The Effect of Deep Brain Stimulation on the Speech Motor System

Mücke, Doris; Becker, Johannes; Barbe, Michael T.; Meister, Ingo G.; Liebhart, Lena; Roettger, Timo B.; Dembek, Till A.; Timmermann, Lars; Grice, Martine

doi:10.1044/2014_jslhr-s-13-0155

Cited by 35 publications

(54 citation statements)

References 43 publications

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“…Overall, patients had significantly less tremor in the ON condition than in the OFF condition (TRS p = 0.047, TTD postural p = 0.03, TTD action p = 0.046) and a subjective deterioration of speech in stimulation ON (VAS p = 0.031). In line with our previous study, 2 the oral DDK rate also deteriorated as shown by the phonetic parameters of syllable duration ( p = 0.021), vowel duration ( p = 0.026), and consonant duration ( p = 0.02). Logopedic evaluation showed a trend toward deterioration of speech in the DDK task during DBS ON ( p = 0.063).…”

Section: Resultssupporting

confidence: 92%

Individualized current-shaping reduces DBS-induced dysarthria in patients with essential tremor

et al. 2014

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Objective:To investigate in patients with essential tremor (ET) treated with thalamic/subthalamic deep brain stimulation (DBS) whether stimulation-induced dysarthria (SID) can be diminished by individualized current-shaping with interleaving stimulation (cs-ILS) while maintaining tremor suppression (TS).Methods:Of 26 patients screened, 10 reported SID and were invited for testing. TS was assessed by the Tremor Rating Scale and kinematic analysis of postural and action tremor. SID was assessed by phonetic and logopedic means. Additionally, patients rated their dysarthria on a visual analog scale.Results:In 6 of the 10 patients with ET, DBS-ON (relative to DBS-OFF) led to SID while tremor was successfully reduced. When comparing individualized cs-ILS with a non–current-shaped interleaving stimulation (ILS) in these patients, there was no difference in TS while 4 of the 6 patients showed subjective improvement of speech during cs-ILS. Phonetic analysis (ILS vs cs-ILS) revealed that during cs-ILS there was a reduction of voicing during the production of voiceless stop consonants and also a trend toward an improvement in oral diadochokinetic rate, reflecting less dysarthria. Logopedic rating showed a trend toward deterioration in the diadochokinesis task when comparing ON with OFF but no difference between ILS and cs-ILS.Conclusion:This is a proof-of-principle evaluation of current-shaping in patients with ET treated with thalamic/subthalamic DBS and experiencing SID. Data suggest a benefit on SID from individual shaping of current spread while TS is preserved.Classification of evidence:This study provides Class IV evidence that in patients with ET treated with DBS with SID, individualized cs-ILS reduces dysarthria while maintaining tremor control.

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Section: Resultssupporting

confidence: 92%

Individualized current-shaping reduces DBS-induced dysarthria in patients with essential tremor

et al. 2014

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“…The task was demonstrated by the examiner before the beginning of the first recording. We used the velar DDK task /kakaka/, which has been shown to reliably reflect stimulation induced impairments of glottal and articulatory control in ET patients under DBS . Furthermore, patients were instructed to read a German standard text (“Northwind and Sun” passage) at a comfortable speech rate in each DBS‐condition.…”

Section: Methodsmentioning

confidence: 99%

“…In a recent study , we acoustically investigated speech under activated and inactivated bilateral VIM‐DBS in ET‐patients. In a detailed phonetic analysis of the glottal and the oral subsystems during consonant production, we found imprecise articulation under stimulation, as well as a trend for syllables to be longer in duration under stimulation.…”

Section: Introductionmentioning

confidence: 99%

“…A similar approach was followed by Putzke et al , whereas the focus of their study was primarily on midline tremor control and not on SID under unilateral and bilateral stimulation. Additionally to the acoustic study , we recorded a read passage which was rated for speech tempo and intelligibility by blinded naive listeners, and included subjective patient ratings on speech performance (visual analog scale, VAS). The combination of unilateral and bilateral stimulation, acoustic parameters, speech ratings, and electrode location in this study allows the postulation of the following hypotheses: The DBS state (OFF, RIGHT, LEFT, BILATERAL) has an impact on acoustic parameters (syllable duration and intensity ratio), on patients' self‐estimated “ability to speak” (visual analog scale, VAS), and on perceived speech tempo and intelligibility by naive listeners.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Uni- and Bilateral Thalamic Deep Brain Stimulation on Speech in Patients With Essential Tremor: Acoustics and Intelligibility

Becker

Barbe

Hartinger

et al. 2017

Neuromodulation: Technology at the Neural Interface

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“…Recent studies suggest that stimulation of more ventral structures like the zona incerta (ZI), which is part of the posterior subthalamic area (PSA), is equally or even more effective in suppressing tremor than VIM stimulation (Barbe et al, 2011, Blomstedt et al, 2010, Sandvik et al, 2012, Xie et al, 2012). Additionally, stimulation-induced side-effects, such as paresthesia, disequilibrium/gait-ataxia, and dysarthria (Fasano et al, 2010, Flora et al, 2010, Mücke et al, 2014), are increasingly spotlighted since they interfere with selecting the optimal stimulation parameters for tremor suppression (Barbe et al, 2014). In ET, only few studies analyzed clinical outcome of DBS with regard to electrode location (Barbe et al, 2011, Phibbs et al, 2014, Sandvik et al, 2012) and only one study specifically investigated the origin of stimulation-induced side-effects (Fytagoridis et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Probabilistic mapping of deep brain stimulation effects in essential tremor

Dembek

Barbe

Åström

et al. 2017

NeuroImage: Clinical

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ObjectiveTo create probabilistic stimulation maps (PSMs) of deep brain stimulation (DBS) effects on tremor suppression and stimulation-induced side-effects in patients with essential tremor (ET).MethodMonopolar reviews from 16 ET-patients which consisted of over 600 stimulation settings were used to create PSMs. A spherical model of the volume of neural activation was used to estimate the spatial extent of DBS for each setting. All data was pooled and voxel-wise statistical analysis as well as nonparametric permutation testing was used to confirm the validity of the PSMs.ResultsPSMs showed tremor suppression to be more pronounced by stimulation in the zona incerta (ZI) than in the ventral intermediate nucleus (VIM). Paresthesias and dizziness were most commonly associated with stimulation in the ZI and surrounding thalamic nuclei.DiscussionOur results support the assumption, that the ZI might be a very effective target for tremor suppression. However stimulation inside the ZI and in its close vicinity was also related to the occurrence of stimulation-induced side-effects, so it remains unclear whether the VIM or the ZI is the overall better target. The study demonstrates the use of PSMs for target selection and evaluation. While their accuracy has to be carefully discussed, they can improve the understanding of DBS effects and can be of use for other DBS targets in the therapy of neurological or psychiatric disorders as well. Furthermore they provide a priori information about expected DBS effects in a certain region and might be helpful to clinicians in programming DBS devices in the future.

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The Effect of Deep Brain Stimulation on the Speech Motor System

Abstract: The detrimental effect of stimulation on the speech motor system can be quantified using acoustic measures at the subsyllabic level.

Cited by 35 publications

References 43 publications

Individualized current-shaping reduces DBS-induced dysarthria in patients with essential tremor

Individualized current-shaping reduces DBS-induced dysarthria in patients with essential tremor

The Effect of Uni- and Bilateral Thalamic Deep Brain Stimulation on Speech in Patients With Essential Tremor: Acoustics and Intelligibility

Probabilistic mapping of deep brain stimulation effects in essential tremor

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