Distinct phenotypes of speech and voice disorders in Parkinson's disease after subthalamic nucleus deep brain stimulation

Tsuboi, Takashi; Watanabe, Haruo; Tanaka, Yasuhiro; Ohdake, Reiko; Yoneyama, Noritaka; Hara, Kazuhiro; Nakamura, Ryoichi; Watanabe, H.; Senda, Joe; Atsuta, Naoki; Ito, Mizuki; Hirayama, Masaaki; Yamamoto, Masahiko; Fujimoto, Yasushi; Kajita, Yasukazu; Wakabayashi, Toshihiko; Sobue, Gen

doi:10.1136/jnnp-2014-308043

Cited by 92 publications

(73 citation statements)

References 37 publications

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“…ILS improved stimulation-induced adverse effects in only 2 out of 9 patients for other stimulation-induced adverse effects. Confirming previous reports [40], dysarthria was the most common stimulation-induced adverse effect ( n = 6). Only in 1 patient (PD5) did reduced stimulation of the pre-ILS contact located within the rZI region and longitudinal current shaping to a ventral contact within the STN permit amelioration of dysarthria.…”

Section: Discussionsupporting

confidence: 78%

Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

Kern

Picillo

Thompson

et al. 2018

Stereotact Funct Neurosurg

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Background/Aims: Interleaving stimulation (ILS) in deep brain stimulation (DBS) provides individualized stimulation of 2 contacts delivered in alternating order. Currently, limited information on the utility of ILS exists. The aims of this study were to determine the practical applications and outcomes of ILS DBS in Parkinson’s disease (PD), tremor, and dystonia. Methods: We performed a single-center, unblinded, retrospective chart review of all patients with DBS attempted on ILS at our referral center assessing for rationale and outcomes. Results: Fifty patients (PD, n = 27; tremor, n = 7; dystonia, n = 16 patients) tried ILS for 2 rationales: management of adverse effects (n = 29) and to improve clinical efficacy (n = 21). A total of 19 patients demonstrated improvement with ILS for adverse effect management predominately for the treatment of dyskinesias (n = 12). In the vast majority of dyskinetic patients, a contact added into the rostral zona incerta with ILS was performed. Nine out of 21 patients demonstrated improved clinical efficacy with ILS with all 6 PD patients who tried ILS for this rationale demonstrating benefit. Conclusions: In PD, ILS provided benefits for dyskinesias and parkinsonism, with minimal improvement of other adverse effects. In tremor and dystonia, marginal effects in terms of mitigation of adverse effects and improvement of clinical outcomes were evident.

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Section: Discussionsupporting

confidence: 78%

Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

Kern

Picillo

Thompson

et al. 2018

Stereotact Funct Neurosurg

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“…Rates in monitored trials are very variable and range between <10% and >50% (Table 1). The exact phenotypic characteristics associated with impaired speech intelligibility and the actual functional impairments caused by DBS therapy still require further elucidation and exhibit high individual variability [30–39]. Whereas reduced volume is observed in almost all PD patients slurred speech has been regarded rather as a side effect of DBS therapy [38].…”

Section: Discussionmentioning

confidence: 99%

Adverse events in deep brain stimulation: A retrospective long-term analysis of neurological, psychiatric and other occurrences

et al. 2017

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Background and objectiveThe extent to which deep brain stimulation (DBS) can improve quality of life may be perceived as a permanent trade-off between neurological improvements and complications of therapy, comorbidities, and disease progression.Patients and methodsWe retrospectively investigated 123 consecutive and non-preselected patients. Indications for DBS surgery were Parkinson's disease (82), dystonia (18), tremor of different etiology (21), Huntington's disease (1) and Gilles de la Tourette syndrome (1). AEs were defined as any untoward clinical occurrence, sign or patient complaint or unintended disease if related or unrelated to the surgical procedures, implanted devices or ongoing DBS therapy.ResultsOver a mean/median follow-up period of 4.7 years (578 patient-years) 433 AEs were recorded in 106 of 123 patients (86.2%). There was no mortality or persistent morbidity from the surgical procedure. All serious adverse events (SAEs) that occurred within 4 weeks of surgery were reversible. Neurological AEs (193 in 85 patients) and psychiatric AEs (78 in 48 patients) were documented most frequently. AEs in 4 patients (suicide under GPI stimulation, weight gain >20 kg, impairment of gait and speech, cognitive decline >2 years following surgery) were severe or worse, at least possibly related to DBS and non reversible. In PD 23.1% of the STN-stimulated patients experienced non-reversible (or unknown reversibility) AEs that were at least possibly related to DBS in the form of impaired speech or gait, depression, weight gain, cognitive disturbances or urinary incontinence (severity was mild or moderate in 15 of 18 patients). Age and Hoehn&Yahr stage of STN-simulated PD patients, but not preoperative motor impairment or response to levodopa, showed a weak correlation (r = 0.24 and 0.22, respectively) with the number of AEs.ConclusionsDBS-related AEs that were severe or worse and non-reversible were only observed in PD (4 of 82 patients; 4.9%), but not in other diseases. PD patients exhibited a significant risk for non-severe AEs most of which also represented preexisting and progressive axial and non-motor symptoms of PD. Mild gait and/or speech disturbances were rather frequent complaints under VIM stimulation. GPI stimulation for dystonia could be applied with negligible DBS-related side effects.

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“…DBS may provoke added speech impairments, with greater spasticity and increased dysfluency besides the existing hypokinetic picture 45. Speech–language therapy interventions successful with patients without DBS may not succeed or require modification for DBS treated individuals 46…”

Section: Language Changesmentioning

confidence: 99%

Communication changes in Parkinson’s disease

Miller

2017

Pract Neurol

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This review looks at the nature and impact of communication changes in Parkinson's disease, approaches to assessment and directions for intervention. This is especially important since medical and surgical interventions that help limb movement are largely ineffective, or even detrimental, for speech. Most people with Parkinson's disease notice changes to their communication. Voice alters early on-even in the prodromal stage. Later, articulation may impair intelligibility further. These changes impact on mood and social participation. However, a full characterisation of communication changes in Parkinson's must acknowledge that changes are far more pervasive and varied than a quiet voice. Communication is affected by marked dysprosody, cognitive-linguistic impairment, alterations to social interaction and pragmatics. Changes entail not just expressive elements but also receptive. A comprehensive evaluation of potential communication challenges faced by people with Parkinson's disease must cover all these aspects. Similarly, interventions that ignore the breadth and depth of changes will always remain incomplete.

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Distinct phenotypes of speech and voice disorders in Parkinson's disease after subthalamic nucleus deep brain stimulation

Abstract: Stuttering and breathy voice can be aggravated by STN-DBS, but are mainly due to aging or PD itself. Strained voice and spastic dysarthria are considered corticobulbar side effects.

Cited by 92 publications

References 37 publications

Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

Adverse events in deep brain stimulation: A retrospective long-term analysis of neurological, psychiatric and other occurrences

Communication changes in Parkinson’s disease

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