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Aspiration secondary to impaired swallow function, or dysphagia, is one of the major causes of mortality in patients with Parkinson’s disease (PD). Dysphagia usually does not respond well to medications. Despite its effectiveness on motor fluctuation, dyskinesia and tremor in patients with PD, deep brain stimulation (DBS) is not as effective on axial symptoms of balance, freezing of gait (FOG), speech and swallow function. Studies even raise concerns about axial symptoms under usual high-frequency stimulation (HFS) of the subthalamic nucleus (STN), particularly ON medication.1 STN DBS has various effects on swallow function.2–4 Swallowing involves multiple phases, with oral and pharyngeal phases most critical for bolus clearance and airway protection. However, the impact of different oral textures on aspiration with or without DBS in patients with PD has not been studied.2 Fast-flowing liquids may be more likely to aspirate before and during the swallow, although with less risk of post-swallow aspiration of residue compared with more viscous solids. Dynamic changes in swallow parameters have not been well characterised either.2 A comprehensive evaluation in a randomised double-blind study under various DBS conditions over time is therefore of significant importance. We hypothesised that liquids would more likely yield aspiration than solids, regardless of DBS conditions and assessment timing, and that swallowing measures could worsen in a year.
Standard protocol approval, registrations and patient consents
The study was approved by the institutional review board, with written consents by patients.3 Unlike our previous publications in which only the whole aspiration events (a combination of liquid and solid bolus) were reported using the Penetration-Aspiration Scale (PAS) on the videofluoroscopic swallow study (VFSS),3 the current study (1) further delineated the impact of different oral textures (liquid vs solid bolus) on aspiration and (2) characterised the swallow dynamics across oral and pharyngeal phases, based on the previously obtained VFSS …
Contributors TX: study concept and design, supervision and execution, data collection, analysis, interpretation, manuscript drafting, revision and final approval. LB, AD and EM: data collection, interpretation, manuscript revision and final approval. MP and KT: data interpretation, manuscript revision and final approval. WK: data analysis, interpretation, manuscript revision and final approval. PW: data interpretation, manuscript revision and final approval.
Funding The Michael J. Fox Foundation for Parkinson’s Research under Rapid Response Innovative Award (TX).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Approved by the institutional review board at the University of Chicago.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data are available on reasonable request.