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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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2
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Gatto RG, Martin PR, Utianski RL, Duffy JR, Clark HM, Botha H, Machulda MM, Josephs KA, Whitwell JL. Diffusion tensor imaging-based multi-fiber tracking reconstructions can regionally differentiate phonetic versus prosodic subtypes of progressive apraxia of speech. Cortex 2024; 171:272-286. [PMID: 38061209 PMCID: PMC10922200 DOI: 10.1016/j.cortex.2023.08.019] [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: 12/20/2022] [Revised: 06/30/2023] [Accepted: 08/09/2023] [Indexed: 02/12/2024]
Abstract
Two subtypes of progressive apraxia of speech (PAOS) have been recognized: phonetic PAOS (PAOS_ph) where speech output is dominated by distorted sound substitutions and prosodic PAOS (PAOS_pr) which is dominated by segmented speech. We investigate whether these PAOS subtypes have different white matter microstructural abnormalities measured by diffusion tensor tractography. Thirty-three patients with PAOS (21 PAOS_ph and 12 PAOS_pr) and 19 healthy controls were recruited by the Neurodegenerative Research Group (NRG) and underwent diffusion MRI. Using a whole-brain tractography approach, fractional anisotropy (FA) and mean diffusivity (MD) were extracted for cortico-cortical, cortico-subcortical, cortical-projection, and cerebello-cortical white matter tracts. A hierarchical linear model was applied to assess tract-level FA and MD across groups. Both PAOS_ph and PAOS_pr showed degeneration of cortico-cortical, cortico-subcortical, cortical-projection, and cerebello-cortical white matter tracts compared to controls. However, degeneration of the body of corpus callosum, superior thalamic radiation, and superior cerebellar peduncle was greater in PAOS_pr compared to PAOS_ph, and degeneration of the inferior segment of the superior longitudinal fasciculus (SLF) was greater in PAOS_ph compared to PAOS_pr. Worse parkinsonism correlated with greater degeneration of cortico-cortical and cortico-subcortical tracts in PAOS_ph. Apraxia of speech articulatory error score correlated with degeneration of the superior cerebellar peduncle tracts in PAOS_pr. Phonetic and prosodic PAOS involve the compromise of a similar network of tracts, although there are connectivity differences between types. Whereas clinical parameters are the current gold standard to distinguish PAOS subtypes, our results allege the use of DTI-based tractography as a supplementary method to investigate such variants.
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Affiliation(s)
| | - Peter R Martin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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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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Suppa A, Asci F, Costantini G, Bove F, Piano C, Pistoia F, Cerroni R, Brusa L, Cesarini V, Pietracupa S, Modugno N, Zampogna A, Sucapane P, Pierantozzi M, Tufo T, Pisani A, Peppe A, Stefani A, Calabresi P, Bentivoglio AR, Saggio G. Effects of deep brain stimulation of the subthalamic nucleus on patients with Parkinson's disease: a machine-learning voice analysis. Front Neurol 2023; 14:1267360. [PMID: 37928137 PMCID: PMC10622670 DOI: 10.3389/fneur.2023.1267360] [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: 07/26/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Deep brain stimulation of the subthalamic nucleus (STN-DBS) can exert relevant effects on the voice of patients with Parkinson's disease (PD). In this study, we used artificial intelligence to objectively analyze the voices of PD patients with STN-DBS. Materials and methods In a cross-sectional study, we enrolled 108 controls and 101 patients with PD. The cohort of PD was divided into two groups: the first group included 50 patients with STN-DBS, and the second group included 51 patients receiving the best medical treatment. The voices were clinically evaluated using the Unified Parkinson's Disease Rating Scale part-III subitem for voice (UPDRS-III-v). We recorded and then analyzed voices using specific machine-learning algorithms. The likelihood ratio (LR) was also calculated as an objective measure for clinical-instrumental correlations. Results Clinically, voice impairment was greater in STN-DBS patients than in those who received oral treatment. Using machine learning, we objectively and accurately distinguished between the voices of STN-DBS patients and those under oral treatments. We also found significant clinical-instrumental correlations since the greater the LRs, the higher the UPDRS-III-v scores. Discussion STN-DBS deteriorates speech in patients with PD, as objectively demonstrated by machine-learning voice analysis.
