Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease

Abstract

Objective: Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for advanced Parkinson disease (PD). Following STN-DBS, speech intelligibility can deteriorate, limiting its beneficial effect. Here we prospectively examined the short-and long-term speech response to STN-DBS in a consecutive series of patients to identify clinical and surgical factors associated with speech change.Methods: Thirty-two consecutive patients were assessed before surgery, then 1 month, 6 months, and 1 year after STN-DBS in 4 conditions on-and off-medication with on-and offstimulation using established and validated speech and movement scales. Fifteen of these patients were followed up for 3 years. A control group of 12 patients with PD were followed up for 1 year. Results:Within the surgical group, speech intelligibility significantly deteriorated by an average of 14.2% Ϯ 20.15% off-medication and 16.9% Ϯ 21.8% on-medication 1 year after STN-DBS. The medical group deteriorated by 3.6% Ϯ 5.5% and 4.5% Ϯ 8.8%, respectively. Seven patients showed speech amelioration after surgery. Loudness increased significantly in all tasks with stimulation. A less severe preoperative on-medication motor score was associated with a more favorable speech response to STN-DBS after 1 year. Medially located electrodes on the left STN were associated with a significantly higher risk of speech deterioration than electrodes within the nucleus. There was a strong relationship between high voltage in the left electrode and poor speech outcome at 1 year. Conclusion:The effect of STN-DBS on speech is variable and multifactorial, with most patients exhibiting decline of speech intelligibility. Both medical and surgical issues contribute to deterioration of speech in STN-DBS patients. Classification of evidence:This study provides Class III evidence that STN-DBS for PD results in deterioration in speech intelligibility in all combinations of medication and stimulation states at 1 month, 6 months, and 1 year compared to baseline and to control subjects treated with best medical therapy. Neurology

The Effect of Short Pulse Width Settings on the Therapeutic Window in Subthalamic Nucleus Deep Brain Stimulation for Parkinson’s disease

“…However, the use of conventional programming parameters presents limitations in some patients due to the emergence of side effects at levels of stimulation required to counteract Parkinsonian motor symptoms (5)(6)(7)(8)(9).…”

Pitch Variability in Patients With Parkinson’s Disease: Effects of Deep Brain Stimulation of Caudal Zona Incerta and Subthalamic Nucleus

“…Previous reports concerning the effect of this treatment on pitch variability have found either no effect (Goberman & Coelho, 2005;Ho, Bradshaw, & Iansek, 2008;Skodda et al, 2011), a small but inconsistent improvement (Goberman, Coelho, & Robb, 2002) or a positive outcome (De Letter et al, 2007). Thus, it is possible that dopaminergic treatment may have a positive effect on pitch variability, but this effect may be dependent on external factors such as the overall stage of the disease as well as the specific disease profile of the patient (De Letter et al, 2007;Ho et al, 2008) Deep brain stimulation (DBS) in the subthalamic nucleus (STN) is an established surgical treatment for a selected group of PD patients (Klostermann, Krugel, & Wahl, 2012;Tripoliti et al, 2011;Volkmann, Daniels, & Witt, 2010). STN-DBS has been shown to have reduce the cardinal symptoms of PD related to motor function (e.g.…”

Low-frequency stimulation of STN-DBS reduces aspiration and freezing of gait in patients with PD

“…STN-DBS might transiently improve the axial symptoms, but could make them worse over the course of 2 to 5 years. [6][7][8][9][10][11][12][13][14][15] The DBS stimulation settings typically used in these studies were high frequency of 130 to 185 Hz.…”