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Smith-Hublou M, Herndon N, Wong JK, Ramirez-Zamora A, Wheeler-Hegland K. Impacts of Deep Brain Stimulation of the Globus Pallidus Internus on Swallowing: A Retrospective, Cross-Sectional Study. Dysphagia 2024; 39:797-807. [PMID: 38236261 DOI: 10.1007/s00455-023-10660-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/16/2023] [Indexed: 01/19/2024]
Abstract
Deep brain stimulation (DBS) is a common treatment for motor symptoms of Parkinson disease (PD), a condition associated with increased risk of dysphagia. The effect of DBS on swallowing function has not been comprehensively evaluated using gold-standard imaging techniques, particularly for globus pallidus internus (GPi) DBS. The objective of this retrospective, cross-sectional study was to identify differences in swallowing safety and timing kinematics among PD subjects with and without GPi DBS. We investigated the effects of unilateral and bilateral GPi DBS as well as the relationship between swallowing safety and DBS stimulation parameters, using retrospective analysis of videofluoroscopy recordings (71 recordings from 36 subjects) from electronic medical records. Outcomes were analyzed by surgical status (pre-surgical, unilateral DBS, bilateral DBS). The primary outcome was percent of thin-liquid bolus trials rated as unsafe, with Penetration-Aspiration Scale scores of 3 or higher. Secondary analyses included swallowing timing measures, relationships between swallowing safety and DBS stimulation parameters, and Dynamic Imaging Grade of Swallowing Toxicity ratings. Most subjects swallowed all boluses safely (19/29 in the pre-surgical, 16/26 in the unilateral DBS, and 10/16 in the bilateral DBS conditions). Swallowing safety impairment did not differ among stimulation groups. There was no main effect of stimulation condition on timing metrics, though main effects were found for sex and bolus type. Stimulation parameters were not correlated with swallowing safety. Swallowing efficiency and overall impairment did not differ among conditions. These results provide evidence that GPi DBS does not affect pharyngeal swallowing function. Further, prospective, investigations are needed.
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Affiliation(s)
- May Smith-Hublou
- Laboratory for the Study of Upper Airway Dysfunction, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, 32603, USA.
- Department of Speech, Language, and Hearing Sciences, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, 32603, USA.
- UF Health Rehab Center at the Norman Fixel Institute for Neurological Diseases, 3009 Williston Road, Gainesville, FL, 32608, USA.
| | - Nicole Herndon
- Department of Speech, Language, and Hearing Sciences, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, 32603, USA
- UF Health Rehab Center at the Norman Fixel Institute for Neurological Diseases, 3009 Williston Road, Gainesville, FL, 32608, USA
| | - Joshua K Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Karen Wheeler-Hegland
- Laboratory for the Study of Upper Airway Dysfunction, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, 32603, USA
- Department of Speech, Language, and Hearing Sciences, University of Florida, 1225 Center Drive, PO Box 100174, Gainesville, FL, 32603, USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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Castillo-Triana N, Camargo-Mendoza M, Bernal-Pacheco Ó. Effects of subthalamic nucleus deep brain stimulation on the speech of Spanish-speaking Parkinson's disease patients during the first year of treatment. Codas 2024; 36:e20230194. [PMID: 39230179 PMCID: PMC11404841 DOI: 10.1590/2317-1782/20242023194en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/01/2024] [Indexed: 09/05/2024] Open
Abstract
PURPOSE To describe the effects of subthalamic nucleus deep brain stimulation (STN-DBS) on the speech of Spanish-speaking Parkinson's disease (PD) patients during the first year of treatment. METHODS The speech measures (SMs): maximum phonation time, acoustic voice measures, speech rate, speech intelligibility measures, and oral diadochokinesis rates of nine Colombian idiopathic PD patients (four females and five males; age = 63 ± 7 years; years of PD = 10 ± 7 years; UPDRS-III = 57 ± 6; H&Y = 2 ± 0.3) were studied in OFF and ON medication states before and every three months during the first year after STN-DBS surgery. Praat software and healthy native listeners' ratings were used for speech analysis. Statistical analysis tried to find significant differences in the SMs during follow-up (Friedman test) and between medication states (Wilcoxon paired test). Also, a pre-surgery variation interval (PSVI) of reference for every participant and SM was calculated to make an individual analysis of post-surgery variation. RESULTS Non-significative post-surgery or medication state-related differences in the SMs were found. Nevertheless, individually, based on PSVIs, the SMs exhibited: no variation, inconsistent or consistent variation during post-surgery follow-up in different combinations, depending on the medication state. CONCLUSION As a group, participants did not have a shared post-surgery pattern of change in any SM. Instead, based on PSVIs, the SMs varied differently in every participant, which suggests that in Spanish-speaking PD patients, the effects of STN-DBS on speech during the first year of treatment could be highly variable.
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Affiliation(s)
- Nicolás Castillo-Triana
- Departamento de Comunicación Humana, Facultad de Medicina, Universidad Nacional de Colombia - UNAL - Bogotá, Colombia
| | - Maryluz Camargo-Mendoza
- Departamento de Comunicación Humana, Facultad de Medicina, Universidad Nacional de Colombia - UNAL - Bogotá, Colombia
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Guidetti M, Bocci T, De Pedro Del Álamo M, Deuschl G, Fasano A, Fernandez RM, Gasca-Salas C, Hamani C, Krauss JK, Kühn AA, Limousin P, Little S, Lozano AM, Maiorana NV, Marceglia S, Okun MS, Oliveri S, Ostrem JL, Scelzo E, Schnitzler A, Starr PA, Temel Y, Timmermann L, Tinkhauser G, Visser-Vandewalle V, Volkmann J, Priori A. Adaptive Deep Brain Stimulation in Parkinson's Disease: A Delphi Consensus Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.26.24312580. [PMID: 39252901 PMCID: PMC11383503 DOI: 10.1101/2024.08.26.24312580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Importance If history teaches, as cardiac pacing moved from fixed-rate to on-demand delivery in in 80s of the last century, there are high probabilities that closed-loop and adaptive approaches will become, in the next decade, the natural evolution of conventional Deep Brain Stimulation (cDBS). However, while devices for aDBS are already available for clinical use, few data on their clinical application and technological limitations are available so far. In such scenario, gathering the opinion and expertise of leading investigators worldwide would boost and guide practice and research, thus grounding the clinical development of aDBS. Observations We identified clinical and academically experienced DBS clinicians (n=21) to discuss the challenges related to aDBS. A 5-point Likert scale questionnaire along with a Delphi method was employed. 42 questions were submitted to the panel, half of them being related to technical aspects while the other half to clinical aspects of aDBS. Experts agreed that aDBS will become clinical practice in 10 years. In the present scenario, although the panel agreed that aDBS applications require skilled clinicians and that algorithms need to be further optimized to manage complex PD symptoms, consensus was reached on aDBS safety and its ability to provide a faster and more stable treatment response than cDBS, also for tremor-dominant Parkinson's disease patients and for those with motor fluctuations and dyskinesias. Conclusions and Relevance Despite the need of further research, the panel concluded that aDBS is safe, promises to be maximally effective in PD patients with motor fluctuation and dyskinesias and therefore will enter into the clinical practice in the next years, with further research focused on algorithms and markers for complex symptoms.
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Affiliation(s)
- M Guidetti
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - T Bocci
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
- Clinical Neurology Unit, "Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo", Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - M De Pedro Del Álamo
- HM CINAC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - G Deuschl
- Department of Neurology University Hospital Schleswig-Holstein, Campus Kiel and Christian Albrechts-University of Kiel Kiel Germany
| | - A Fasano
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, ON, Canada
- KITE, University Health Network, Toronto, ON, Canada
- Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - R Martinez Fernandez
- HM CINAC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Instituto Carlos III, CIBERNED, Madrid, Spain
| | - C Gasca-Salas
- HM CINAC, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Instituto Carlos III, CIBERNED, Madrid, Spain
| | - C Hamani
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N 3M5, ON, Canada
- Harquail Centre for Neuromodulation, 2075 Bayview Avenue, Toronto, M4N 3M5, ON, Canada
- Department of Surgery, University of Toronto, 149 College Street, Toronto, M5T 1P5, ON, Canada
| | - J K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - A A Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Bernstein Center for Computational Neuroscience, Humboldt-Universität, Berlin, Germany
- NeuroCure, Exzellenzcluster, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZNE, German Center for Neurodegenerative Diseases, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - P Limousin
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - S Little
- Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, California, USA
| | - A M Lozano
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - N V Maiorana
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - S Marceglia
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - M S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, United States
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, United States
| | - S Oliveri
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
- Clinical Neurology Unit, "Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo", Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - J L Ostrem
- Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, California, USA
| | - E Scelzo
- Clinical Neurology Unit, "Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo", Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - A Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - P A Starr
- UCSF Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
- UCSF Department of Physiology, University of California San Francisco, San Francisco, CA, USA
| | - Y Temel
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - L Timmermann
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
| | - G Tinkhauser
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - V Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - J Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - A Priori
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
- Clinical Neurology Unit, "Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo", Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
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Jergas H, Petry-Schmelzer JN, Hannemann JH, Thies T, Strelow JN, Rubi-Fessen I, Quinting J, Baldermann JC, Mücke D, Fink GR, Visser-Vandewalle V, Dembek TA, Barbe MT. One side effect: two networks? Lateral and posteromedial stimulation spreads induce dysarthria in subthalamic deep brain stimulation for Parkinson's disease. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333434. [PMID: 39147574 DOI: 10.1136/jnnp-2024-333434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/15/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Stimulation-induced dysarthria (SID) is a troublesome and potentially therapy-limiting side effect of deep brain stimulation of the subthalamic nucleus (STN-DBS) in patients with Parkinson's disease (PD). To date, the origin of SID, and especially whether there is an involvement of cerebellar pathways as well as the pyramidal tract, remains a matter of debate. Therefore, this study aims to shed light on structural networks associated with SID and to derive a data-driven model to predict SID in patients with PD and STN-DBS. METHODS Randomised, double-blinded monopolar reviews determining SID thresholds were conducted in 25 patients with PD and STN-DBS. A fibre-based mapping approach, implementing the calculation of fibr-wise ORs for SID, was employed to identify the distributional pattern of SID in the STN's vicinity. The ability of the data-driven model to classify stimulation volumes as 'causing SID' or 'not causing SID' was validated by calculating receiver operating characteristics (ROC) in an independent out-of-sample cohort comprising 14 patients with PD and STN-DBS. RESULTS Local fibre-based stimulation maps showed an involvement of fibres running lateral and posteromedial to the STN in the pathogenesis of SID, independent of the investigated hemisphere. ROC analysis in the independent out-of-sample cohort resulted in a good fit of the data-driven model for both hemispheres (area under the curve (AUC)left=0.88, AUCright=0.88). CONCLUSIONS This study reveals an involvement of both, cerebello-thalamic fibres, as well as the pyramidal tract, in the pathogenesis of SID in STN-DBS. The results may impact future postoperative programming strategies to avoid SID in patients with PD and STN-DBS TRIAL REGISTRATION NUMBER: DRKS00023221; German Clinical Trials Register (DRKS) Number.
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Affiliation(s)
- Hannah Jergas
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | | | | | - Tabea Thies
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- iFL Phonetics, University of Cologne, Cologne, Germany
| | - Joshua N Strelow
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Ilona Rubi-Fessen
- RehaNova Neurological Rehabilitation Clinic, Cologne, Germany
- Department of Special Education and Rehabilitation, University of Cologne, Koln, Germany
| | - Jana Quinting
- Department of Special Education and Rehabilitation, University of Cologne, Koln, Germany
| | - Juan Carlos Baldermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- Department of Psychiatry, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Doris Mücke
- iFL Phonetics, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience Section, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Till A Dembek
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Michael T Barbe
- Department of Neurology, University Hospital Cologne, Cologne, Germany
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Gates K, Knowles T, Mach H, Higginbotham J, Holder T. Speech Amplification Device Usage for the Management of Hypophonia: A Survey of Speech-Language Pathologists. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1662-1697. [PMID: 38563721 DOI: 10.1044/2024_ajslp-23-00395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
PURPOSE The purpose of this study was to survey speech-language pathologists (SLPs) who assess and treat people with Parkinson's disease (PD) to gather insights into their decision making regarding their use or potential use of speech amplification technology for the management of hypophonia. METHOD A total of 111 SLPs who were currently practicing in the United States or Canada and had experience working with clients with PD for at least 2 years completed an anonymous Qualtrics survey. Questions were designed to probe the following areas: (a) degree of familiarity with amplification devices as a form of treatment for PD, (b) attitudes and perceptions of the implementation of these devices for PD, and (c) factors that influence the clinical decision to prescribe such devices. RESULTS Most participants (75; 71%) reported they had considered prescribing a device to at least one client with PD. When asked at which stages of speech or voice impairment they would consider the use of an amplification device for clients with PD, the most common response was for clients with moderate or severe hypophonia who were not stimulable for louder speech. However, 36 (32%) respondents indicated they would also consider an amplification device for clients who were stimulable for louder speech with severe hypophonia. When asked to rank the most important factors they would weigh when considering the prescription of an amplification device, they ranked the client's preference and comfort level as the most important consideration. CONCLUSION This study provides valuable clinical insights regarding how SLPs can approach utilizing speech amplification devices in the therapy environment.
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Affiliation(s)
- Kelly Gates
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Thea Knowles
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Helen Mach
- Department of Communication Sciences and Disorders, University of Delaware, Newark
| | - Jeff Higginbotham
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Thea Holder
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
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Vissani M, Bush A, Lipski WJ, Fischer P, Neudorfer C, Holt LL, Fiez JA, Turner RS, Richardson RM. Spike-phase coupling of subthalamic neurons to posterior opercular cortex predicts speech sound accuracy. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.10.18.562969. [PMID: 37905141 PMCID: PMC10614892 DOI: 10.1101/2023.10.18.562969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Speech provides a rich context for understanding how cortical interactions with the basal ganglia contribute to unique human behaviors, but opportunities for direct intracranial recordings across cortical-basal ganglia networks are rare. We recorded electrocorticographic signals in the cortex synchronously with single units in the basal ganglia during awake neurosurgeries where subjects spoke syllable repetitions. We discovered that individual STN neurons have transient (200ms) spike-phase coupling (SPC) events with multiple cortical regions. The spike timing of STN neurons was coordinated with the phase of theta-alpha oscillations in the posterior supramarginal and superior temporal gyrus during speech planning and production. Speech sound errors occurred when this STN-cortical interaction was delayed. Our results suggest that the STN supports mechanisms of speech planning and auditory-sensorimotor integration during speech production that are required to achieve high fidelity of the phonological and articulatory representation of the target phoneme. These findings establish a framework for understanding cortical-basal ganglia interaction in other human behaviors, and additionally indicate that firing-rate based models are insufficient for explaining basal ganglia circuit behavior.
