of this study was to examine self-reported swallowing-specific quality of life before and after caudal zona incerta DBS (cZI DBS) in comparison with a control group. Methods: Nine PD patients (2 women and 7 men) completed the self-report Swallowing Quality of Life questionnaire (SWAL-QOL) before and 12 months after cZI DBS surgery. The postoperative data were compared to 9 controls. Median ages were 53 years (range, 40-70 years) for patients and 54 years (range, 42-72 years) for controls. Results: No significant differences were found between the pre- or postoperative scores. The SWAL-QOL total scores did not differ significantly between PD patients and controls. The PD patients reported significantly lower scores in the burden subscale and the symptom scale. Conclusions: Patients with PD selected for cZI DBS showed good self-reported swallowing-specific quality of life, in many aspects equal to controls. The cZI DBS did not negatively affect swallowing-specific quality of life in this study.

Effect of Deep Brain Stimulation on Swallowing Function: A Systematic Review

“…There was no clear-cut effect of DBS at 6 and 12 months on any of the swallowing parameters except for the pre-swallow spillage, which was slightly worse in the ON stimulation state 12 months after DBS, although the medication was cut down by one-third post-operatively. Sundstedt et al found no significant difference in SWAL-QOL score and VA scale score 12 months after the DBS at ON medication state in nine PD patients with bilateral cZi ( 23 ). Sundstedt et al also did a prospective longitudinal study on 14 PD patients with bilateral cZi, extending their previous report on swallowing function, before and after DBS at ON medications and ON DBS vs. OFF DBS state by FEES ( 24 ).…”

“…LFS of STN was found to have beneficial effect on dysphagia compared to HFS in patients with FOG refractory to usual HFS of STN (16,17). DBS targeting the post-subthalamic area and caudal zona incerta (PSA/cZi) was thought to be associated with fewer side effects compared to ventralis intermedius (ViM) or STN (21), including the swallowing function (22)(23)(24). GPi DBS has also been used to treat various dystonia (25)(26)(27)(28), including Meige syndrome (29)(30)(31)(32), and its effect on the swallowing function is also of interest to review compared to that in PD.…”

Consensus on the treatment of dysphagia in Parkinson's disease

“…Results from studies on the effects of DBS on swallowing function are controversial. Twelve studies (3 Class II [48][49][50], 9 Class IV [51][52][53][54][55][56][57][58][59]) were retrieved from literature search. In the majority of the studies, DBS targeted the bilateral STN and was delivered with high frequency stimulation.…”

“…In the majority of the studies, DBS targeted the bilateral STN and was delivered with high frequency stimulation. Two studies compared the stimulation of the STN with the stimulation of the GPi [48,55], while one study targeted the caudal zona incerta [57]. Another study compared bilateral stimulation in STN with the combined stimulation of STN and substantia nigra [50].…”

Deep Brain Stimulation in Parkinson’s Disease: New and Emerging Targets for Refractory Motor and Nonmotor Symptoms

“…While STN-DBS has beneficial effects on pitch variability and range, cZI-DBS displayed no such benefit in a small study of 16 patients with 1-year follow-up [98]. The effect of cZI-DBS on swallowing dysfunction has also been evaluated in 2 longitudinal, prospective studies of 8 and 9 patients [99, 100]. Both studies demonstrated that cZI-DBS did not have a clinically significant impact on either swallowing function or self-reported swallowing-specific quality of life at 1 year postoperatively.…”