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Affiliation(s)
- Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, IS, Italy
| | - Francesco Asci
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, IS, Italy
| | - Giovanni Costantini
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Bove
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carla Piano
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Coppito, AQ, Italy
- Neurology Unit, San Salvatore Hospital, Coppito, AQ, Italy
| | - Rocco Cerroni
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Livia Brusa
- Neurology Unit, S. Eugenio Hospital, Rome, Italy
| | - Valerio Cesarini
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy
| | - Sara Pietracupa
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, IS, Italy
| | | | | | | | | | - Tommaso Tufo
- Neurosurgery Unit, Policlinico A. Gemelli University Hospital Foundation IRCSS, Rome, Italy
- Neurosurgery Department, Fakeeh University Hospital, Dubai, United Arab Emirates
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | | | - Alessandro Stefani
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Calabresi
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Giovanni Saggio
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy
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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: 0] [Impact Index Per Article: 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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An Q, Yin Z, Ma R, Fan H, Xu Y, Gan Y, Gao Y, Meng F, Yang A, Jiang Y, Zhu G, Zhang J. Adaptive deep brain stimulation for Parkinson's disease: looking back at the past decade on motor outcomes. J Neurol 2023; 270:1371-1387. [PMID: 36471098 DOI: 10.1007/s00415-022-11495-z] [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: 07/30/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adaptive deep brain stimulation (aDBS) has been reported to be an effective treatment for motor symptoms in patients with Parkinson's disease (PD). However, it remains unclear whether and in which motor domain aDBS provides greater/less benefits than conventional DBS (cDBS). OBJECTIVE To conduct a meta-analysis and systematic review to explore the improvement of the motor symptoms of PD patients undergoing aDBS and the comparison between aDBS and cDBS. METHODS Nineteen studies from PubMed, Embase, and the Cochrane Library database were eligible for the main analysis. Twelve studies used quantitative plus qualitative analysis; seven studies were only qualitatively analyzed. The efficacy of aDBS was evaluated and compared to cDBS through overall motor function improvements, changes in symptoms of rigidity-bradykinesia, dyskinesia, tremor, and speech function, and total electrical energy delivered (TEED). The overall motor improvement and TEED were investigated through meta-analyses, while other variables were investigated by systematic review. RESULTS Quantitative analysis showed that aDBS, with a reduction of TEED (55% of that of cDBS), significantly improved motor functions (33.9%, p < 0.01) and may be superior to cDBS in overall motor improvement (p = 0.002). However, significant publication bias was detected regarding the superiority (p = 0.006, Egger's test). In the qualitative analysis, rigidity-bradykinesia, dyskinesia, and speech function outcomes after aDBS and cDBS were comparable. Beta-based aDBS may not be as efficient as cDBS for tremor control. CONCLUSIONS aDBS can effectively relieve the clinical symptoms of advanced PD as did cDBS, at least in acute trials, delivering less stimulation than cDBS. Specific symptoms including tremor and axial disability remain to be compared between aDBS and cDBS in long-term studies.
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Affiliation(s)
- Qi An
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Ruoyu Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Houyou Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Yichen Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Yifei Gan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Yuan Gao
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Fangang Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, 100070, Beijing, China.,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Yin Jiang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Guanyu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, 100070, Beijing, China.
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, 100070, Beijing, China. .,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, 100070, Beijing, China. .,Beijing Key Laboratory of Neurostimulation, Beijing, China.