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Affiliation(s)
- Matteo Vissani
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Alan Bush
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Witold J. Lipski
- Department of Neurobiology, Systems Neuroscience Center and Center for Neuroscience, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Petra Fischer
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, University Walk, BS8 1TD Bristol, United Kingdom
| | - Clemens Neudorfer
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Lori L. Holt
- Department of Psychology, The University of Texas at Austin, Austin, TX 78712 USA
| | - Julie A. Fiez
- Department of Psychology, University of Pittsburgh, Pittsburgh 15260, PA, USA
| | - Robert S. Turner
- Department of Neurobiology, Systems Neuroscience Center and Center for Neuroscience, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
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Manes JL, Bullock L, Meier AM, Turner RS, Richardson RM, Guenther FH. A neurocomputational view of the effects of Parkinson's disease on speech production. Front Hum Neurosci 2024; 18:1383714. [PMID: 38812472 PMCID: PMC11133703 DOI: 10.3389/fnhum.2024.1383714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
The purpose of this article is to review the scientific literature concerning speech in Parkinson's disease (PD) with reference to the DIVA/GODIVA neurocomputational modeling framework. Within this theoretical view, the basal ganglia (BG) contribute to several different aspects of speech motor learning and execution. First, the BG are posited to play a role in the initiation and scaling of speech movements. Within the DIVA/GODIVA framework, initiation and scaling are carried out by initiation map nodes in the supplementary motor area acting in concert with the BG. Reduced support of the initiation map from the BG in PD would result in reduced movement intensity as well as susceptibility to early termination of movement. A second proposed role concerns the learning of common speech sequences, such as phoneme sequences comprising words; this view receives support from the animal literature as well as studies identifying speech sequence learning deficits in PD. Third, the BG may play a role in the temporary buffering and sequencing of longer speech utterances such as phrases during conversational speech. Although the literature does not support a critical role for the BG in representing sequence order (since incorrectly ordered speech is not characteristic of PD), the BG are posited to contribute to the scaling of individual movements in the sequence, including increasing movement intensity for emphatic stress on key words. Therapeutic interventions for PD have inconsistent effects on speech. In contrast to dopaminergic treatments, which typically either leave speech unchanged or lead to minor improvements, deep brain stimulation (DBS) can degrade speech in some cases and improve it in others. However, cases of degradation may be due to unintended stimulation of efferent motor projections to the speech articulators. Findings of spared speech after bilateral pallidotomy appear to indicate that any role played by the BG in adult speech must be supplementary rather than mandatory, with the sequential order of well-learned sequences apparently represented elsewhere (e.g., in cortico-cortical projections).
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Affiliation(s)
- Jordan L. Manes
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, United States
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, United States
| | - Latané Bullock
- Program in Speech and Hearing Bioscience and Technology, Division of Medical Sciences, Harvard Medical School, Boston, MA, United States
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Andrew M. Meier
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, United States
| | - Robert S. Turner
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, United States
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD, United States
| | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Frank H. Guenther
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, United States
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States
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Tabari F, Berger JI, Flouty O, Copeland B, Greenlee JD, Johari K. Speech, voice, and language outcomes following deep brain stimulation: A systematic review. PLoS One 2024; 19:e0302739. [PMID: 38728329 PMCID: PMC11086900 DOI: 10.1371/journal.pone.0302739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) reliably ameliorates cardinal motor symptoms in Parkinson's disease (PD) and essential tremor (ET). However, the effects of DBS on speech, voice and language have been inconsistent and have not been examined comprehensively in a single study. OBJECTIVE We conducted a systematic analysis of literature by reviewing studies that examined the effects of DBS on speech, voice and language in PD and ET. METHODS A total of 675 publications were retrieved from PubMed, Embase, CINHAL, Web of Science, Cochrane Library and Scopus databases. Based on our selection criteria, 90 papers were included in our analysis. The selected publications were categorized into four subcategories: Fluency, Word production, Articulation and phonology and Voice quality. RESULTS The results suggested a long-term decline in verbal fluency, with more studies reporting deficits in phonemic fluency than semantic fluency following DBS. Additionally, high frequency stimulation, left-sided and bilateral DBS were associated with worse verbal fluency outcomes. Naming improved in the short-term following DBS-ON compared to DBS-OFF, with no long-term differences between the two conditions. Bilateral and low-frequency DBS demonstrated a relative improvement for phonation and articulation. Nonetheless, long-term DBS exacerbated phonation and articulation deficits. The effect of DBS on voice was highly variable, with both improvements and deterioration in different measures of voice. CONCLUSION This was the first study that aimed to combine the outcome of speech, voice, and language following DBS in a single systematic review. The findings revealed a heterogeneous pattern of results for speech, voice, and language across DBS studies, and provided directions for future studies.
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Affiliation(s)
- Fatemeh Tabari
- Human Neurophysiology and Neuromodulation Laboratory, Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, LA, United States of America
| | - Joel I. Berger
- Human Brain Research Laboratory, Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States of America
| | - Oliver Flouty
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States of America
| | - Brian Copeland
- Department of Neurology, LSU Health Sciences Center, New Orleans, LA, United States of America
| | - Jeremy D. Greenlee
- Human Brain Research Laboratory, Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States of America
- Iowa Neuroscience Institute, Iowa City, IA, United States of America
| | - Karim Johari
- Human Neurophysiology and Neuromodulation Laboratory, Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, LA, United States of America
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Kim Y, Thompson A, Nip ISB. Effects of Deep-Brain Stimulation on Speech: Perceptual and Acoustic Data. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1090-1106. [PMID: 38498664 PMCID: PMC11005955 DOI: 10.1044/2024_jslhr-23-00511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/15/2023] [Accepted: 01/16/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE This study examined speech changes induced by deep-brain stimulation (DBS) in speakers with Parkinson's disease (PD) using a set of auditory-perceptual and acoustic measures. METHOD Speech recordings from nine speakers with PD and DBS were compared between DBS-On and DBS-Off conditions using auditory-perceptual and acoustic analyses. Auditory-perceptual ratings included voice quality, articulation precision, prosody, speech intelligibility, and listening effort obtained from 44 listeners. Acoustic measures were made for voicing proportion, second formant frequency slope, vowel dispersion, articulation rate, and range of fundamental frequency and intensity. RESULTS No significant changes were found between DBS-On and DBS-Off for the five perceptual ratings. Four of six acoustic measures revealed significant differences between the two conditions. While articulation rate and acoustic vowel dispersion increased, voicing proportion and intensity range decreased from the DBS-Off to DBS-On condition. However, a visual examination of the data indicated that the statistical significance was mostly driven by a small number of participants, while the majority did not show a consistent pattern of such changes. CONCLUSIONS Our data, in general, indicate no-to-minimal changes in speech production ensued from DBS stimulation. The findings are discussed with a focus on large interspeaker variability in PD in terms of their speech characteristics and the potential effects of DBS on speech.
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Affiliation(s)
- Yunjung Kim
- School of Communication Science and Disorders, Florida State University, Tallahassee
| | - Austin Thompson
- Department of Communication Sciences and Disorders, University of Houston, TX
| | - Ignatius S. B. Nip
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
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10
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Knowles T, Adams SG, Jog M. Effects of speech rate modifications on phonatory acoustic outcomes in Parkinson's disease. Front Hum Neurosci 2024; 18:1331816. [PMID: 38450224 PMCID: PMC10914948 DOI: 10.3389/fnhum.2024.1331816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/30/2024] [Indexed: 03/08/2024] Open
Abstract
Speech rate reduction is a global speech therapy approach for speech deficits in Parkinson's disease (PD) that has the potential to result in changes across multiple speech subsystems. While the overall goal of rate reduction is usually improvements in speech intelligibility, not all people with PD benefit from this approach. Speech rate is often targeted as a means of improving articulatory precision, though less is known about rate-induced changes in other speech subsystems that could help or hinder communication. The purpose of this study was to quantify phonatory changes associated with speech rate modification across a broad range of speech rates from very slow to very fast in talkers with and without PD. Four speaker groups participated: younger and older healthy controls, and people with PD with and without deep brain stimulation of the subthalamic nucleus (STN-DBS). Talkers read aloud standardized sentences at 7 speech rates elicited using magnitude production: habitual, three slower rates, and three faster rates. Acoustic measures of speech intensity, cepstral peak prominence, and fundamental frequency were measured as a function of speech rate and group. Overall, slower rates of speech were associated with differential effects on phonation across the four groups. While all talkers spoke at a lower pitch in slow speech, younger talkers showed increases in speech intensity and cepstral peak prominence, while talkers with PD and STN-DBS showed the reverse pattern. Talkers with PD without STN-DBS and older healthy controls behaved in between these two extremes. At faster rates, all groups uniformly demonstrated increases in cepstral peak prominence. While speech rate reductions are intended to promote positive changes in articulation to compensate for speech deficits in dysarthria, the present results highlight that undesirable changes may be invoked across other subsystems, such as at the laryngeal level. In particular, talkers with STN-DBS, who often demonstrate speech deterioration following DBS surgery, demonstrated more phonatory detriments at slowed speech rates. Findings have implications for speech rate candidacy considerations and speech motor control processes in PD.
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Affiliation(s)
- Thea Knowles
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, United States
| | - Scott G. Adams
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, University Hospital, London, ON, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, University Hospital, London, ON, Canada
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11
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Johari K, Berger JI. Theta oscillations within right dorsolateral prefrontal cortex contribute differently to speech versus limb inhibition. J Neurosci Res 2024; 102:e25298. [PMID: 38361410 DOI: 10.1002/jnr.25298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/03/2024] [Accepted: 01/14/2024] [Indexed: 02/17/2024]
Abstract
Evidence suggests that speech and limb movement inhibition are subserved by common neural mechanisms, particularly within the right prefrontal cortex. In a recent study, we found that cathodal stimulation of right dorsolateral prefrontal cortex (rDLPFC) differentially modulated P3 event-related potentials for speech versus limb inhibition. In the present study, we further analyzed these data to examine the effects of cathodal high-definition transcranial direct current stimulation (HD-tDCS) over rDLPFC on frontal theta - an oscillatory marker of cognitive control - in response to speech and limb inhibition, during a Go/No-Go task in 21 neurotypical adults. Electroencephalography data demonstrated that both speech and limb No-Go elicited prominent theta activity over right prefrontal electrodes, with stronger activity for speech compared to limb. Moreover, we found that cathodal stimulation significantly increased theta power over right prefrontal electrodes for speech versus limb No-Go. Source analysis revealed that cathodal, but not sham, stimulation increased theta activity within rDLPFC and bilateral premotor cortex for speech No-Go compared to limb movement inhibition. These findings complement our previous report and suggest (1) right prefrontal theta activity is an amodal oscillatory mechanism supporting speech and limb inhibition, (2) larger theta activity in prefrontal electrodes for speech versus limb following cathodal stimulation may reflect allocation of additional neural resources for a more complex motor task, such as speech compared to limb movement. These findings have translational implications for conditions such as Parkinson's disease, wherein both speech and limb movement are impaired.
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Affiliation(s)
- Karim Johari
- Human Neurophysiology and Neuromodulation Lab, Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Joel I Berger
- Human Brain Research Laboratory, Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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12
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El Ouadih Y, Marques A, Pereira B, Luisoni M, Claise B, Coste J, Sontheimer A, Chaix R, Debilly B, Derost P, Morand D, Durif F, Lemaire JJ. Deep brain stimulation of the subthalamic nucleus in severe Parkinson's disease: relationships between dual-contact topographic setting and 1-year worsening of speech and gait. Acta Neurochir (Wien) 2023; 165:3927-3941. [PMID: 37889334 DOI: 10.1007/s00701-023-05843-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/24/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Subthalamic nucleus (STN) deep brain stimulation (DBS) alleviates severe motor fluctuations and dyskinesia in Parkinson's disease, but may result in speech and gait disorders. Among the suspected or demonstrated causes of these adverse effects, we focused on the topography of contact balance (CB; individual, right and left relative dual positions), a scantly studied topic, analyzing the relationships between symmetric or non-symmetric settings, and the worsening of these signs. METHOD An observational monocentric study was conducted on a series of 92 patients after ethical approval. CB was specified by longitudinal and transversal positions and relation to the STN (CB sub-aspects) and totalized at the patient level (patient CB). CB was deemed symmetric when the two contacts were at the same locations relative to the STN. CB was deemed asymmetric when at least one sub-aspect differed in the patient CB. Baseline and 1-year characteristics were routinely collected: (i) general, namely, Unified Parkinson's Disease Rating Scores (UPDRS), II, III motor and IV, daily levodopa equivalent doses, and Parkinson's Disease Questionnaire of Quality of Life (PDQ39) scores; (ii) specific, namely scores for speech (II-5 and III-18) and axial signs (II-14, III-28, III-29, and III-30). Only significant correlations were considered (p < 0.05). RESULTS Baseline characteristics were comparable (symmetric versus asymmetric). CB settings were related to deteriorations of speech and axial signs: communication PDQ39 and UPDRS speech and gait scores worsened exclusively with symmetric settings; the most influential CB sub-aspect was symmetric longitudinal position. CONCLUSION Our findings suggest that avoiding symmetric CB settings, whether by electrode positioning or shaping of electric fields, could reduce worsening of speech and gait.
