JNNP: Effects of oral food properties on inhalation and swallowing dynamics in patients treated with DBS

Mistaken suction, which is secondary to impaired swallowing function or difficulty swallowing, is one of the main causes of death in patients with Parkinson's disease (PD).
drugs usually do not have a good therapeutic effect on dysphagy.
Although deep brain stimulation is effective for movement disorders and tremors in people with Parkinson's disease, it is not ideal for treating axial symptoms such as balance, gait freezing, speech and swallowing function.
even raised concerns about the axial symptoms of the hyalthesia substrate (STN), which is usually high-frequency stimulation (HFS), especially in the area of medication.
STN DBS has several effects on swallowing functions.
swallowing involves multiple stages, with the mouth and pharynx most critical for removal and gas channel protection.
, the effects of different oral textures on the inhalation of DBS in PD patients have not been studied.
flowing liquid is easier to inhale before and during swallowing, although the risk of swallowing residues after swallowing is low.
, the dynamic changes of DBS are not well described in both cases under double-blind conditions.
this paper assumes that liquids are more susceptible to inhalation than solids.
In the Video Perspective Swallowing Study (VFSS), the entire inhalation event (combination of liquids and solids) was reported using the Penetrating Inhalation Scale (PAS), and the current study (1) further describes the effects of different oral food properties (liquids and solids) on inhalation, (2) based on previously obtained VFSS data, supplemented by functional scales, describes the swallowing dynamics of the entire mouth and pharynx.
VFSS data from VFSS data for patients with the best two-sided HFS (130 Hz) treatment for STNs and drugs.
all 11 PD patients completed their first visit (V1), with 10 completing follow-up (V2) at an average interval of 14.5 months.
Each visit, with the exception of the Unified PD Scale Motion Function (UPDRS-III) and FOG, each patient under three DBS conditions (130 Hz, 60 Hz, DBS off) was tested three times in a random double-blind crossover and regular medication state.
who programmed DBS were not involved in any evaluation.
patients and inspectors were unaware of the situation.
each patient is examined 30 minutes before the test.
PAS is used to assess the depth (severity) and frequency of penetration and inhalation, but in this study, liquids (thin, thick liquids and fruit puree/pudding of different volumes in each VFS 9 trial) were separated from solids (cookies tested once per VFS).
Improved Dysphagic Disorders Scale (MBSImP) assessed the overall (combined liquid and solid) oral and pharynx severity scores, as well as 16 motion parameters for oral swallowing function.
the overall oral intake function using the Functional Oral Intake Scale (FOIS).
all patients were tested under three DBS conditions during initial visits and follow-up.
a total of 126 observations were recorded for analysis (11 subjects for V1, 10 subjects for V2, each subject tested under 3 DBS conditions, resulting in a maximum PAS score of 11×3×2 plus 10×3×12.126).
same time, the comparison of liquids and solids in the suction frequency, penetration and inhalation frequency is fitted to the logic mixing model to predict DBS conditions, visits, and the frequency of food (liquid or solid).
a total of 630 observations were recorded for analysis (11 subjects for V1, 10 subjects for V2, 9 trials per subject in various liquids under 3 DBS conditions, and 1 trial in solid foods, as mentioned earlier: 11×3×10×3×10 x 10×10 x 630).
in each visit, the variance analysis was used to compare the various swallowing function parameters in MBSImP and FOIS under three DBS conditions.
after adjusting DBS conditions and visits, more severe Max PAS (OR 1248, p.lt;0.01), more frequent inhalation (OR 6.3, p=0.003) and penetration and inhalation (OR 13.9, p.lt;0.001) (Table 1A) were found.
LFS and non-DBS groups also had lower puncture frequencies (OR 0.21 and 0.35, both p.lt;0.001) than HFS, while non-DBS groups also had lower puncture and suction frequencies (OR 0.50, p-0.004).
V2 group had more frequent inhalation (OR 1.71, p-0.019) and more frequent penetration and suction (OR 1.68, p-0.009) than V1, and no significant differences were found in the swallowing parameters of MBSImP and FOIS under DBS conditions in any visit.
is one of the main causes of death in people with Parkinson's disease, and difficulty swallowing is usually not a good response to medication.
for PD patients, especially DBS patients, there has been no previous study of which food texture is more prone to missorption.
here, we found that liquids are always more likely (in severity and frequency) to cause penetration and inhalation than solid foods, regardless of DBS conditions and assessment time.
is of great clinical significance.
Recent studies have shown that HFS in STN DBS may have adverse effects on swallowing function (usually in objective measurement and/or medication), beneficial (usually when subjectively evaluated and/or stopped), or have no effect, and that LFS is beneficial compared to HFS in FOG patients Current studies have increased the clinical significance of the effects of food texture on Parkinson's disease partners or without DBS suction.
Xie T, Bloom L, Padmanaban M, et al Impact of oral textures on aspiration and changes in swallow dynamics in patients with PD with DBSJournal of Neurology, Neurosurgery and Psymy Published Online First: 26 November 2020. doi: 10.1136/jnnp-2020-324579MedSci Original Source: MedSci Original Copyright Notice: All text, images and audio and video materials on this website that indicate "Source: Met Medical" or "Source: MedSci Original" are owned by Mets Medicine and are not authorized to be reproduced by any media, website or individual Source: Mays Medicine.
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