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7
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Baudouin R, Lechien JR, Carpentier L, Gurruchaga JM, Lisan Q, Hans S. Deep Brain Stimulation Impact on Voice and Speech Quality in Parkinson's Disease: A Systematic Review. Otolaryngol Head Neck Surg 2023; 168:307-318. [PMID: 36040825 DOI: 10.1177/01945998221120189] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) has considerable efficacy for the motor dysfunction of idiopathic Parkinson's disease (PD) on patient quality of life. However, the benefit of DBS on voice and speech quality remains controversial. We carried out a systematic review to understand the influence of DBS on parkinsonian dysphonia and dysarthria. DATA SOURCES A PubMed/MEDLINE and Cochrane systematic review was carried out following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Population, Intervention, Comparison, Outcome, Timing, and Setting (PICOTS) statements. REVIEW METHODS Three investigators screened studies published in the literature from inception to May 2022. The following data were retrieved: age, demographic, sex, disease duration, DBS duration, DBS location, speech, and voice quality measurements. RESULTS From the 180 studies identified, 44 publications met the inclusion criteria, accounting for 866 patients. Twenty-nine studies focused on voice/speech quality in subthalamic DBS patients, and 6 included patients with stimulation of pallidal, thalamic, and zona incerta regions. Most studies (4/6) reported a deterioration of the vocal parameters on subjective voice quality evaluation. For speech, the findings were more contrasted. There was an important heterogeneity between studies regarding the voice and speech quality outcomes used to evaluate the impact of DBS on voice/speech quality. CONCLUSION The impact of DBS on voice and speech quality significantly varies between studies. The stimulated anatomical region may have a significant role since the stimulation of the pallidal area was mainly associated with voice quality improvement, in contrast with other regions. Future controlled studies comparing all region stimulation are needed to get reliable findings. LEVEL OF EVIDENCE Level III: evidence from evidence summaries developed from systematic reviews.
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Affiliation(s)
- Robin Baudouin
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Université Paris Saclay), Versailles, France
| | - Jérôme R Lechien
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Université Paris Saclay), Versailles, France
- Department of Otolaryngology, Elsan Hospital, Paris, France
- Department of Otolaryngology-Head Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Brussels, Belgium
| | | | - Jean-Marc Gurruchaga
- Department of Neurosurgery, Henri Mondor Hospital, Université Paris-Est Créteil, Créteil, France
| | - Quentin Lisan
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Université Paris Saclay), Versailles, France
| | - Stéphane Hans
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Université Paris Saclay), Versailles, France
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8
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Pfister R. Tiefe Hirnstimulation beim idiopathischen Parkinson-Syndrom. SPRACHE · STIMME · GEHÖR 2022. [DOI: 10.1055/a-1941-3571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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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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10
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Lipp I, Mole JP, Subramanian L, Linden DEJ, Metzler-Baddeley C. Investigating the Anatomy and Microstructure of the Dentato-rubro-thalamic and Subthalamo-ponto-cerebellar Tracts in Parkinson's Disease. Front Neurol 2022; 13:793693. [PMID: 35401393 PMCID: PMC8987292 DOI: 10.3389/fneur.2022.793693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Abstract
Cerebellar-thalamic connections play a central role in deep brain stimulation-based treatment of tremor syndromes. Here, we used diffusion Magnetic Resonance Imaging (MRI) tractography to delineate the main cerebellar peduncles as well as two main white matter tracts that connect the cerebellum with the thalamus, the dentato-rubro-thalamic tract (DRTT) and the subthalamo-ponto-cerebellar tract (SPCT). We first developed a reconstruction protocol in young healthy adults with high-resolution diffusion imaging data and then demonstrate feasibility of transferring this protocol to clinical studies using standard diffusion MRI data from a cohort of patients with Parkinson's disease (PD) and their matched healthy controls. The tracts obtained closely corresponded to the previously described anatomical pathways and features of the DRTT and the SPCT. Second, we investigated the microstructure of these tracts with fractional anisotropy (FA), radial diffusivity (RD), and hindrance modulated orientational anisotropy (HMOA) in patients with PD and healthy controls. By reducing dimensionality of both the microstructural metrics and the investigated cerebellar and cerebellar-thalamic tracts using principal component analyses, we found global differences between patients with PD and controls, suggestive of higher fractional anisotropy, lower radial diffusivity, and higher hindrance modulated orientational anisotropy in patients. However, separate analyses for each of the tracts did not yield any significant differences. Our findings contribute to the characterization of the distinct anatomical connections between the cerebellum and the diencephalon. Microstructural differences between patients and controls in the cerebellar pathways suggest involvement of these structures in PD, complementing previous functional and diffusion imaging studies.