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Affiliation(s)
- Youssef El Ouadih
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Ana Marques
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de La Recherche Clinique Et de L'Innovation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Maxime Luisoni
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
| | - Béatrice Claise
- Service de Radiologie, Unité de Neuroradiologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Jérôme Coste
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Anna Sontheimer
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Rémi Chaix
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Bérangère Debilly
- Service de Neurologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Philippe Derost
- Service de Neurologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Dominique Morand
- Direction de La Recherche Clinique Et de L'Innovation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Franck Durif
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France
- Service de Neurologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Jean-Jacques Lemaire
- Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000, Clermont-Ferrand, France.
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France.
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13
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Avantaggiato F, Farokhniaee A, Bandini A, Palmisano C, Hanafi I, Pezzoli G, Mazzoni A, Isaias IU. Intelligibility of speech in Parkinson's disease relies on anatomically segregated subthalamic beta oscillations. Neurobiol Dis 2023; 185:106239. [PMID: 37499882 DOI: 10.1016/j.nbd.2023.106239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/16/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Speech impairment is commonly reported in Parkinson's disease and is not consistently improved by available therapies - including deep brain stimulation of the subthalamic nucleus (STN-DBS), which can worsen communication performance in some patients. Improving the outcome of STN-DBS on speech is difficult due to our incomplete understanding of the contribution of the STN to fluent speaking. OBJECTIVE To assess the relationship between subthalamic neural activity and speech production and intelligibility. METHODS We investigated bilateral STN local field potentials (LFPs) in nine parkinsonian patients chronically implanted with DBS during overt reading. LFP spectral features were correlated with clinical scores and measures of speech intelligibility. RESULTS Overt reading was associated with increased beta-low ([1220) Hz) power in the left STN, whereas speech intelligibility correlated positively with beta-high ([2030) Hz) power in the right STN. CONCLUSION We identified separate contributions from frequency and brain lateralization of the STN in the execution of an overt reading motor task and its intelligibility. This subcortical organization could be exploited for new adaptive stimulation strategies capable of identifying the occurrence of speaking behavior and facilitating its functional execution.
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Affiliation(s)
- Federica Avantaggiato
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany.
| | - AmirAli Farokhniaee
- Fondazione Grigioni per il Morbo di Parkinson, Via Gianfranco Zuretti 35, 20125 Milano, Italy.
| | - Andrea Bandini
- The BioRobotics Institute, Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggo 34, Pontedera, Pisa, Italy; KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggo 34, Pontedera, Pisa, Italy.
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany; Parkinson Institute Milan, ASST G. Pini-CTO, via Bignami 1, 20126 Milano, Italy.
| | - Ibrahem Hanafi
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany.
| | - Gianni Pezzoli
- Fondazione Grigioni per il Morbo di Parkinson, Via Gianfranco Zuretti 35, 20125 Milano, Italy; Parkinson Institute Milan, ASST G. Pini-CTO, via Bignami 1, 20126 Milano, Italy.
| | - Alberto Mazzoni
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggo 34, Pontedera, Pisa, Italy.
| | - Ioannis U Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany; Parkinson Institute Milan, ASST G. Pini-CTO, via Bignami 1, 20126 Milano, Italy.
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14
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Johari K, Berger JI. High-definition transcranial direct current stimulation over right dorsolateral prefrontal cortex differentially modulates inhibitory mechanisms for speech vs. limb movement. Psychophysiology 2023; 60:e14289. [PMID: 36883294 DOI: 10.1111/psyp.14289] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 01/25/2023] [Accepted: 02/17/2023] [Indexed: 03/09/2023]
Abstract
Evidence suggests that planning and execution of speech and limb movement are subserved by common neural substrates. However, less is known about whether they are supported by a common inhibitory mechanism. P3 event-related potentials (ERPs) is a neural signature of motor inhibition, which are found to be generated by several brain regions including the right dorsolateral prefrontal cortex (rDLPFC). However, the relative contribution of rDLPFC to the P3 response associated with speech versus limb inhibition remains elusive. We investigated the contribution of rDLPFC to the P3 underlying speech versus limb movement inhibition. Twenty-one neurotypical adults received both cathodal and sham high-definition transcranial direct current stimulation (HD-tDCS) over rDLPFC. ERPs were subsequently recorded while subjects were performing speech and limb Go/No-Go tasks. Cathodal HD-tDCS decreased accuracy for speech versus limb No-Go. Both speech and limb No-Go elicited a similar topographical distribution of P3, with significantly larger amplitudes for speech versus limb at a frontocentral location following cathodal HD-tDCS. Moreover, results showed stronger activation in cingulate cortex and rDLPFC for speech versus limb No-Go following cathodal HD-tDCS. These results indicate (1) P3 is an ERP marker of amodal inhibitory mechanisms that support both speech and limb inhibition, (2) larger P3 for speech versus limb No-Go following cathodal HD-tDCS may reflect the recruitment of additional neural resources-particularly within rDLPFC and cingulate cortex-as compensatory mechanisms to counteract the temporary stimulation-induced decline in speech inhibitory process. These findings have translational implications for neurological conditions that concurrently affect speech and limb movement.
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Affiliation(s)
- Karim Johari
- Human Neurophysiology and Neuromodulation Laboratory, Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Joel I Berger
- Human Brain Research Laboratory, Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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15
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Gessani A, Cavallieri F, Fioravanti V, Campanini I, Merlo A, Di Rauso G, Damiano B, Scaltriti S, Bardi E, Corni MG, Antonelli F, Cavalleri F, Molinari MA, Contardi S, Menozzi E, Fraternali A, Versari A, Biagini G, Fraix V, Pinto S, Moro E, Budriesi C, Valzania F. Long-term effects of subthalamic nucleus deep brain stimulation on speech in Parkinson's disease. Sci Rep 2023; 13:11462. [PMID: 37454168 PMCID: PMC10349811 DOI: 10.1038/s41598-023-38555-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023] Open
Abstract
Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment in advanced Parkinson's Disease (PD). However, the effects of STN-DBS on speech are still debated, particularly in the long-term follow-up. The objective of this study was to evaluate the long-term effects of bilateral STN-DBS on speech in a cohort of advanced PD patients treated with bilateral STN-DBS. Each patient was assessed before surgery through a neurological evaluation and a perceptual-acoustic analysis of speech and re-assessed in the long-term in different stimulation and drug conditions. The primary outcome was the percentage change of speech intelligibility obtained by comparing the postoperative on-stimulation/off-medication condition with the preoperative off-medication condition. Twenty-five PD patients treated with bilateral STN-DBS with a 5-year follow-up were included. In the long-term, speech intelligibility stayed at the same level as preoperative values when compared with preoperative values. STN-DBS induced a significant acute improvement of speech intelligibility (p < 0.005) in the postoperative assessment when compared to the on-stimulation/off-medication and off-stimulation/off-medication conditions. These results highlight that STN-DBS may handle speech intelligibility even in the long-term.
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Affiliation(s)
- Annalisa Gessani
- Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | - Valentina Fioravanti
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Isabella Campanini
- LAM - Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Italy
| | - Andrea Merlo
- LAM - Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Italy
| | - Giulia Di Rauso
- Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Benedetta Damiano
- LAM - Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Italy
| | - Sara Scaltriti
- LAM - Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Italy
| | - Elisa Bardi
- Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Maria Giulia Corni
- Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Francesca Antonelli
- Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Francesca Cavalleri
- Division of Neuroradiology, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy
| | - Maria Angela Molinari
- Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Sara Contardi
- Department of Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | - Elisa Menozzi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Alessandro Fraternali
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Biagini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Valérie Fraix
- Grenoble Alpes University, Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, Grenoble, France
| | - Serge Pinto
- Aix-Marseille Univ, CRNS, LPL, Aix-en-Provence, France
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, Grenoble, France
| | - Carla Budriesi
- Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Franco Valzania
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
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16
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Bóna J. Speech rate and fluency in young-onset Parkinson's disease: A longitudinal case study from early to post brain surgery stage. CLINICAL LINGUISTICS & PHONETICS 2023; 37:385-397. [PMID: 36314241 DOI: 10.1080/02699206.2022.2138784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 05/20/2023]
Abstract
The aim of this study is to analyse the speech rate, pausing and fluency of a patient with young-onset Parkinson's Disease in different stages of the disease. Speech samples of the patient were recorded in the early stages of the disease until after the brain surgery. The recordings were compared to the speech of healthy control speakers. Speech rate, articulation rate, pausing and the frequency of disfluencies were analysed. Results show that all parameters are influenced by the severity of the disease, but articulation rate is the most affected.
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Affiliation(s)
- Judit Bóna
- Department of Applied Linguistics and Phonetics, ELTE Eötvös Loránd University, Budapest, Hungary
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17
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Meng H, Wei JH, Yu PZ, Ren JX, Tang MY, Sun JY, Yan XY, Su J. Insights into Advanced Neurological Dysfunction Mechanisms Following DBS Surgery in Parkinson's Patients: Neuroinflammation and Pyroptosis. Curr Issues Mol Biol 2023; 45:4480-4494. [PMID: 37232753 DOI: 10.3390/cimb45050284] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
Parkinson's disease is a severe neurodegenerative disorder. Currently, deep brain electrical stimulation (DBS) is the first line of surgical treatment. However, serious neurological impairments such as speech disorders, disturbances of consciousness, and depression after surgery limit the efficacy of treatment. In this review, we summarize the recent experimental and clinical studies that have explored the possible causes of neurological deficits after DBS. Furthermore, we tried to identify clues from oxidative stress and pathological changes in patients that could lead to the activation of microglia and astrocytes in DBS surgical injury. Notably, reliable evidence supports the idea that neuroinflammation is caused by microglia and astrocytes, which may contribute to caspase-1 pathway-mediated neuronal pyroptosis. Finally, existing drugs and treatments may partially ameliorate the loss of neurological function in patients following DBS surgery by exerting neuroprotective effects.
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Affiliation(s)
- Hao Meng
- Department of Pathophysiology, College of Basic Medical Sciences, Jilin University, 126 Xinmin Street, Changchun 130021, China
| | - Jia-Hang Wei
- Department of Pathophysiology, College of Basic Medical Sciences, Jilin University, 126 Xinmin Street, Changchun 130021, China
| | - Peng-Zheng Yu
- Department of Pathophysiology, College of Basic Medical Sciences, Jilin University, 126 Xinmin Street, Changchun 130021, China
| | - Jia-Xin Ren
- Department of Pathophysiology, College of Basic Medical Sciences, Jilin University, 126 Xinmin Street, Changchun 130021, China
| | - Meng-Yao Tang
- Department of Pathophysiology, College of Basic Medical Sciences, Jilin University, 126 Xinmin Street, Changchun 130021, China
| | - Jun-Yi Sun
- Department of Pathophysiology, College of Basic Medical Sciences, Jilin University, 126 Xinmin Street, Changchun 130021, China
| | - Xiao-Yu Yan
- Department of Pathophysiology, College of Basic Medical Sciences, Jilin University, 126 Xinmin Street, Changchun 130021, China
| | - Jing Su
- Department of Pathophysiology, College of Basic Medical Sciences, Jilin University, 126 Xinmin Street, Changchun 130021, China
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18
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Nip ISB, Burke MM, Kim Y. The Effects of Deep Brain Stimulation on Speech Motor Control in People With Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:804-819. [PMID: 36780302 DOI: 10.1044/2022_jslhr-22-00443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE Despite the overall benefits of deep brain stimulation (DBS) in Parkinson's disease (PD), its effects on speech production have been mixed when examined using auditory-perceptual and acoustic measures. This study investigated the effects of DBS on the lip and jaw kinematics during sentence production in individuals with dysarthria secondary to PD. METHOD Twenty-seven participants from three groups were included in the study: (a) individuals with PD and without DBS (PD group), (b) individuals with PD and with DBS (PD-DBS group), and (c) neurologically healthy control speakers (HC group). Lip and jaw movements during speech were recorded using optical motion capture and analyzed for path distance, speed, duration, articulatory stability, and interarticulator coordination. RESULTS The PD-DBS group showed (a) increased path distance compared with the PD and HC groups and (b) increased speed compared with the PD group but not the HC group. Both PD and PD-DBS groups exhibited lengthened sentence duration compared with the HC group. Articulatory stability was greater for the two PD groups, PD and PD-DBS, compared with the HC group. Spatial, but not temporal, coordination was lower for the PD group than for the other two groups. The only kinematic changes between the DBS on and off conditions within the PD-DBS group were increases in spatial coordination. CONCLUSIONS These data suggest that DBS primarily affects the amplitude scaling of articulatory movements, but not the temporal scaling, in individuals with PD. The findings are discussed with respect to the DBS-induced neural changes and their effects on speech motor control in PD.
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Affiliation(s)
- Ignatius S B Nip
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
| | - Mathes M Burke
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
| | - Yunjung Kim
- School of Communication Science and Disorders, Florida State University, Tallahassee
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Finnimore A, Theodoros D, Rumbach AF. Clinical outcomes of PD Check-In, a model for supported self-managed maintenance of speech in Parkinson's disease: A Phase 1 study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:241-255. [PMID: 36036751 DOI: 10.1111/1460-6984.12772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND For many people with Parkinson's disease (PWPD), the long-term maintenance of speech following intensive treatment remains elusive. PD Check-In, a model for supported self-managed maintenance of speech following LSVT LOUD® , was developed and evaluated. AIMS To evaluate the impact of PD Check-In on vocal intensity and level of satisfaction of PWPD and their communication partners (CPs) over 24 months following LSVT LOUD. METHODS & PROCEDURES A repeated-measures study design examined the impact of PD Check-In on the speech of 16 PWPD. Participants received LSVT LOUD followed by PD Check-In at 6 and 12 weeks, and 6, 12 and 24 months after treatment. Outcome measures included acoustic measures of vocal intensity (sound pressure level-SPL) during sustained phonation, functional phrases, reading, and monologue, and satisfaction questionnaires for PWPD and their CPs. OUTCOMES & RESULTS A significant treatment effect for time (p < 0.01) was identified for all SPL variables. Planned comparisons showed significant improvements for each variable pre- to post-LSVT LOUD. There was a significant maintenance effect for SPL maximum sustained phonation only, post-LSVT LOUD to 24 months. SPL remained significantly above baseline for functional phrases and maximum sustained phonation at 24 months. Participants' satisfaction with PD Check-In was high, at 93.75% for PWPD and 79.99% for CPs, at 24 months post-treatment. Long intervals between appointments led PWPD to feel less motivated about speech practice but more confident in self-management. CONCLUSIONS & IMPLICATIONS For PWPD and CPs, maintenance of speech following LSVT LOUD encompasses more than acoustic outcomes. WHAT THIS PAPER ADDS What is already known on this subject? Maintenance of speech following LSVT LOUD has been shown to be variable in individual and group models. For PWPD and their CPs, a model for speech maintenance supports their expectation of sustained treatment effect over time and meets their changing needs for speech and language therapy services. Supported self-management is a model under investigation for long-term maintenance of speech. What this paper adds to existing knowledge? This study presents the impact of five individual PD Check-In interventions on the maintenance of vocal intensity (SPL) of 16 PWPD over 24 months following LSVT LOUD. PWPD and CPs reported a high level of satisfaction with PD Check-In independent of acoustic outcomes. What are the potential or actual clinical implications of this work? Participant satisfaction with PD Check-In is derived from multiple factors and not limited to acoustic outcomes post-LSVT LOUD. Further investigation of the efficacy of PD Check-In to support the perceived maintenance of speech of PWPD and CPs is warranted.
