‘Speech Initiation Hesitation’ following Subthalamic Nucleus Stimulation in a Patient with Parkinson’s Disease

Moretti, Rita; Torre, Paola; Antonello, Rodolfo M.; Capus, L.; Gioulis, Manuela; Marsala, Sandro Zambito; Cazzato, Giuseppe; Bava, Antonio

doi:10.1159/000070199

Cited by 33 publications

(16 citation statements)

References 7 publications

(8 reference statements)

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“…[33][34][35]41 By contrast, some studies using perceptual scales such as the UPDRS generally reveal either no significant speech improvement 38 or even worsening of speech. 37,39,57,58 In order to understand these seemingly conflicting results, the different mechanisms illustrated in our case reports need to be considered: (1) respiratory, phonatory, and articulatory components of speech can be improved like other limb motor function (speech subcomponents are improved); (2) complex coordination of all anatomical substrates involved in speech might not be responsive to STN stimulation (intelligibility is not improved); and (3) current diffusion outside the target or target-related dyskinesias may lead to a worsening of speech intelligibility and seems to be a frequent fact (intelligibility can worsen). 36,39 In other words, item 18 of the UPDRS does not adequately evaluate the often complex speech changes that may result from L-dopa treatment or STN stimulation.…”

Section: Discussionmentioning

confidence: 99%

Changes induced by levodopa and subthalamic nucleus stimulation on parkinsonian speech

et al. 2005

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Levodopa (L‐dopa) and subthalamic nucleus (STN) stimulation treatments have been associated with both improvement and exacerbation of dysarthria in Parkinson's disease (PD). We report four cases illustrating variant responses of dysarthria to dopaminergic and STN stimulation therapies. Patients' motor disability and dysarthria were perceptually rated by the Unified Parkinson's Disease Rating Scale (UPDRS) in four conditions according to medication and STN stimulation. Dedicated software packages allowed acquisition and analysis of acoustic recordings. Case 1, who had a severe off period aphonia, experienced improvement of speech induced by both levodopa and STN stimulation. In Case 2, both treatments worsened speech due to the appearance of dyskinesias. Case 3 had a dysarthria exacerbation induced by STN stimulation with parameters above optimal levels, interpreted as current diffusion from the STN to corticobulbar fibers. In Case 4, dysarthria exacerbation occurred with stimulation at an electrode contact located caudally to the target, also arguing for current diffusion as a potential mechanism of speech worsening. The presented cases demonstrated variant effects in relation to L‐dopa and STN stimulation on speech. It seems that motor speech subcomponents can be improved like other limb motor aspect, but that complex coordination of all speech anatomical substrates is not responsive to STN stimulation. These hypotheses may be helpful for better understanding and management of STN stimulation effects on motor speech and skeleton–motor subsystems. © 2005 Movement Disorder Society

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Section: Discussionmentioning

confidence: 99%

Changes induced by levodopa and subthalamic nucleus stimulation on parkinsonian speech

et al. 2005

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“…In fact, presurgical dysarthria can be aggravated by DBS and dysarthria may emerge as a side effect. Re-occurring and aggravated stuttering has been reported in 2 cases of DBS-STN where speech fluency improved considerably when the stimulator was turned off [10,11,12]. However, unilateral DBS-STN to the language-dominant hemisphere has been reported to improve acquired stuttering associated with PD in a case study [13], and bilateral DBS-STN has recently been reported to improve developmental stuttering in another case study [14].…”

Section: Introductionmentioning

confidence: 99%

“…One of the treatments of PD is DBS-STN, which has been shown to cause increased dysfluencies in non-stuttering individuals and re-emerging stuttering in individuals with recovered developmental stuttering. Other studies have shown that DBS-STN decreased existing stuttering [10,11,12,13,14]. …”

Section: Introductionmentioning

confidence: 99%

Incidence of Developmental Speech Dysfluencies in Individuals with Parkinson's Disease

Hartelius

2014

Folia Phoniatr Logop

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Objective: The aim of this study was to investigate the incidence of developmental speech dysfluencies in individuals with Parkinson's disease (PD). Background: The possible relationship between PD and dysfluencies such as stuttering has engaged researchers for many years. However, whether there is a higher-than-expected incidence of reported childhood stuttering in adults with a diagnosis of PD is unknown. Participants and Methods: A questionnaire including items regarding present and former speech difficulties was answered by 280 individuals with PD. Results: The total number of persons who reported that they had stuttered (often or sometimes) before the age of 10 years was 11, corresponding to 3.9%. The number of persons who reported unusually fast speech before the age of 10 years was 17, corresponding to 6.1%. The reported incidence of childhood stuttering in this group was consequently not higher than that in previously published reports on childhood stuttering (approx. 5%). The frequency of unusually fast speech was notable, but the lack of a control group made it difficult to conclude on the significance of that finding. Conclusion: Although no direct comparison between self-reported incidences of childhood dysfluencies and published incidence figures regarding childhood stuttering can be made, different possible relationships between speech dysfluency and basal ganglia dysfunction are discussed. © 2014 S. Karger AG, Basel

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“…Regarding DBS of the subthalamic nucleus (STN-DBS), previous studies reported that speech was degraded under stimulation [28,29]. For example, heterogeneity of speech outcomes following STN-DBS was illustrated in one study reporting four cases from among which three patients suffered speech degradation [30].…”

Section: Systematic Review Atkinson-clement Sadat and Pintomentioning

confidence: 99%

Behavioral Treatments for Speech in Parkinson’s Disease: Meta-Analyses and Review of the Literature

Atkinson-Clément

Sadat

Pinto

2015

Neurodegener. Dis. Manag.

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Parkinson's disease (PD) results from neurodegenerative processes leading to alteration of motor functions. Most motor symptoms respond well to pharmacological and neurosurgical treatments, except some axial symptoms such as speech impairment, so-called dysarthria. However, speech therapy is rarely proposed to PD patients. This review aims at evaluating previous research on the effects of speech behavioral therapies in patients with PD. We also performed two meta-analyses focusing on speech loudness and voice pitch. We showed that intensive therapies in PD are the most effective for hypophonia and can lead to some improvement of voice pitch. Although speech therapy is effective in handling PD dysarthria, behavioral speech rehabilitation in PD still needs further validation.

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‘Speech Initiation Hesitation’ following Subthalamic Nucleus Stimulation in a Patient with Parkinson’s Disease

Cited by 33 publications

References 7 publications

Changes induced by levodopa and subthalamic nucleus stimulation on parkinsonian speech

Changes induced by levodopa and subthalamic nucleus stimulation on parkinsonian speech

Incidence of Developmental Speech Dysfluencies in Individuals with Parkinson's Disease

Behavioral Treatments for Speech in Parkinson’s Disease: Meta-Analyses and Review of the Literature

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