2011 Volume 15 Issue 3 Pages 324-331
Parkinson's disease is associated with swallowing dysfunction which causes the risk of aspiration and pneumonia. Subthalamic nucleus deep brain stimulation (STN-DBS) is a widely accepted surgical treatment for advanced Parkinson's disease (PD): quadripolar electrodes are placed in the subthalamic nucleus and deliver high-frequency stimulation. Swallowing dysfunction was reported to be therapeutically resistant to STN-DBS, while it was reported that STN-DBS improved not the oral stage but the oropharyngeal stage. However, these inconsistent results were based on small studies. We report the changes of swallowing function in three cases by comparing the DBS ON and OFF conditions. All cases underwent videofluoroscopy at 6 months after the DBS surgery and two cases also underwent videofluoroscopy three times before the surgery, at 1 week and at 6 months after the surgery.
Case 1: A 69-year-old man who had had PD for 18 years. The motor examination score of Unified Parkinson's Disease Rating Scale (UPDRS, Part III) dropped to 24 after STN-DBS from 66 before STNDBS. In videofluorography (VF) findings, the oral and oropharyngeal transit times in the condition of DBS ON at 6 months after surgery were the shortest. Thus, the videofluoroscopic dysphagia scale was improved in the DBS ON condition.
Case 2: A 72-year-old woman who had had PD for 10 years. The UPDRS Part III score dropped to 17 after STN-DBS from 19 before STN-DBS. In VF findings at 1 week after the surgery, the oral and oropharyngeal transit times were longer in the DBS ON condition. The videofluoroscopic dysphagia scale worsened in the DBS ON condition. At 6 months after surgery, the oral and oropharyngeal transit times and the videofluoroscopic dysphagia scale were improved.
Case 3: A 56-year-old woman who had had PD for 13 years. The UPDRS Part III score dropped to 5 after STN-DBS from 56 before STN-DBS. The oral and oropharyngeal transit times and the videofluoroscopic dysphagia scale did not show a remarkable change under each condition.