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Affiliation(s)
- Ann Finnimore
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
- The Prince Charles Hospital, Metro North Hospital & Health Service, Brisbane, QLD, Australia
| | - Deborah Theodoros
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
| | - Anna F Rumbach
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
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20
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Chen Q, Chen B, Wan Q, Wang Y, Li J, Huang Z. Effects of intensive speech treatment on Mandarin speakers with Parkinson's Disease: A review. Medicine (Baltimore) 2023; 102:e32900. [PMID: 36820601 PMCID: PMC9907986 DOI: 10.1097/md.0000000000032900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Benefits of intensive speech treatment have been documented for a range of speech signs in English speakers with Parkinson's Disease (PD). However, the answer to a critical question that whether the same treatment benefits speech variables including intelligibility in Mandarin speakers is still unclear. In order to develop a targeted speech treatment for Mandarin speakers with PD, we reviewed the efficacy of intensive speech treatment to improve vocal loudness and functional communication and discuss possible explanations for efficacy on Mandarin speakers with PD. METHODS Literatures about intensive speech treatment for Mandarin speakers with PD were retrieved from PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), Wanfang and Weipu Database for Chinese Technical Periodicals (VIP) Database. Search strategy was (voice therapy OR speech therapy OR voice treatment OR speech treatment OR voice training OR speech training OR voice rehabilitation OR speech rehabilitation OR Lee Silverman voice treatment OR intensive speech treatment) and (Parkinson's disease) and (Mandarin speakers OR Chinese OR Chinese people). RESULTS Five randomized controlled trials were selected and possible explanations for efficacy on individuals with PD are discussed. Further research directions are suggested. CONCLUSION The existing evidence from treatment efficacy studies of intensive speech treatment provides support for improving vocal loudness, speech intelligibility, pitch and rate in Mandarin speakers with PD. Our future research will continue to work to conduct a large sample multicenter randomized controlled trial to provide high quality evidence and understand the basic mechanisms accompanying treatment-related change.
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Affiliation(s)
- Qingqing Chen
- Department of Education and Rehabilitation, Faculty of Education, East China Normal University, Shanghai, China
| | - Bailin Chen
- KangDa College of Nanjing Medical University, Lian Yungang, China
| | - Qin Wan
- Department of Education and Rehabilitation, Faculty of Education, East China Normal University, Shanghai, China
| | - Yongli Wang
- Department of Education and Rehabilitation, Faculty of Education, East China Normal University, Shanghai, China
| | - Jian Li
- Faculty of Traditional Chinese Medicine, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Zhaoming Huang
- Department of Education and Rehabilitation, Faculty of Education, East China Normal University, Shanghai, China
- * Correspondence: Zhaoming Huang, Department of Education and Rehabilitation, Faculty of Education, East China Normal University, Shanghai 200062, China (e-mail: )
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21
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Pinto S, Nebel A, Rau J, Espesser R, Maillochon P, Niebuhr O, Krack P, Witjas T, Ghio A, Cuartero MC, Timmermann L, Schnitzler A, Hesekamp H, Meier N, Müllner J, Hälbig TD, Möller B, Paschen S, Paschen L, Volkmann J, Barbe MT, Fink GR, Becker J, Reker P, Kühn AA, Schneider GH, Fraix V, Seigneuret E, Kistner A, Rascol O, Brefel-Courbon C, Ory-Magne F, Hartmann CJ, Wojtecki L, Fradet A, Maltête D, Damier P, Le Dily S, Sixel-Döring F, Benecke P, Weiss D, Wächter T, Pinsker MO, Régis J, Thobois S, Polo G, Houeto JL, Hartmann A, Knudsen K, Vidailhet M, Schüpbach M, Deuschl G. Results of a Randomized Clinical Trial of Speech After Early Neurostimulation in Parkinson's Disease. Mov Disord 2023; 38:212-222. [PMID: 36461899 DOI: 10.1002/mds.29282] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/03/2022] [Accepted: 11/06/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND The EARLYSTIM trial demonstrated for Parkinson's disease patients with early motor complications that deep brain stimulation of the subthalamic nucleus (STN-DBS) and best medical treatment (BMT) was superior to BMT alone. OBJECTIVE This prospective, ancillary study on EARLYSTIM compared changes in blinded speech intelligibility assessment between STN-DBS and BMT over 2 years, and secondary outcomes included non-speech oral movements (maximum phonation time [MPT], oral diadochokinesis), physician- and patient-reported assessments. METHODS STN-DBS (n = 102) and BMT (n = 99) groups underwent assessments on/off medication at baseline and 24 months (in four conditions: on/off medication, ON/OFF stimulation-for STN-DBS). Words and sentences were randomly presented to blinded listeners, and speech intelligibility rate was measured. Statistical analyses compared changes between the STN-DBS and BMT groups from baseline to 24 months. RESULTS Over the 2-year period, changes in speech intelligibility and MPT, as well as patient-reported outcomes, were not different between groups, either off or on medication or OFF or ON stimulation, but most outcomes showed a nonsignificant trend toward worsening in both groups. Change in oral diadochokinesis was significantly different between STN-DBS and BMT groups, on medication and OFF STN-DBS, with patients in the STN-DBS group performing slightly worse than patients under BMT only. A signal for clinical worsening with STN-DBS was found for the individual speech item of the Unified Parkinson's Disease Rating Scale, Part III. CONCLUSION At this early stage of the patients' disease, STN-DBS did not result in a consistent deterioration in blinded speech intelligibility assessment and patient-reported communication, as observed in studies of advanced Parkinson's Disease. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Serge Pinto
- Aix-Marseille Univ, CNRS, LPL, Aix-en-Provence, France
| | - Adelheid Nebel
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Jörn Rau
- Coordinating Centre for Clinical Trials of the Philipps-University of Marburg, Marburg, Germany
| | | | | | - Oliver Niebuhr
- Department of Scandinavian Studies, Frisian, and General Linguistics, Kiel University, Kiel, Germany
| | - Paul Krack
- Department of Neurology or Neurosurgery, Grenoble University Hospital, Grenoble Alpes University, Grenoble Institut des Neurosciences, Grenoble, France
| | - Tatiana Witjas
- Aix Marseille Univ, APHM, La Timone, Neurology Department or Department of Functional and Stereotactic Neurosurgery and Radiosurgery, Marseille, France
| | - Alain Ghio
- Aix-Marseille Univ, CNRS, LPL, Aix-en-Provence, France
| | | | - Lars Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Alfons Schnitzler
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Helke Hesekamp
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC), Paris, France
| | - Niklaus Meier
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC), Paris, France
| | - Julia Müllner
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC), Paris, France
| | - Thomas D Hälbig
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC), Paris, France
| | - Bettina Möller
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Steffen Paschen
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Laura Paschen
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Jens Volkmann
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Michael T Barbe
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Johannes Becker
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Paul Reker
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité Hospital, Berlin University, Berlin, Germany
| | | | - Valérie Fraix
- Department of Neurology or Neurosurgery, Grenoble University Hospital, Grenoble Alpes University, Grenoble Institut des Neurosciences, Grenoble, France
| | - Eric Seigneuret
- Department of Neurology or Neurosurgery, Grenoble University Hospital, Grenoble Alpes University, Grenoble Institut des Neurosciences, Grenoble, France
| | - Andrea Kistner
- Department of Neurology or Neurosurgery, Grenoble University Hospital, Grenoble Alpes University, Grenoble Institut des Neurosciences, Grenoble, France
| | - Olivier Rascol
- Department of Neurology and Centre Expert Parkinson, and INSERM U1214, Toulouse University Hospital, Toulouse NeuroImaging Centre, Toulouse, France
| | - Christine Brefel-Courbon
- Department of Neurology and Centre Expert Parkinson, and INSERM U1214, Toulouse University Hospital, Toulouse NeuroImaging Centre, Toulouse, France
| | - Fabienne Ory-Magne
- Department of Neurology and Centre Expert Parkinson, and INSERM U1214, Toulouse University Hospital, Toulouse NeuroImaging Centre, Toulouse, France
| | - Christian J Hartmann
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Lars Wojtecki
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Anne Fradet
- Department of Neurology, CIC-INSERM 1402, CHU de Poitiers, Université de Poitiers, Poitiers, France
| | - David Maltête
- Department of Neurology, Rouen University Hospital, INSERM U1073, Rouen Faculty of Medicine, Rouen, France
| | - Philippe Damier
- CHU Nantes, INSERM, CIC1413, Hôpital Laënnec, Nantes, France
| | | | | | - Petra Benecke
- Department of Neurology, Paracelsus-Elena-Klinik, Kassel, Germany
| | - Daniel Weiss
- Department for Neurodegenerative Diseases, Centre for Neurology, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Tobias Wächter
- Department for Neurodegenerative Diseases, Centre for Neurology, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Marcus O Pinsker
- Department of Neurosurgery, University Hospital, Freiburg, Germany
| | - Jean Régis
- Aix Marseille Univ, APHM, La Timone, Neurology Department or Department of Functional and Stereotactic Neurosurgery and Radiosurgery, Marseille, France
| | - Stéphane Thobois
- Hôpital Neurologique Pierre Wertheimer, Centre Expert Parkinson, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 Lyon, France, and Centre de Neurosciences Cognitives, Bron, France
| | - Gustavo Polo
- Hôpital Neurologique Pierre Wertheimer, Centre Expert Parkinson, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 Lyon, France, and Centre de Neurosciences Cognitives, Bron, France
| | - Jean-Luc Houeto
- Department of Neurology, CIC-INSERM 1402, CHU de Poitiers, Université de Poitiers, Poitiers, France
| | - Andreas Hartmann
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC), Paris, France
| | - Karina Knudsen
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Marie Vidailhet
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC), Paris, France
| | - Michael Schüpbach
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC), Paris, France
| | - Günther Deuschl
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
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Johari K, Kelley RM, Tjaden K, Patterson CG, Rohl AH, Berger JI, Corcos DM, Greenlee JDW. Human subthalamic nucleus neurons differentially encode speech and limb movement. Front Hum Neurosci 2023; 17:962909. [PMID: 36875233 PMCID: PMC9983637 DOI: 10.3389/fnhum.2023.962909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 01/25/2023] [Indexed: 02/19/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN), which consistently improves limb motor functions, shows mixed effects on speech functions in Parkinson's disease (PD). One possible explanation for this discrepancy is that STN neurons may differentially encode speech and limb movement. However, this hypothesis has not yet been tested. We examined how STN is modulated by limb movement and speech by recording 69 single- and multi-unit neuronal clusters in 12 intraoperative PD patients. Our findings indicated: (1) diverse patterns of modulation in neuronal firing rates in STN for speech and limb movement; (2) a higher number of STN neurons were modulated by speech vs. limb movement; (3) an overall increase in neuronal firing rates for speech vs. limb movement; and (4) participants with longer disease duration had higher firing rates. These data provide new insights into the role of STN neurons in speech and limb movement.
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Affiliation(s)
- Karim Johari
- Human Neurophysiology and Neuromodulation Lab, Department of Communication Science and Disorders, Louisiana State University, Baton Rouge, LA, United States.,Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
| | - Ryan M Kelley
- Medical Scientist Training Program, The University of Iowa, Iowa City, IA, United States.,Program in Neuroscience, The University of Iowa, Iowa City, IA, United States
| | - Kris Tjaden
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, United States
| | - Charity G Patterson
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrea H Rohl
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
| | - Joel I Berger
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
| | - Daniel M Corcos
- Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL, United States
| | - Jeremy D W Greenlee
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States.,Program in Neuroscience, The University of Iowa, Iowa City, IA, United States.,Iowa Neuroscience Institute, Iowa City, IA, United States
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23
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McAuley MD. Deep brain stimulation for Parkinson's disease: A case for patient empowerment. Brain Stimul 2023; 16:97-99. [PMID: 36682717 DOI: 10.1016/j.brs.2023.01.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/17/2022] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
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Dai L, Xu W, Song Y, Huang P, Li N, Hollunder B, Horn A, Wu Y, Zhang C, Sun B, Li D. Subthalamic deep brain stimulation for refractory Gilles de la Tourette's syndrome: clinical outcome and functional connectivity. J Neurol 2022; 269:6116-6126. [PMID: 35861855 PMCID: PMC9553760 DOI: 10.1007/s00415-022-11266-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is a promising novel approach for managing refractory Gilles de la Tourette's syndrome (GTS). The subthalamic nucleus (STN) is the most common DBS target for treating movement disorders, and smaller case studies have reported the efficacy of bilateral STN-DBS treatment for relieving tic symptoms. However, management of GTS and treatment mechanism of STN-DBS in GTS remain to be elucidated. METHODS Ten patients undergoing STN-DBS were included. Tics severity was evaluated using the Yale Global Tic Severity Scale. The severities of comorbid psychiatric symptoms of obsessive-compulsive behavior (OCB), attention-deficit/hyperactivity disorder, anxiety, and depression; social and occupational functioning; and quality of life were assessed. Volumes of tissue activated were used as seed points for functional connectivity analysis performed using a control dataset. RESULTS The overall tics severity significantly reduced, with 62.9% ± 26.2% and 58.8% ± 27.2% improvements at the 6- and 12-months follow-up, respectively. All three patients with comorbid OCB showed improvement in their OCB symptoms at both the follow-ups. STN-DBS treatment was reasonably well tolerated by the patients with GTS. The most commonly reported side effect was light dysarthria. The stimulation effect of STN-DBS might regulate these symptoms through functional connectivity with the thalamus, pallidum, substantia nigra pars reticulata, putamen, insula, and anterior cingulate cortices. CONCLUSIONS STN-DBS was associated with symptomatic improvement in severe and refractory GTS without significant adverse events. The STN is a promising DBS target by stimulating both sensorimotor and limbic subregions, and specific brain area doses affect treatment outcomes.
