Introduction: Gastrointestinal and bladder dysfunction is a prevalent symptom of Parkinson’s disease (PD) that greatly impacts a patient’s quality of life. How deep brain stimulation (DBS) affects these nonmotor symptoms of PD has not been explored.
Methods: We prospectively examined 15 PD patients to assess the role of bilateral subthalamic nucleus DBS (STN-DBS) treatment on gastrointestinal and bladder dysfunction. Patients completed six questionnaires pre-operatively and at 6 months post-operatively on symptoms including drooling, swallowing difficulty, and urinary complaints associated with PD.
Results: Analysis of the surveys revealed two groups of subjects – “responders” who had a significant improvement in the measured quality, in contrast to “nonresponders” who had worse or stable scores. Responders exhibited a significant improvement in swallowing difficulty (p < 0.05) but not in drooling severity. Responders exhibited a significant improvement in quality of life based on urinary conditions (p = 0.001) and voiding dysfunction (p = 0.001) while also showing a trend towards improvement in urinary symptoms (p = 0.068).
Conclusions: The results show that STN-DBS in PD patients has a significant positive effect on swallowing, voiding and quality of life related to urinary symptoms. How DBS affects these symptoms mechanistically requires further investigation.
Patient Care: Gastrointestinal and bladder dysfunction can significantly impact a PD patient’s health and quality of life. Symptoms such as dribbling of excess saliva, difficulty swallowing food or drink, constipation and/or bowel incontinence, urgency for micturition and getting up frequently for urination put patients at increased risk for aspiration pneumonia, choking, and increased risk of falling due to urgency of micturition and nocturia. The results of our study suggest STN-DBS had a significant positive effect on gastrointestinal and bladder complications associated with PD when the patient presented with more severe dysfunction preoperatively. While the positive improvements of motor function due to DBS are widely accepted, our results add to the ongoing research on the use of DBS to manage autonomic symptoms of PD. We can counsel our patients that they should see an improvement in motor function and may see an improvement in their gastrointestinal and urinary symptoms, thus improving their overall quality of life dramatically.
Learning Objectives: 1. Determine whether STN-DBS affects voiding and dysphagia in PD patients.
2. Examine the use of multi-modality questionnaires for nonmotor symptoms of PD.
3. To provide insight into the use of DBS for management of nonmotor symptoms of PD.