Deep Brain Stimulation and Swimming Performance A Randomized Within-Person Crossover Study

Objective To determine whether deep brain stimulation (DBS) causes swimming impairment, we systematically compared swimming ability between DBS on vs off in 18 patients. Methods We conducted a randomized blinded crossover study, comparing swimming ability between DBS on vs off, within participants. Participants swam 3 laps of front crawl and 3 laps of breaststroke. Prespecifed primary outcomes were proportion of lap completed, lap time, and Aquatic Skills Proficiency Assessment (ASPA) score. Prespecified secondary outcomes were a qualitative description of marked changes observed. Results Eighteen participants with Parkinson disease (n = 13), essential tremor (n = 3), Tourette syndrome (n = 1), or posttraumatic brain injury proximal tremor (n = 1), treated with posterior subthalamic area (n = 15) or globus pallidus interna (n = 3) DBS were assessed. There was no significant effect of DBS on/off status on any outcome measure for front crawl or breaststroke. Three participants showed changes in both qualitative and quantitative assessments. Of these, 1 participant displayed reduction in swimming ability: impairment in all outcomes with DBS on, normalizing with DBS off (the same individual as previously reported). The participant displayed difficulty coordinating limb movement as well as postural control. Two participants showed improvements in lap time and ASPA scores with DBS on. Conclusion Overall DBS did not impair swimming performance, although 1 patient demonstrated a stimulation-induced drowning hazard. There were no anatomic or clinical features unique to the individual with swimming impairment. Patients should be warned about the possibility of DBS-induced drowning hazard and should swim with capable supervision after DBS. Classification of Evidence This study provides Class IV evidence that for patients with implanted DBS electrodes, the stimulation on condition, compared with stimulation off, did not significantly impair swimming performance. A formal assessment of unblinding would have been helpful.