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Affiliation(s)
- Lulin Dai
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenying Xu
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunhai Song
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neurosurgery, Shanghai Children's Medical Center, Affiliated to the Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Peng Huang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ningfei Li
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Barbara Hollunder
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Horn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
- MGH Neurosurgery and Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Yiwen Wu
- Department of Neurology, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Research Center for Brain Science and Brain-Inspired Technology, Shanghai, China.
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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25
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Kluin KJ, Mossner JM, Costello JT, Chou KL, Patil PG. Motor speech effects in subthalamic deep brain stimulation for Parkinson's disease. J Neurosurg 2022; 137:722-728. [PMID: 35090126 PMCID: PMC10193494 DOI: 10.3171/2021.12.jns211729] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A motor speech disorder or dysarthria commonly arises in patients with Parkinson's disease (PD). The impact of subthalamic nucleus (STN) deep brain stimulation (DBS) on motor speech and the potential of intraoperative motor speech testing to predict outcomes are unknown. This study examined 1) the types and prevalence of motor speech changes observed with STN DBS and their relation to the preoperative condition, 2) the ability of intraoperative testing to predict postoperative changes in motor speech, and 3) the spatial relationship between stimulation sites producing maximal motor improvement, as measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and maximal motor speech deterioration. METHODS Comprehensive preoperative, intraoperative, and postoperative motor speech/dysarthria evaluations were performed in consecutive patients with advanced idiopathic PD who underwent STN DBS surgery in the period from 2011 to 2016. Preoperative type of dysarthria and overall dysarthria severity rating along with intraoperative motor speech testing results were evaluated as predictors of postoperative change. Atlas-independent, fully individualized field modeling was used to identify stimulation sites associated with maximal MDS-UPDRS motor improvement and motor speech deterioration. RESULTS Forty-three patients with PD treated with STN DBS were prospectively studied. Improved MDS-UPDRS motor scores and worsened dysarthria were demonstrated by a subset of patients (16/43). Preoperative dysarthria characteristics did not predict postoperative deterioration. Intraoperative assessment of motor speech strongly predicted postoperative outcomes (OR 4.4, p = 0.02). Sites of maximal MDS-UPDRS motor improvement and worsened dysarthria were distinct. Worsened dysarthria was associated with capsular stimulation, anterior and ventral to the site of maximal MDS-UPDRS motor improvement. CONCLUSIONS The predictive reliability of intraoperative motor speech testing, together with the identification of distinct stimulation sites for motor speech impairment and improved MDS-UPDRS motor function, raise the possibility that DBS lead repositioning or reprogramming could reduce adverse effects on motor speech without impacting MDS-UPDRS motor outcomes in patients undergoing STN DBS.
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Affiliation(s)
| | | | | | | | - Parag G. Patil
- Neurology
- Neurosurgery
- Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
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Random Forest Algorithm Based on Speech for Early Identification of Parkinson's Disease. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:3287068. [PMID: 35586090 PMCID: PMC9110120 DOI: 10.1155/2022/3287068] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022]
Abstract
To investigate the effectiveness of identifying patients with Parkinson's disease (PD) from speech signals, various acoustic parameters including prosodic and segmental features are extracted from speech and then the random forest classification (RF) algorithm based on these acoustic parameters is applied to diagnose early-stage PD patients. To validate the proposed method of RF algorithm in early-stage PD identification, this study compares the accuracy rate of RF with that of neurologists' judgments based on auditory test outcomes, and the results clearly show the superiority of the proposed method over its rival. Random forest algorithm based on speech can improve the accuracy of patients' identification, which provides an efficient auxiliary method in the early diagnosis of PD patients.
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Catalano Chiuvé S, Fournet M, Wegrzyk J, Assal F, Burkhard PR, Laganaro M. Longitudinal study of speech and dual-task performance in Parkinson's disease patients treated with subthalamic nucleus deep brain stimulation. Parkinsonism Relat Disord 2022; 97:75-78. [PMID: 35349893 DOI: 10.1016/j.parkreldis.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Impairments in speech and executive functions are both observed in Parkinson's disease (PD) and might be influenced by subthalamic nucleus deep brain stimulation (STN-DBS). We investigated the effects of STN-DBS on speech and executive functions and their mutual interference in PD. METHODS 14 PD patients eligible for bilateral STN-DBS (PD-DBS), and 16 PD patients with best medical treatment (PD-BMT) were included. Global cognition, executive functions (inhibition and verbal fluency), speech tasks with acoustic measures, and a dual-task (DT) combining a speech task with a Go or Go/NoGo task were performed at baseline and 12 months follow-up. A normative group of matched healthy participants was included at baseline for the evaluation of speech and DT performance. RESULTS In both patient groups, global cognition mildly decreased after 12 months (p < .001). PD-DBS showed decreased inhibition (p = .016) whereas PD-BMT deteriorated in vowel articulation (p = .011). Using the DT paradigm, PD-DBS showed a slowing of speech rate after 12 months (p = .009) in contrast to PD-BMT (p = .203). CONCLUSION STN-DBS does not seem to impair speech and global cognition but might affect certain executive functions (notably inhibition). Speech-cognition interference is relatively preserved in PD patients, even though PD-DBS present larger DT cost on speech rate at 12 months post-DBS compared to PD-BMT. An evaluation with a longer follow-up using a larger sample is needed to confirm long-term effects.
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Affiliation(s)
| | - Maryll Fournet
- Department of Neurorehabilitation, Geneva University Hospitals, Geneva, Switzerland; University of Geneva, Faculty of Psychology and Educational Sciences, Geneva, Switzerland
| | - Jennifer Wegrzyk
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Frédéric Assal
- Department of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre R Burkhard
- Department of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - Marina Laganaro
- University of Geneva, Faculty of Psychology and Educational Sciences, Geneva, Switzerland
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Dash D, Cote D, Conway J, Grimes D, Mestre TA. Evaluation of the Impact of Integrated Care and Self-Management After Deep Brain Stimulation in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:JPD212911. [PMID: 35253775 DOI: 10.3233/jpd-212911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a progressive neurodegenerative disorder with a myriad of motor and non-motor symptoms. Although deep brain stimulation (DBS) has a dramatic impact in the lives of people with PD, care delivery remains complex. There is a lack of evidence on the implementation and role of integrated care and self-management support in people with PD with chronic DBS. OBJECTIVE To evaluate care needs, implementation and impact of a pragmatic network for PD care, the Integrated Parkinson Care Network (IPCN). METHODS This is a subgroup analyses of a 6-month, pre-post design, single-centre, phase 2 study to assess a patient-centred care model based on integrated care, self-management support (IPCN) in PD, focusing on those participants with chronic DBS. RESULTS We included 22 people with PD and chronic DBS (median time since DBS - 30 months). The mean age was 63.9 (7.6) years and mean disease duration was 15.2 (6.9) years. The top three care priorities were speech (54.5%), mobility (40.9%) and mood (31.8%). After the IPCN program, there was a positive change in the perception of support for chronic care (Patient Assessment of Chronic Illness Case: 0.85; 95% CI: 1.2 to -0.4) and self-management (5As: 0.77; 95% CI: 0.39 -1.15), along with quality of life (PDQ8 : 7.1, 95% CI:1.8 -12.4). CONCLUSION The IPCN is a care delivery model that addresses specific care needs of people with PD and chronic DBS. The current study showed its feasibility and warrants further evaluation.
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Affiliation(s)
- Deepa Dash
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital and the University of Ottawa Brain and Mind Research Institute, Ottawa, Canada
| | - Diane Cote
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jennifer Conway
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - David Grimes
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital and the University of Ottawa Brain and Mind Research Institute, Ottawa, Canada
| | - Tiago A Mestre
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital and the University of Ottawa Brain and Mind Research Institute, Ottawa, Canada
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Voice handicap Index in Parkinson's patients: Subthalamic versus globus pallidus deep brain stimulation. J Clin Neurosci 2022; 98:83-88. [PMID: 35151061 DOI: 10.1016/j.jocn.2022.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 11/22/2021] [Accepted: 01/22/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE Subthalamic nucleus (STN) and globus pallidus interna (GPI) are the two most common sites for deep brain stimulation (DBS) in people with Parkinson's disease (PWP). Voice impairments are a common symptom of Parkinson's disease and information about voice outcomes with DBS is limited. Most studies in speech-language pathology have focused on STN-DBS and few have examined the effects of GPI-DBS. This was an initial effort to examine the impact of DBS location on Vocal Handicap Index (VHI) scores, which assess the impact of a voice disorder on an individual. METHOD Twenty-four gender-matched PWP (12 STN-DBS and 12 GPI-DBS) completed the VHI post-DBS implantation. Two-tailed independent samples t-tests were used to compare each VHI scale score (physical, functional, emotional, total) and patient factors between the two groups. RESULTS No significant differences in total or subscale VHI scores were identified between the two DBS groups. A trend toward greater impairment in PWP with GPI-DBS was noted. An association between higher VHI scores and DBS settings was found. CONCLUSIONS Studies directly comparing speech outcomes for different DBS targets are lacking. The current findings provide new insights concerning voice outcomes following DBS by adding to the limited literature directly comparing speech outcomes in multiple DBS targets. Limitations and directions for future research are discussed.
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Rohl A, Gutierrez S, Johari K, Greenlee J, Tjaden K, Roberts A. Speech dysfunction, cognition, and Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:153-173. [PMID: 35248193 PMCID: PMC11321444 DOI: 10.1016/bs.pbr.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Communication difficulties are a ubiquitous symptom of Parkinson's disease and include changes to both motor speech and language systems. Communication challenges are a significant driver of lower quality of life. They are associated with decreased communication participation, social withdrawal, and increased risks for social isolation and stigmatization in persons with Parkinson's disease. Recent theoretical advances and experimental evidence underscore the intersection of cognition and motor processes in speech production and their impact on spoken language. This chapter overviews a growing evidence base demonstrating that cognitive impairments interact with motor changes in Parkinson's disease to negatively affect communication abilities in myriad ways, at all stages of the disease, both in the absence and presence of dementia. The chapter highlights common PD interventions (pharmacological, surgical, and non-pharmacological) and how cognitive influences on speech production outcomes are considered in each.
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Affiliation(s)
- Andrea Rohl
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - Stephanie Gutierrez
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Karim Johari
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - Jeremy Greenlee
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - Kris Tjaden
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, United States
| | - Angela Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States; Department of Computer Science, Western University, London, ON, Canada.
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Bokulić E, Medenica T, Knezović V, Štajduhar A, Almahariq F, Baković M, Judaš M, Sedmak G. The Stereological Analysis and Spatial Distribution of Neurons in the Human Subthalamic Nucleus. Front Neuroanat 2022; 15:749390. [PMID: 34970124 PMCID: PMC8712451 DOI: 10.3389/fnana.2021.749390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
The subthalamic nucleus (STN) is a small, ovoid structure, and an important site of deep brain stimulation (DBS) for the treatment of Parkinson’s disease. Although the STN is a clinically important structure, there are many unresolved issues with regard to it. These issues are especially related to the anatomical subdivision, neuronal phenotype, neuronal composition, and spatial distribution. In this study, we have examined the expression pattern of 8 neuronal markers [nNOS, NeuN, parvalbumin (PV), calbindin (CB), calretinin (CR), FOXP2, NKX2.1, and PAX6] in the adult human STN. All of the examined markers, except CB, were present in the STN. To determine the neuronal density, we have performed stereological analysis on Nissl-stained and immunohistochemical slides of positive markers. The stereology data were also used to develop a three-dimensional map of the spatial distribution of neurons within the STN. The nNOS population exhibited the largest neuronal density. The estimated total number of nNOS STN neurons is 281,308 ± 38,967 (± 13.85%). The STN neuronal subpopulations can be divided into two groups: one with a neuronal density of approximately 3,300 neurons/mm3 and the other with a neuronal density of approximately 2,200 neurons/mm3. The largest density of STN neurons was observed along the ventromedial border of the STN and the density gradually decreased toward the dorsolateral border. In this study, we have demonstrated the presence of 7 neuronal markers in the STN, three of which were not previously described in the human STN. The human STN is a collection of diverse, intermixed neuronal subpopulations, and our data, as far as the cytoarchitectonics is concerned, did not support the tripartite STN subdivision.