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Affiliation(s)
- Ilona Lipp
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, United Kingdom
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Jilu Princy Mole
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, United Kingdom
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Leena Subramanian
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - David E. J. Linden
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, United Kingdom
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Claudia Metzler-Baddeley
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom
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11
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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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Wang J, Shang R, He L, Zhou R, Chen Z, Ma Y, Li X. Prediction of Deep Brain Stimulation Outcome in Parkinson's Disease With Connectome Based on Hemispheric Asymmetry. Front Neurosci 2021; 15:620750. [PMID: 34764846 PMCID: PMC8576048 DOI: 10.3389/fnins.2021.620750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
Parkinson’s disease (PD) is a neurodegenerative disease that is associated with motor and non-motor symptoms and caused by lack of dopamine in the substantia nigra of the brain. Subthalamic nucleus deep brain stimulation (STN-DBS) is a widely accepted therapy of PD that mainly inserts electrodes into both sides of the brain. The effect of STN-DBS was mainly for motor function, so this study focused on the recovery of motor function for PD after DBS. Hemispherical asymmetry in the brain network is considered to be a potential indicator for diagnosing PD patients. This study investigated the value of hemispheric brain connection asymmetry in predicting the DBS surgery outcome in PD patients. Four types of brain connections, including left intra-hemispheric (LH) connection, right intra-hemispheric (RH) connection, inter-hemispheric homotopic (Ho) connection, and inter-hemispheric heterotopic (He) connection, were constructed based on the resting state functional magnetic resonance imaging (rs-fMRI) performed before the DBS surgery. We used random forest for selecting features and the Ridge model for predicting surgical outcome (i.e., improvement rate of motor function). The functional connectivity analysis showed that the brain has a right laterality: the RH networks has the best correlation (r = 0.37, p = 5.68E-03) between the predicted value and the true value among the above four connections. Moreover, the region-of-interest (ROI) analysis indicated that the medioventral occipital cortex (MVOcC)–superior temporal gyrus (STG) and thalamus (Tha)–precentral gyrus (PrG) contributed most to the outcome prediction model for DBS without medication. This result provides more support for PD patients to evaluate DBS before surgery.
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Affiliation(s)
- Jingqi Wang
- School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China
| | - Ruihong Shang
- School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China
| | - Le He
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, School of Medicine, Tsinghua University, Beijing, China
| | - Rongsong Zhou
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing, China
| | - Zhensen Chen
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Yu Ma
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing, China
| | - Xuesong Li
- School of Computer Science and Technology, Beijing Institute of Technology, Beijing, 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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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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15
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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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16
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Ehlen F, Al-Fatly B, Kühn AA, Klostermann F. Impact of deep brain stimulation of the subthalamic nucleus on natural language in patients with Parkinson's disease. PLoS One 2020; 15:e0244148. [PMID: 33373418 PMCID: PMC7771859 DOI: 10.1371/journal.pone.0244148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/03/2020] [Indexed: 12/30/2022] Open
Abstract
Background In addition to the typical motor symptoms, a majority of patients suffering from Parkinson’s disease experience language impairments. Deep Brain Stimulation of the subthalamic nucleus robustly reduces motor dysfunction, but its impact on language skills remains ambiguous. Method To elucidate the impact of subthalamic deep brain stimulation on natural language production, we systematically analyzed language samples from fourteen individuals (three female / eleven male, average age 66.43 ± 7.53 years) with Parkinson’s disease in the active (ON) versus inactive (OFF) stimulation condition. Significant ON-OFF differences were considered as stimulation effects. To localize their neuroanatomical origin within the subthalamic nucleus, they were correlated with the volume of tissue activated by therapeutic stimulation. Results Word and clause production speed increased significantly under active stimulation. These enhancements correlated with the volume of tissue activated within the associative part of the subthalamic nucleus, but not with that within the dorsolateral motor part, which again correlated with motor improvement. Language error rates were lower in the ON vs. OFF condition, but did not correlate with electrode localization. No significant changes in further semantic or syntactic language features were detected in the current study. Conclusion The findings point towards a facilitation of executive language functions occurring rather independently from motor improvement. Given the presumed origin of this stimulation effect within the associative part of the subthalamic nucleus, this could be due to co-stimulation of the prefrontal-subthalamic circuit.
