Control of phonatory onset and offset in Parkinson patients following deep brain stimulation of the subthalamic nucleus and caudal zona incerta

Karlsson, Fredrik; Blomstedt, Patric; Olofsson, Katarina; Lindér, Jan; Nordh, Erik; Doorn, Jan van

doi:10.1016/j.parkreldis.2012.03.025

Cited by 22 publications

(18 citation statements)

References 20 publications

(18 reference statements)

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“…A number of 35 publications were identified with numbers of participants ranging from one (case reports) up to 57 ([56, 58–91], see Table 1). The great majority of data ( n = 34) were derived from patients under STN-DBS; three studies compared speech performance under STN-DBS with DBS of the caudal zona incerta (cZi), and there were three further investigations on STN-GPi and STN-Vim.…”

Section: Resultsmentioning

confidence: 99%

“…Up till now, there are only few investigations with speech testings before and at certain time intervals after DBS surgery which would be a reasonable approach to define subgroups of PD patients who are particularly on risk to experience deterioration of speech under STN-DBS or to identify a possible microlesion effect of electrode placement [58, 60, 65, 70, 83, 88, 90]. In the largest of these studies, 32 PD patients under STN-DBS were tested pre- and postsurgically with several follow-up examinations and compared with a group of medically treated PD patients [70].…”

Section: Resultsmentioning

confidence: 99%

“…Another study on 7 patients found no consistent effects of DBS surgery alone (i.e., no hint for microlesion effect) and no consistent stimulation effect on speech under STN-DBS after three months but a slight improvement of pitch variability and sound pressure levels under stimulation six month post-op [88]. Another two studies with PD patients tested before and 12 months after DBS surgery in the stimulation off-condition provided evidence for a progressive reduction of phonatory control, but not of speech intensity, which was interpreted as either progression of the disease, an effect of reduced post-op levodopa dosage, or a microlesion effect [58, 60]. …”

Section: Resultsmentioning

confidence: 99%

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Effect of Deep Brain Stimulation on Speech Performance in Parkinson's Disease

Skodda

2012

Parkinson's Disease

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Deep brain stimulation (DBS) has been reported to be successful in relieving the core motor symptoms of Parkinson's disease (PD) and motor fluctuations in the more advanced stages of the disease. However, data on the effects of DBS on speech performance are inconsistent. While there are some series of patients documenting that speech function was relatively unaffected by DBS of the nucleus subthalamicus (STN), other investigators reported on improvements of distinct parameters of oral control and voice. Though, these ameliorations of single speech modalities were not always accompanied by an improvement of overall speech intelligibility. On the other hand, there are also indications for an induction of dysarthria as an adverse effect of STN-DBS occurring at least in some patients with PD. Since a deterioration of speech function has more often been observed under high stimulation amplitudes, this phenomenon has been ascribed to a spread of current-to-adjacent pathways which might also be the reason for the sporadic observation of an onset of dysarthria under DBS of other basal ganglia targets (e.g., globus pallidus internus/GPi or thalamus/Vim). The aim of this paper is to review and evaluate reports in the literature on the effects of DBS on speech function in PD.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Effect of Deep Brain Stimulation on Speech Performance in Parkinson's Disease

Skodda

2012

Parkinson's Disease

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“…Similarly, dysarthria and postural instability have also been described and correlated to the possible diffusion of current to the cerebellothalamic tract and on the other hand by blocking levodopa effects [34]. Karlsson et al [35,36] reported a negative effect on voice intensity and speech articulation of PSA/caudal Zi compared with STN stimulation. Finally, ataxia has been reported when supratherapeutic stimulation of the PSA was performed [20].…”

Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation for Tremor: Is There a Common Structure?

Fiechter¹,

Nowacki²,

Oertel³

et al. 2017

Stereotact Funct Neurosurg

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Background: Subthalamic nucleus (STN) stimulation has been recognized to control resting tremor in Parkinson disease. Similarly, thalamic stimulation (ventral intermediate nucleus; VIM) has shown tremor control in Parkinson disease, essential, and intention tremors. Recently, stimulation of the posterior subthalamic area (PSA) has been associated with excellent tremor control. Thus, the optimal site of stimulation may be located in the surrounding white matter. Aims: The objective of this work was to investigate the area of stimulation by determining the contact location correlated with the best tremor control in STN/VIM patients. Methods: The mean stimulation site and related volume of tissue activated (VTA) of 25 tremor patients (STN or VIM) were projected on the Morel atlas and compared to stimulation sites from other tremor studies. Results: All patients showed a VTA that covered ≥50% of the area superior and medial to the STN or inferior to the VIM. Our stimulation areas suggest involvement of the more lateral and superior part of the dentato-rubro-thalamic tract (DRTT), whereas targets described in other studies seem to involve the DRTT in its more medial and inferior part when it crosses the PSA. Conclusions: According to anatomical and diffusion tensor imaging data, the DRTT might be the common structure stimulated at different portions within the PSA/caudal zona incerta.

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“…Up till now, there are only very few investigations with speech testings before and at certain follow-up intervals after DBS surgery (11, 19, 28, 35). In the largest of these studies, there was a correlation between poorer speech outcome after 1 year and higher pre-surgical general motor impairment (19).…”

Section: Discussionmentioning

confidence: 99%

Effect of Subthalamic Stimulation on Voice and Speech in Parkinson’s Disease: For the Better or Worse?

et al. 2014

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Background: Deep brain stimulation of the subthalamic nucleus, although highly effective for the treatment of motor impairment in Parkinson’s disease (PD), can induce speech deterioration in a subgroup of patients. The aim of the current study was to survey (1) if there are distinctive stimulation effects on the different parameters of voice and speech and (2) if there is a special pattern of preexisting speech abnormalities indicating a risk for further worsening under stimulation.Methods: N = 38 patients with PD had to perform a speech test without medication with stimulation ON (StimON) and stimulation OFF (StimOFF). Speech samples were analyzed: (1) according to a four-dimensional perceptual speech score and (2) by acoustic analysis to obtain quantifiable measures of distinctive speech parameters.Results: Quality of voice was ameliorated with StimON, and there were trends of increased loudness and better pitch variability. N = 8 patients featured a deterioration of speech with StimON, caused by worsening of articulation or/and fluency. These patients already had more severe overall speech impairment with characteristic features of articulatory slurring and articulatory acceleration under StimOFF condition.Conclusion: The influence of subthalamic StimON Parkinsonian speech differs considerably between individual patients, however, there is a trend to amelioration of voice quality and prosody. Patients with stimulation-associated speech deterioration featured higher overall speech impairment and showed a distinctive pattern of articulatory abnormalities at baseline. Further investigations to confirm these preliminary findings are necessary to allow neurologists to pre-surgically estimate the individual risk of deterioration of speech under stimulation.

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Control of phonatory onset and offset in Parkinson patients following deep brain stimulation of the subthalamic nucleus and caudal zona incerta

Cited by 22 publications

References 20 publications

Effect of Deep Brain Stimulation on Speech Performance in Parkinson's Disease

Effect of Deep Brain Stimulation on Speech Performance in Parkinson's Disease

Deep Brain Stimulation for Tremor: Is There a Common Structure?

Effect of Subthalamic Stimulation on Voice and Speech in Parkinson’s Disease: For the Better or Worse?

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