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Affiliation(s)
- Ema Bokulić
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
| | - Tila Medenica
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
| | - Vinka Knezović
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
| | - Andrija Štajduhar
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia.,School of Public Health "Andrija Štampar," University of Zagreb School of Medicine, Zagreb, Croatia
| | - Fadi Almahariq
- Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia.,Department of Neurosurgery, Clinical Hospital "Dubrava," Zagreb, Croatia
| | - Marija Baković
- Department of Forensic Medicine, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Miloš Judaš
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
| | - Goran Sedmak
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
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Pu T, Huang M, Kong X, Wang M, Chen X, Feng X, Wei C, Weng X, Xu F. Lee Silverman Voice Treatment to Improve Speech in Parkinson's Disease: A Systemic Review and Meta-Analysis. PARKINSON'S DISEASE 2021; 2021:3366870. [PMID: 35070257 PMCID: PMC8782619 DOI: 10.1155/2021/3366870] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Speech changes occur in the early stages of Parkinson's disease (PD) and cause communication difficulties, leading to social isolation. Lee Silverman voice treatment (LSVT) is a speech therapy approach designed to improve patients' language and voice capabilities. OBJECTIVE The effectiveness of the LSVT was compared with that of other speech interventions or no treatment to evaluate PD patients with dysarthria. DESIGN Systematic review with meta-analysis of randomized trials. Data Sources: PubMed, Embase, Cochrane Library, CNKI, and SinoMed library were searched from inception to December 2021 related to PD and LSVT. METHOD Abstracts were screened and reviewed against the eligibility criteria (intervention group participants were PD assessed based on LSVT (LSVT Loud) and randomized control). RESULT Ten randomized controlled trials were identified on speech symptoms in patients with PD. Compared with the respiratory therapy (RET) exercise, or no training group, a significant improvement was detected in the sound press level (SPL) after immediate treatment during the reading of vowel and rainbow passages and an increase in semitone standard deviation (STSD). Furthermore, the LSVT training significantly increased the participants' scores on unified Parkinson's disease rating scale (UPDRS-III) and speech intelligibility. CONCLUSION This meta-analysis demonstrated the efficacy of LSVT in increasing vocal loudness and functional communication among individuals with PD. However, most studies included participants with mild-moderate PD. Thus, additional randomized controlled trials (RCTs) with large sample sizes are needed to validate the efficacy of LSVT in patients with different progressions of PD, including severe PD.
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Affiliation(s)
- Tingting Pu
- School of Pharmacy, Dali University, Yunnan 671000, Dali, China
- Department of Public Health, Chengdu Medical College, Sichuan 610500, Chengdu, China
| | - Min Huang
- Department of Physiology, Chengdu Medical College, Sichuan 610500, Chengdu, China
| | - Xiangyu Kong
- Department of Public Health, Chengdu Medical College, Sichuan 610500, Chengdu, China
| | - Meng Wang
- Department of Public Health, Chengdu Medical College, Sichuan 610500, Chengdu, China
| | - Xiangling Chen
- Department of Public Health, Chengdu Medical College, Sichuan 610500, Chengdu, China
| | - Xixi Feng
- Department of Public Health, Chengdu Medical College, Sichuan 610500, Chengdu, China
| | - Changyou Wei
- Department of Public Health, Chengdu Medical College, Sichuan 610500, Chengdu, China
| | - Xiechuan Weng
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Fan Xu
- Department of Public Health, Chengdu Medical College, Sichuan 610500, Chengdu, China
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Knowles T, Adams SG, Jog M. Speech Rate Mediated Vowel and Stop Voicing Distinctiveness in Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4096-4123. [PMID: 34582276 DOI: 10.1044/2021_jslhr-21-00160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose The purpose of this study was to quantify changes in acoustic distinctiveness in two groups of talkers with Parkinson's disease as they modify across a wide range of speaking rates. Method People with Parkinson's disease with and without deep brain stimulation and older healthy controls read 24 carrier phrases at different speech rates. Target nonsense words in the carrier phrases were designed to elicit stop consonants and corner vowels. Participants spoke at seven self-selected speech rates from very slow to very fast, elicited via magnitude production. Speech rate was measured in absolute words per minute and as a proportion of each talker's habitual rate. Measures of segmental distinctiveness included a temporal consonant measure, namely, voice onset time, and a spectral vowel measure, namely, vowel articulation index. Results All talkers successfully modified their rate of speech from slow to fast. Talkers with Parkinson's disease and deep brain stimulation demonstrated greater baseline speech impairment and produced smaller proportional changes at the fast end of the continuum. Increasingly slower speaking rates were associated with increased temporal contrasts (voice onset time) but not spectral contrasts (vowel articulation). Faster speech was associated with decreased contrasts in both domains. Talkers with deep brain stimulation demonstrated more aberrant productions across all speaking rates. Conclusions Findings suggest that temporal and spectral segmental distinctiveness are asymmetrically affected by speaking rate modifications in Parkinson's disease. Talkers with deep brain stimulation warrant further investigation with regard to speech changes they make as they adjust their speaking rate.
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Affiliation(s)
- Thea Knowles
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Scott G Adams
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
- Health & Rehabilitation Sciences, Western University, London, Ontario, Canada
- Department of Clinical Neurological Sciences, University Hospital, London, Ontario, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, University Hospital, London, Ontario, Canada
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Atkinson-Clement C, Cavazzini É, Zénon A, Legou T, Witjas T, Fluchère F, Azulay JP, Baunez C, Pinto S, Eusebio A. Subthalamic stimulation breaks the balance between distal and axial signs in Parkinson's disease. Sci Rep 2021; 11:21810. [PMID: 34750479 PMCID: PMC8575789 DOI: 10.1038/s41598-021-01386-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/20/2021] [Indexed: 11/09/2022] Open
Abstract
In Parkinson’s disease (PD), the effects of both Ldopa and subthalamic deep brain stimulation (STN-DBS) are known to change cost-valuation. However, this was mostly studied through reward-effort task involving distal movements, while axial effort, less responsive to treatments, have been barely studied. Thus, our objective was to compare the influence of both Ldopa and STN-DBS on cost-valuation between two efforts modalities: vowel production (as an example of axial movement) and hand squeezing (as an example of distal movement). Twelve PD patients were recruited to participate in this study. The task consisted in deciding whether to accept or reject trials based on a reward-effort trade-off. Participants performed two blocks with hand squeezing, and two with vowel production, in the four treatment conditions (LdopaOn/Off; STN-DBS On/Off). We found that STN-DBS changed the ratio difference between hand and phonation efforts. Vowel production effort was estimated easier to perform with STN-DBS alone, and harder when associated with Ldopa. The difference between hand and phonation efforts was correlated with quality of life in Off/Off and On Ldopa alone conditions, and with impulsive assessment On STN-DBS alone. We highlighted that STN-DBS could introduce an imbalance between the actual motor impairments and their subjective costs. With this finding, we also suggest paying particular attention to the different treatment effects that should be expected for axial and distal movement dysfunctions.
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Affiliation(s)
- Cyril Atkinson-Clement
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière (DMU 6), Paris, France.
| | | | - Alexandre Zénon
- INCIA, Université de Bordeaux, CNRS UMR5287, Bordeaux, France
| | - Thierry Legou
- Aix-Marseille Univ, CRNS, LPL, Aix-en-Provence, France
| | - Tatiana Witjas
- Institut de Neurosciences de la Timone, UMR7289, CNRS and Aix-Marseille Univ, Marseille, France.,Department of Neurology and Movement Disorders, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France
| | - Frédérique Fluchère
- Department of Neurology and Movement Disorders, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France.,Aix-Marseille Univ, CNRS, LNC, Marseille, France
| | - Jean-Philippe Azulay
- Institut de Neurosciences de la Timone, UMR7289, CNRS and Aix-Marseille Univ, Marseille, France.,Department of Neurology and Movement Disorders, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France
| | - Christelle Baunez
- Institut de Neurosciences de la Timone, UMR7289, CNRS and Aix-Marseille Univ, Marseille, France
| | - Serge Pinto
- Aix-Marseille Univ, CRNS, LPL, Aix-en-Provence, France
| | - Alexandre Eusebio
- Institut de Neurosciences de la Timone, UMR7289, CNRS and Aix-Marseille Univ, Marseille, France.,Department of Neurology and Movement Disorders, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France
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Instability of speech in Parkinson disease patients with subthalamic nucleus deep brain stimulation. Parkinsonism Relat Disord 2021; 93:8-11. [PMID: 34753003 DOI: 10.1016/j.parkreldis.2021.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The impact of deep brain stimulation (DBS) on speech rhythm and its mechanism remains unclear. We investigated speech rhythm characteristics of patients with Parkinson's disease (PD) treated with subthalamic nucleus (STN) DBS to understand the underlying pathophysiology better. METHODS We enrolled a total of 105 participants and evaluated speech rhythm performances among patients with PD who had undergone STN-DBS (the PD-DBS group), patients with PD treated only with medication (the PD-Med group), patients with cerebellar ataxia (the CA group), and healthy controls (the HC group). Each participant was asked to repeat the syllable/pa/at a comfortable self-chosen steady pace. A widely-used software (the Motor Speech Profile) program performed an acoustic analysis. RESULTS Compared to the PD-Med and HC groups, speech rate instability (DDKjit) was significantly higher in the PD-DBS and CA groups (p < 0.01). However, after DBS was turned off, the DDKjit of the PD-DBS group improved to a level comparable to that of the PD-Med and HC groups. In contrast to the significantly higher variability of speech volume (DDKcvi) in the CA group, the PD-DBS group showed similar DDKcvi to the PD-Med and HC groups. CONCLUSIONS STN-DBS affects the speech rate stability of patients with PD. Speech rhythm disorders caused by STN-DBS were phenotypically similar to that in CA in terms of interval variability but different regarding amplitude variability. Further studies are warranted to elucidate the underlying pathophysiology of speech rhythm disorders in PD patients treated with DBS.
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Chrabaszcz A, Wang D, Lipski W, Bush A, Crammond D, Shaiman S, Dickey M, Holt L, Turner R, Fiez J, Richardson R. Simultaneously recorded subthalamic and cortical LFPs reveal different lexicality effects during reading aloud. JOURNAL OF NEUROLINGUISTICS 2021; 60:101019. [PMID: 34305315 PMCID: PMC8294107 DOI: 10.1016/j.jneuroling.2021.101019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Many language functions are traditionally assigned to cortical brain areas, leaving the contributions of subcortical structures to language processing largely unspecified. The present study examines a potential role of the subthalamic nucleus (STN) in lexical processing, specifically, reading aloud of words (e.g., 'fate') and pseudowords (e.g., 'fape'). We recorded local field potentials simultaneously from the STN and the cortex (precentral, postcentral, and superior temporal gyri) of 13 people with Parkinson's disease undergoing awake deep brain stimulation and compared STN's lexicality-related neural activity with that of the cortex. Both STN and cortical activity demonstrated significant task-related modulations, but the lexicality effects were different in the two brain structures. In the STN, an increase in gamma band activity (31-70 Hz) was present in pseudoword trials compared to word trials during subjects' spoken response. In the cortex, a greater decrease in beta band activity (12-30 Hz) was observed for pseudowords in the precentral gyrus. Additionally, 11 individual cortical sites showed lexicality effects with varying temporal and topographic characteristics in the alpha and beta frequency bands. These findings suggest that the STN and the sampled cortical regions are involved differently in the processing of lexical distinctions.
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Affiliation(s)
- A. Chrabaszcz
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA, 15213
| | - D. Wang
- School of Medicine, Tsinghua University, Beijing, China, 100084
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA, 15213
| | - W.J. Lipski
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA, 15213
| | - A. Bush
- Brain Modulation Lab, Department of Neurosurgery, Massachusetts General Hospital, Boston, USA, 02114
- Harvard Medical School, Boston, USA, 02115
| | - D.J. Crammond
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA, 15213
| | - S. Shaiman
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, USA, 15213
| | - M.W. Dickey
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, USA, 15213
| | - L.L. Holt
- Department of Psychology, Carnegie Mellon University, Pittsburgh, USA, 15213
| | - R.S. Turner
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, USA, 15213
- University of Pittsburgh Brain Institute, Pittsburgh, USA, 15213
| | - J.A. Fiez
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA, 15213
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, USA, 15213
- University of Pittsburgh Brain Institute, Pittsburgh, USA, 15213
| | - R.M. Richardson
- Brain Modulation Lab, Department of Neurosurgery, Massachusetts General Hospital, Boston, USA, 02114
- Harvard Medical School, Boston, USA, 02115
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Dastolfo-Hromack C, Bush A, Chrabaszcz A, Alhourani A, Lipski W, Wang D, Crammond DJ, Shaiman S, Dickey MW, Holt LL, Turner RS, Fiez JA, Richardson RM. Articulatory Gain Predicts Motor Cortex and Subthalamic Nucleus Activity During Speech. Cereb Cortex 2021; 32:1337-1349. [PMID: 34470045 DOI: 10.1093/cercor/bhab251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 06/14/2021] [Accepted: 06/18/2021] [Indexed: 11/12/2022] Open
Abstract
Speaking precisely is important for effective verbal communication, and articulatory gain is one component of speech motor control that contributes to achieving this goal. Given that the basal ganglia have been proposed to regulate the speed and size of limb movement, that is, movement gain, we explored the basal ganglia contribution to articulatory gain, through local field potentials (LFP) recorded simultaneously from the subthalamic nucleus (STN), precentral gyrus, and postcentral gyrus. During STN deep brain stimulation implantation for Parkinson's disease, participants read aloud consonant-vowel-consonant syllables. Articulatory gain was indirectly assessed using the F2 Ratio, an acoustic measurement of the second formant frequency of/i/vowels divided by/u/vowels. Mixed effects models demonstrated that the F2 Ratio correlated with alpha and theta activity in the precentral gyrus and STN. No correlations were observed for the postcentral gyrus. Functional connectivity analysis revealed that higher phase locking values for beta activity between the STN and precentral gyrus were correlated with lower F2 Ratios, suggesting that higher beta synchrony impairs articulatory precision. Effects were not related to disease severity. These data suggest that articulatory gain is encoded within the basal ganglia-cortical loop.
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Affiliation(s)
- C Dastolfo-Hromack
- Department of Communication Science and Disorders, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA 15260, USA
| | - A Bush
- Department of Neurological Surgery, Massachusetts General Hospital, MA 02114, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - A Chrabaszcz
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - A Alhourani
- Department of Neurosurgery, University of Louisville, Louisville, KY 40292, USA
| | - W Lipski
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - D Wang
- School of Medicine, Tsinghua University, Beijing 100084, China
| | - D J Crammond
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - S Shaiman
- Department of Communication Science and Disorders, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA 15260, USA
| | - M W Dickey
- Department of Communication Science and Disorders, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA 15260, USA
| | - L L Holt
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - R S Turner
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - J A Fiez
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - R M Richardson
- Department of Neurological Surgery, Massachusetts General Hospital, MA 02114, USA.,Harvard Medical School, Boston, MA 02115, USA
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Xu H, Bao Z, Liang D, Li M, Wei M, Ge X, Liu J, Li J. Speech and Language Therapy for Voice Problems in Parkinson's Disease: A Meta-Analysis. J Neuropsychiatry Clin Neurosci 2021; 32:344-351. [PMID: 32374650 DOI: 10.1176/appi.neuropsych.19020044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with Parkinson's disease (PD) commonly have speech and voice problems that affect their functional communication and that are not sensitive to pharmacological or neurosurgical treatments. The authors aimed to evaluate the effects of speech and language therapies (SLTs) on dysphonia in patients with PD by analyzing data from published randomized controlled trials (RCTs). Studies in English and Chinese that were related to speech and language treatment for patients with PD were retrieved from PubMed, Embase, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, Chinese Biomedical Literature Database, and Wanfang Database. On the basis of exclusion criteria, 391 records identified through the search were reduced to 10 studies that included 230 patients in the treatment groups and 205 patients in the control groups. A meta-analysis of data from the 10 studies was performed to examine the effects of SLTs on dysphonia in patients with PD. SLTs increased sound pressure level during sustained phonation, reading of the Rainbow Passage, and monologue 6 months after treatment, enhanced semitone standard deviation during reading of the Rainbow Passage more than 12 months after treatment, and reduced Voice Handicap Index scores among patients with PD with dysphonia problems at least 3 months after treatment. These findings demonstrate the efficacy of SLTs, especially Lee Silverman Voice Treatment, in increasing vocal loudness and functional communication among patients with PD. Further RCTs with large samples and multicenter participation are needed to validate the long-term effects and the efficacy of SLTs among patients with severe PD.
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Affiliation(s)
- Hongyan Xu
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Zhuohua Bao
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Daye Liang
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Mengxia Li
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Minguang Wei
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Xueqing Ge
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Jingli Liu
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
| | - Jinpin Li
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China (Xu); and Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Guangxi, China (Bao, Liang, M. Li, Wei, Ge, Liu, J. Li)
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Vos SH, Kessels RPC, Vinke RS, Esselink RAJ, Piai V. The Effect of Deep Brain Stimulation of the Subthalamic Nucleus on Language Function in Parkinson's Disease: A Systematic Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2794-2810. [PMID: 34157249 DOI: 10.1044/2021_jslhr-20-00515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose This systematic review focuses on the effect of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) on language function in Parkinson's disease (PD). It fills an important gap in recent reviews by considering other language tasks in addition to verbal fluency. Method We critically and systematically reviewed the literature on studies that investigated the effect of bilateral STN-DBS on language function in PD. All studies included a matched PD control group who were on best medical treatment, with language testing at similar baseline and follow-up intervals as the DBS PD group. Results Thirteen identified studies included a form of a verbal fluency task, seven studies included picture naming, and only two studies included more language-oriented tasks. We found that verbal fluency was negatively affected after DBS, whereas picture naming was unaffected. Studies investigating individual change patterns using reliable change indices showed that individual variability is larger for picture naming than for verbal fluency. Conclusions Verbal fluency is the most frequently investigated aspect of language function. Our analysis showed a pattern of decline in verbal fluency across multiple studies after STN-DBS, whereas picture naming was unaffected. Data on more language-oriented tests in a large DBS sample and best medical treatment control group are sparse. The investigation of language function in PD after DBS requires sensitive language tests (with and without time pressure) and experimental designs as used in the studies reviewed here. Reliable change index statistics are a promising tool for investigating individual differences in performance after DBS. Supplemental Material https://doi.org/10.23641/asha.14794458.
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Affiliation(s)
- Sandra H Vos
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roy P C Kessels
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - R Saman Vinke
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rianne A J Esselink
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Vitória Piai
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
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Sandström L, Schalling E, Karlsson F, Blomstedt P, Hartelius L. Speech Function Following Deep Brain Stimulation of the Caudal Zona Incerta: Effects of Habitual and High-Amplitude Stimulation. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2121-2133. [PMID: 33647213 DOI: 10.1044/2020_jslhr-20-00256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Deep brain stimulation (DBS) is often successful in alleviating motor symptoms of essential tremor (ET); however, DBS may also induce adverse speech effects. The caudal zona incerta (cZi) is a promising DBS target for tremor, but less is known about the consequences of cZi DBS for speech. This preliminary study examined how habitual cZi DBS and cZi stimulation at high amplitudes may affect speech function in persons with ET. Method Fourteen participants with ET were evaluated: off stimulation, on habitual cZi DBS, and with unilateral cZi stimulation at increasing stimulation amplitudes. At each stimulation condition, the participants read three 16-word sentences. Two speech-language pathologists made audio-perceptual consensus ratings of overall speech function, articulation, and voice using a visual sort and rate method. Rated functions when off stimulation, on habitual cZi DBS, and at maximal-amplitude stimulation were compared using Friedman nonparametric tests. For participants with bilateral habitual DBS (n = 5), the effects of bilateral and unilateral stimulation were described in qualitative terms. Results Habitual cZi DBS had no significant group-level effect on any of the investigated speech parameters. Maximal-amplitude stimulation had a small but significant negative effect on articulation. Participants with reduced articulatory precision (n = 9) had more medially placed electrodes than the nonaffected group (n = 5). Bilateral and unilateral left stimulation had comparable effects on speech. Conclusions Findings from this preliminary study of cZi DBS indicate that speech is generally not affected by stimulation at habitual levels. High-amplitude cZi stimulation may, however, induce adverse effects, particularly on articulation. Instances of decreased articulatory function were associated with stimulation of more medial electrode contacts, which could suggest cerebello-rubrospinal involvement.
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Affiliation(s)
- Linda Sandström
- Division of Speech and Language Pathology, Department of Clinical Science, Umeå University, Sweden
| | - Ellika Schalling
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm Sweden
- Medical Unit of Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Karlsson
- Division of Speech and Language Pathology, Department of Clinical Science, Umeå University, Sweden
| | - Patric Blomstedt
- Division of Clinical Neuroscience, Department of Clinical Science, Umeå University Sweden
| | - Lena Hartelius
- Speech and Language Pathology Unit, Department of Health and Rehabilitation, Sahlgrenska Academy at the University of Gothenburg, Sweden
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41
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Knowles T, Adams SG, Jog M. Variation in Speech Intelligibility Ratings as a Function of Speech Rate Modification in Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:1773-1793. [PMID: 33950711 DOI: 10.1044/2021_jslhr-20-00593] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The aim of this study was to quantify changes in speech intelligibility in two cohorts of people with Parkinson's disease (PD; those with and without deep brain stimulation [DBS]) across a broad range of self-selected speech rate alterations in (a) read sentences and (b) extemporaneous speech (monologues). Method Four speaker groups participated in this study: younger and older controls, people with PD undergoing standard pharmaceutical treatment, and people with PD and DBS. Naïve listeners rated the intelligibility of read sentences and extemporaneous monologues, spoken by participants at seven self-selected speech rates from very slow to very fast. Intelligibility was modeled as a function of group, speech rate condition, and speech task. Results Overall, compared to habitual speech rate, slower speech rate conditions were not associated with changes in speech intelligibility, whereas faster-than-habitual conditions were associated in declines in intelligibility. Results were mediated by group and task effects, such that talkers with PD and DBS were more likely to see intelligibility benefits at slower self-selected speech rates and less likely to see detriments at faster rates, and these differences were amplified in monologues compared to sentences. Conclusion Findings suggest differences in the ways in which slower and faster speech rate adjustments impact speech intelligibility in people with PD with and without DBS, with the latter demonstrating greater magnitudes of change.
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Affiliation(s)
- Thea Knowles
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Scott G Adams
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Department of Clinical Neurological Sciences, University Hospital, London, Ontario, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, University Hospital, London, Ontario, Canada
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Schalling E, Winkler H, Franzén E. HiCommunication as a novel speech and communication treatment for Parkinson's disease: A feasibility study. Brain Behav 2021; 11:e02150. [PMID: 33943030 PMCID: PMC8213924 DOI: 10.1002/brb3.2150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/05/2021] [Accepted: 03/14/2021] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Speech and communication problems are common in Parkinson's disease (PD) and can result in social withdrawal and reduced quality of life. Intervention may improve symptoms but transfer and maintenance remain challenging for many. Access to treatment may also be limited. Group intervention incorporating principles for experience-dependent plasticity may address these challenges. The aim of this study was to develop and study feasibility aspects of a new intervention program for group training of speech and communication in people with PD. MATERIALS & METHODS Development and content of the program called HiCommunication is described. Core target areas are voice, articulation, word-finding and memory. Five participants with mild-moderate PD completed this feasibility trial. Attendance rate and possible adverse events as well as the participants' experiences were documented. A speech recording and dysarthria testing were completed to study feasibility of the assessment procedure and evaluate possible changes in voice sound level and intelligibility. RESULTS Attendance rate was 89%. No adverse events occurred. Participants reported a positive experience and limited fatigue. Assessment was completed in approximately 30 min and was well tolerated. Four of five participants had an increased voice sound level during text-reading postintervention and mean intelligibility improved. CONCLUSIONS Results indicate that HiCommunication is feasible for people with mild-moderate PD. The program was appreciated and well tolerated. Positive outcomes regarding voice sound level and intelligibility were observed; however, the number of participants was very limited. The results motivate that effects of HiCommunication are further studied in a randomized controlled trial, which is ongoing.
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Affiliation(s)
- Ellika Schalling
- Division of Speech and Language Pathology, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Winkler
- Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Erika Franzén
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
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Liu W, Yamamoto T, Yamanaka Y, Asahina M, Uchiyama T, Hirano S, Shimizu K, Higuchi Y, Kuwabara S. Neuropsychiatric Symptoms in Parkinson's Disease After Subthalamic Nucleus Deep Brain Stimulation. Front Neurol 2021; 12:656041. [PMID: 34017303 PMCID: PMC8129644 DOI: 10.3389/fneur.2021.656041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Indications for subthalamic nucleus deep brain stimulation (STN-DBS) surgery are determined basically by preoperative motor function; however, postoperative quality of life (QOL) is not necessarily associated with improvements in motor symptoms, suggesting that neuropsychiatric symptoms might be related to QOL after surgery in patients with Parkinson's disease. Objectives: We aimed to examine temporal changes in neuropsychiatric symptoms and their associations with QOL after STN-DBS. Materials and Methods: We prospectively enrolled a total of 61 patients with Parkinson's disease (mean age = 65.3 ± 0.9 years, mean disease duration = 11.9 ± 0.4 years). Motor function, cognitive function, and neuropsychiatric symptoms were evaluated before and after DBS surgery. Postoperative evaluation was performed at 3 months, 1 year, and 3 years after surgery. Results: Of the 61 participants, 54 completed postoperative clinical evaluation after 3 months, 47 after 1 year, and 23 after 3 years. Frontal lobe functions, depression, and verbal fluency significantly worsened 3 years after STN-DBS. Non-motor symptoms such as impulsivity and the Unified PD Rating Scale (UPDRS) part I score were associated with QOL after STN-DBS. Conclusions: Frontal lobe functions, depression, and verbal fluency significantly worsened 3 years after STN-DBS. The UPDRS part I score and higher impulsivity might be associated with QOL after STN-DBS.
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Affiliation(s)
- Weibing Liu
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tatsuya Yamamoto
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Division of Occupational Therapy, Department of Rehabilitation, Chiba Prefectural University of Health Sciences, Chiba, Japan
| | - Yoshitaka Yamanaka
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Tomoyuki Uchiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Neurology, International University of Health and Welfare, Ichikawa, Japan
| | - Shigeki Hirano
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keisuke Shimizu
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshinori Higuchi
- Department of Neurological Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Bryans LA, Palmer AD, Anderson S, Schindler J, Graville DJ. The impact of Lee Silverman Voice Treatment (LSVT LOUD®) on voice, communication, and participation: Findings from a prospective, longitudinal study. JOURNAL OF COMMUNICATION DISORDERS 2021; 89:106031. [PMID: 33259945 DOI: 10.1016/j.jcomdis.2020.106031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Lee Silverman Voice Treatment (LSVT LOUD®), an intensive 4-week program of voice therapy, is regarded as the most well-researched, efficacious treatment for hypokinetic dysarthria in individuals with Parkinson's disease (PD). Although numerous studies have published acoustic and perceptual findings, there is comparatively little information about the impact of LSVT LOUD® on functional communication outcomes. METHODS This prospective, longitudinal study investigated the impact of treatment on daily communication in 25 individuals with PD. Three validated communication measures (the Voice Handicap Index, the Communicative Effectiveness Scale, and the Communicative Participation Item Bank) were given before and after treatment and again 4-8 weeks and 3-6 months following treatment. Communication partners were also asked to rate communication effectiveness at all four timepoints. RESULTS Significant improvements were found for all three self-reported scales which remained above baseline across all post-treatment timepoints. In addition, self-reported communicative effectiveness was significantly correlated with the assessments of communication partners. Particular benefits were reported for more complex communicative activities such as asking questions, giving detailed information, communicating in noisy situations, and speaking in groups. CONCLUSIONS Overall, the findings suggested that LSVT LOUD® promotes an increased sense of personal control over the communication difficulties resulting from PD by decreasing voice handicap and improving communication effectiveness and communicative participation. For individuals with PD, LSVT LOUD® may reduce the risk of social isolation by improving communication and facilitating social participation. LEARNING OUTCOMES As a result of this activity, the participant will be able to (1) describe the impact of PD on voice and communication, (2) discuss how these characteristics may be associated with more global measures of functional communication and particularly communicative participation, (3) explain which aspects of functional communication were affected by LSVT LOUD® as assessed by study participants and their communication partners.
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Affiliation(s)
- Linda A Bryans
- NW Center for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Rd., Portland, OR, 97239, USA.
| | - Andrew D Palmer
- NW Center for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Rd., Portland, OR, 97239, USA.
| | - Shannon Anderson
- Dept. of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - Joshua Schindler
- NW Center for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Rd., Portland, OR, 97239, USA.
| | - Donna J Graville
- NW Center for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Rd., Portland, OR, 97239, USA.
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Castaño-Candamil S, Ferleger BI, Haddock A, Cooper SS, Herron J, Ko A, Chizeck HJ, Tangermann M. A Pilot Study on Data-Driven Adaptive Deep Brain Stimulation in Chronically Implanted Essential Tremor Patients. Front Hum Neurosci 2020; 14:541625. [PMID: 33250727 PMCID: PMC7674800 DOI: 10.3389/fnhum.2020.541625] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 10/15/2020] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation (DBS) is an established therapy for Parkinson's disease (PD) and essential-tremor (ET). In adaptive DBS (aDBS) systems, online tuning of stimulation parameters as a function of neural signals may improve treatment efficacy and reduce side-effects. State-of-the-art aDBS systems use symptom surrogates derived from neural signals-so-called neural markers (NMs)-defined on the patient-group level, and control strategies assuming stationarity of symptoms and NMs. We aim at improving these aDBS systems with (1) a data-driven approach for identifying patient- and session-specific NMs and (2) a control strategy coping with short-term non-stationary dynamics. The two building blocks are implemented as follows: (1) The data-driven NMs are based on a machine learning model estimating tremor intensity from electrocorticographic signals. (2) The control strategy accounts for local variability of tremor statistics. Our study with three chronically implanted ET patients amounted to five online sessions. Tremor quantified from accelerometer data shows that symptom suppression is at least equivalent to that of a continuous DBS strategy in 3 out-of 4 online tests, while considerably reducing net stimulation (at least 24%). In the remaining online test, symptom suppression was not significantly different from either the continuous strategy or the no treatment condition. We introduce a novel aDBS system for ET. It is the first aDBS system based on (1) a machine learning model to identify session-specific NMs, and (2) a control strategy coping with short-term non-stationary dynamics. We show the suitability of our aDBS approach for ET, which opens the door to its further study in a larger patient population.
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Affiliation(s)
- Sebastián Castaño-Candamil
- Brain State Decoding Lab, Department of Computer Science, BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg im Breisgau, Germany
| | - Benjamin I Ferleger
- BioRobotics Lab, Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, United States
| | - Andrew Haddock
- BioRobotics Lab, Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, United States
| | - Sarah S Cooper
- BioRobotics Lab, Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, United States
| | - Jeffrey Herron
- Department of Neurological Surgery, University of Washington Medical Center, Seattle, WA, United States
| | - Andrew Ko
- Department of Neurological Surgery, University of Washington Medical Center, Seattle, WA, United States
| | - Howard J Chizeck
- BioRobotics Lab, Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, United States
| | - Michael Tangermann
- Brain State Decoding Lab, Department of Computer Science, BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg im Breisgau, Germany.,Autonomous Intelligent Systems, Department of Computer Science, University of Freiburg, Freiburg im Breisgau, Germany.,Artificial Cognitive Systems Lab, Artificial Intelligence Department, Faculty of Social Sciences, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
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46
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Chiu SY, Tsuboi T, Hegland KW, Herndon NE, Shukla AW, Patterson A, Almeida L, Foote KD, Okun MS, Ramirez-Zamora A. Dysarthria and Speech Intelligibility Following Parkinson’s Disease Globus Pallidus Internus Deep Brain Stimulation. JOURNAL OF PARKINSONS DISEASE 2020; 10:1493-1502. [DOI: 10.3233/jpd-202246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Although earlier studies reported variable speech changes following subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson’s disease (PD) patients, the effects of globus pallidus internus (GPi) DBS on speech performance in PD remain largely unknown. Objective: We aimed to characterize speech changes following PD GPi-DBS. Methods: We retrospectively analyzed clinical and speech outcomes of 25 PD patients treated with bilateral GPi-DBS at a single center. Outcome measures included the Unified Parkinson’s Disease Rating Scale (UPDRS), speech subsystem domains (respiratory, laryngeal, resonance, orofacial, rate, prosody, rhythm, and naturalness), and overall speech intelligibility. Scores at baseline were compared with those at 6 months, 1 year, and the longest clinical follow-up available. Results: In the off-medication state, activities of daily living and motor function based on UPDRS II and III significantly improved postoperatively. We observed unique patterns of speech changes in patients with PD following GPi-DBS in the short- (n = 25) and longer-term (n = 8) follow-up periods. Velopharyngeal (resonance), laryngeal components, and prosody worsened after bilateral GPi-DBS (p < 0.015). Speech intelligibility did not worsen after GPi-DBS in the short-term, but there was a trend to deteriorate at long-term follow-up (e.g., one year and beyond). We observed worsening of hypokinetic dysarthria in individual patients. Also, a minority of patients developed stuttering, spastic dysarthria, or ataxic dysarthria. Conclusion: Bilateral GPi-DBS worsened several modalities of parkinsonian speech without compromising overall speech intelligibility. GPi-DBS can potentially worsen or induce hypokinetic dysarthria, stuttering, spastic dysarthria, or ataxic dysarthria. GPi-DBS may have different and variable effects on speech function when compared to STN-DBS.
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Affiliation(s)
- Shannon Y. Chiu
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Takashi Tsuboi
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Karen W. Hegland
- UF Health Rehab Center at the Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | - Nicole E. Herndon
- UF Health Rehab Center at the Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Addie Patterson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Leonardo Almeida
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kelly D. Foote
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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47
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Jorge A, Dastolfo-Hromack C, Lipski WJ, Kratter IH, Smith LJ, Gartner-Schmidt JL, Richardson RM. Anterior Sensorimotor Subthalamic Nucleus Stimulation Is Associated With Improved Voice Function. Neurosurgery 2020; 87:788-795. [PMID: 32199026 PMCID: PMC7490159 DOI: 10.1093/neuros/nyaa024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the impact of Parkinson disease (PD) on speech communication, there is no consensus regarding the effect of lead location on voice-related outcomes in subthalamic nucleus (STN) deep brain stimulation (DBS). OBJECTIVE To determine the relationship of stimulation location to changes in cepstral analyses of voice following STN DBS. METHODS Speech pathology evaluations were obtained from 14 PD subjects, before and after STN DBS, including audio-perceptual voice ratings (overall severity, loudness, hoarseness changes), measured indices of dysphonia (cepstral peak prominence and cepstral spectral index of dysphonia), and phonatory aerodynamics. The contact locations used for active stimulation at the time of postoperative voice evaluations were determined and assessed in relation to voice outcomes. RESULTS Voice outcomes remained relatively unchanged on average. Stimulation locations in the anterior portion of the sensorimotor region of the left STN, however, were associated with improvements in voice severity scores, cepstral spectral index of dysphonia, shortness of breath, and phonatory airflow during connected speech. Posterior locations were associated with worsening of these outcomes. Variation in the medial-lateral or dorsal-ventral position on the left, and in any direction on the right, did not correlate with any voice outcome. CONCLUSION Active contact placement within the anterior sensorimotor STN was associated with improved perceptual and acoustic-aerodynamic voice-related outcomes. These findings suggest an STN topography for improving airflow for speech, in turn improving how PD patients' voices sound.
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Affiliation(s)
- Ahmed Jorge
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christina Dastolfo-Hromack
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Witold J Lipski
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ian H Kratter
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Libby J Smith
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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48
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Prent N, Potters WV, Boon LI, Caan MWA, de Bie RMA, van den Munckhof P, Schuurman PR, van Rootselaar AF. Distance to white matter tracts is associated with deep brain stimulation motor outcome in Parkinson's disease. J Neurosurg 2020; 133:433-442. [PMID: 31349226 DOI: 10.3171/2019.5.jns1952] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/01/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) of the subthalamic nucleus (STN) alleviates motor symptoms in patients with Parkinson's disease (PD). However, the underlying mechanism of tremor suppression is not well understood. Stimulation of white matter tracts, such as the dentatorubrothalamic tract (DRT), might be involved. Also, side effects, including dysarthria, might result from (unwanted) stimulation of white matter tracts in proximity to the STN. The aim of this study was to establish an association between stimulation effect on tremor and dysarthria and stimulation location relative to relevant white matter tracts. METHODS In 35 PD patients in whom a bilateral STN DBS system was implanted, the authors established clinical outcome measures per electrode contact. The distance from each stimulation location to the center of the DRT, corticopontocerebellar tract, pyramidal tract (PT), and medial lemniscus was determined using diffusion-weighted MRI data. Clinical outcome measures were subsequently related to the distances to the white matter tracts. RESULTS Patients with activated contacts closer to the DRT showed increased tremor improvement. Proximity of activated contacts to the PT was associated with dysarthria. CONCLUSIONS Proximity to specific white matter tracts is associated with tremor outcome and side effects in DBS. This knowledge can help to optimize both electrode placement and postsurgical electrode contact selection. Presurgical white matter tract visualization may improve targeting and DBS outcome. These findings are of interest not only for treatment in PD, but potentially also for other (movement) disorders.
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Affiliation(s)
- Naomi Prent
- 1Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience
| | - Wouter V Potters
- 1Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience
| | - Lennard I Boon
- 1Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience
- 2Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience
| | - Matthan W A Caan
- 3Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience
| | - Rob M A de Bie
- 5Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Pepijn van den Munckhof
- 4Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience; and
| | - P Richard Schuurman
- 4Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience; and
| | - Anne-Fleur van Rootselaar
- 1Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience
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49
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Cernera S, Eisinger RS, Wong JK, Ho KWD, Lopes JL, To K, Carbunaru S, Ramirez-Zamora A, Almeida L, Foote KD, Okun MS, Gunduz A. Long-term Parkinson's disease quality of life after staged DBS: STN vs GPi and first vs second lead. NPJ Parkinsons Dis 2020; 6:13. [PMID: 32656315 PMCID: PMC7338364 DOI: 10.1038/s41531-020-0115-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 06/04/2020] [Indexed: 12/11/2022] Open
Abstract
Deep brain stimulation (DBS) for Parkinson's disease (PD) improves quality of life (QoL), but longitudinal follow-up data are scarce. We sought to quantify long-term benefits of subthalamic nucleus (STN) vs globus pallidus internus (GPi), and unilateral vs staged bilateral PD-DBS on postoperative QoL. This is a retrospective, longitudinal, non-randomized study using the PD QoL questionnaire (PDQ)-39 in patients with STN- or GPi-DBS, and with unilateral (N = 191) or staged bilateral (an additional contralateral lead implant) surgery (N = 127 and 156 for the first and second lead, respectively). Changes in PDQ-39 summary index (PDQ-39SI) and subscores throughout 60 months of follow-up were used as the primary analysis. We applied mixed models that included levodopa and covariates that differed at baseline across groups. For unilateral implantation, we observed an initial improvement in PDQ-39SI of 15.55 ± 3.29% (µ ± SE) across both brain targets at 4 months postoperatively. Unilateral STN patients demonstrated greater improvement in PDQ-39SI than GPi patients at 4 and 18 months postoperatively. Analysis of patients with staged bilateral leads revealed an initial 25.34 ± 2.74% (µ ± SE) improvement in PDQ-39SI at 4 months after the first lead with further improvement until 18 months, with no difference across targets. Scores did not improve after the second lead with gradual worsening starting at 18 months postoperatively. STN-DBS provided greater short-term QoL improvement than GPi-DBS for unilateral surgery. For staged bilateral DBS, overall QoL improvement was explained primarily by the first lead. Decision-making for patients considering DBS should include a discussion surrounding the potential risks and benefits from a second DBS lead.
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Affiliation(s)
- Stephanie Cernera
- J. Crayton Pruitt Department of Biomedical Engineering, Gainesville, FL USA
| | - Robert S. Eisinger
- Department of Neuroscience, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Joshua K. Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Kwo Wei David Ho
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Janine Lobo Lopes
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Kevin To
- Department of Neuroscience, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Samuel Carbunaru
- Department of Neuroscience, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Leonardo Almeida
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Kelly D. Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Michael S. Okun
- Department of Neuroscience, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
| | - Aysegul Gunduz
- J. Crayton Pruitt Department of Biomedical Engineering, Gainesville, FL USA
- Department of Neuroscience, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL USA
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50
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Sarac ET, Yilmaz A, Aydinli FE, Yildizgoren MT, Okuyucu EE, Okuyucu S, Akakin A. Investigating the effects of subthalamic Nucleus-Deep brain stimulation on the voice quality. Somatosens Mot Res 2020; 37:157-164. [PMID: 32397796 DOI: 10.1080/08990220.2020.1761317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Deep brain stimulation (DBS) is a standard surgical treatment method which is generally applied to subthalamic nucleus in Parkinson's patients in cases where medical treatment is insufficient in treating the motor symptoms. It is known that Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) treats many motor symptoms. However, the results of studies on speech and voice vary. The aim of the study is analysing the effect of STN-DBS on the characteristics of voice.Materials/methods: A total of 12 patients, (8 male-4 female) with an age average of 58.8 ± 9.6, who have been applied DBS surgery on STN included in the study. The voice recordings of the patients have been done prior to surgery and 6 months after the surgery. The evaluation of voice has been carried out through the instrumental method. The patients' voice recordings of the /a,e,i/ vowels have been done. The obtained recordings were evaluated by the Praat programme and the effects on jhitter, shimmer, fundamental frequency (F0) and noise harmonic rate (NHR) were analysed.Results: Numerical values of F0 of all female participants have been decreased for all of the vowels postoperatively. In the females; jhitter and fraction parameters were found to be significantly different (0.056 and 0.017, perspectively) for the vowel /e/. In addition, p values in the shimmer for vowels /e,i/ were thought to be clinically significant (.087, .079 and .076) respectively. All these changes in second measurements were found to indicate worsening vocal quality after the DBS in females. In males, there is not any significant difference observed between two measures in any of the parameters of any vowels.Conclusions: Acoustic voice quality deteriorated after STN-DBS predominantly for females however this deterioration was not prominent audio-perceptually. This finding commented as a result of the fact that that voice quality deviance of the participants was not severe.
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Affiliation(s)
- Elif Tugba Sarac
- Faculty of Medicine, Audiology Department, Mustafa Kemal University, Hatay, Turkey
| | | | | | | | - Emine Esra Okuyucu
- Faculty of Medicine, Audiology Department, Mustafa Kemal University, Hatay, Turkey
| | - Semsettin Okuyucu
- Faculty of Medicine, Audiology Department, Mustafa Kemal University, Hatay, Turkey
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