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Affiliation(s)
- Felicitas Ehlen
- Department of Neurology, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Jüdisches Krankenhaus Berlin, Berlin, Germany
- * E-mail:
| | - Bassam Al-Fatly
- Department of Neurology, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea A. Kühn
- Department of Neurology, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- Neurocure Cluster of Excellence, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Bernstein Center for Computational Neuroscience, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Berlin, Germany
| | - Fabian Klostermann
- Department of Neurology, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
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Sasagawa A, Enatsu R, Kitagawa M, Mikami T, Nakayama-Kamada C, Kuribara T, Hirano T, Arihara M, Mikuni N. Target Selection of Directional Lead in Patients with Parkinson's Disease. Neurol Med Chir (Tokyo) 2020; 60:622-628. [PMID: 33162470 PMCID: PMC7803701 DOI: 10.2176/nmc.tn.2020-0210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Several structures including subthalamic nucleus (STN), the caudal zona incerta (cZI), the prelemniscal radiation (Raprl), and the thalamic ventral intermediate nucleus (Vim) have been reported to be useful for improving symptoms of Parkinson’s disease (PD). However, the effect of each target is still unclear. Therefore, we investigated each structure’s effects and adverse effects using a directional lead implanted in the posterior STN adjacent to the cZI and Raprl in two patients with tremor-dominant PD. In Case 1, maximal reduction of tremor was obtained by stimulation toward the Vim, and stimulation toward the thalamic reticular nucleus (TRN) reduced verbal fluency, but did not induce dysarthria. In Case 2, maximal reduction of tremor was obtained by stimulation toward the dorsal STN and Raprl. Maximal reduction of rigidity was achieved by stimulation toward the dorsal STN, Raprl, and cZI. Bradykiensia was improved by stimulation in all directions, but dyskinesia and dysarthria were evoked by stimulation toward the dorsal STN and cZI. The directional lead may elucidate the stimulation effect of each structure and broaden target selection depending on patients’ symptoms and adverse effects.
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Affiliation(s)
- Ayaka Sasagawa
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | | | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | | | - Tomoyoshi Kuribara
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Tsukasa Hirano
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Masayasu Arihara
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University School of Medicine
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Petry-Schmelzer JN, Jergas H, Thies T, Steffen JK, Reker P, Dafsari HS, Mücke D, Fink GR, Visser-Vandewalle V, Dembek TA, Barbe MT. Network Fingerprint of Stimulation-Induced Speech Impairment in Essential Tremor. Ann Neurol 2020; 89:315-326. [PMID: 33201528 DOI: 10.1002/ana.25958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 10/27/2020] [Accepted: 11/08/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study was undertaken to gain insights into structural networks associated with stimulation-induced dysarthria (SID) and to predict stimulation-induced worsening of intelligibility in essential tremor patients with bilateral thalamic deep brain stimulation (DBS). METHODS Monopolar reviews were conducted in 14 essential tremor patients. Testing included determination of SID thresholds, intelligibility ratings, and a fast syllable repetition task. Volumes of tissue activated (VTAs) were calculated to identify discriminative fibers for stimulation-induced worsening of intelligibility in a structural connectome. The resulting fiber-based atlas structure was then validated in a leave-one-out design. RESULTS Fibers determined as discriminative for stimulation-induced worsening of intelligibility were mainly connected to the ipsilateral precentral gyrus as well as to both cerebellar hemispheres and the ipsilateral brain stem. In the thalamic area, they ran laterally to the thalamus and posteromedially to the subthalamic nucleus, in close proximity, mainly anterolaterally, to fibers beneficial for tremor control as published by Al-Fatly et al in 2019. The overlap of the respective clinical stimulation setting's VTAs with these fibers explained 62.4% (p < 0.001) of the variance of stimulation-induced change in intelligibility in a leave-one-out analysis. INTERPRETATION This study demonstrates that SID in essential tremor patients is associated with both motor cortex and cerebellar connectivity. Furthermore, the identified fiber-based atlas structure might contribute to future postoperative programming strategies to achieve optimal tremor control without speech impairment in essential tremor patients with thalamic DBS. ANN NEUROL 2021;89:315-326.
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Affiliation(s)
- Jan Niklas Petry-Schmelzer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hannah Jergas
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tabea Thies
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Linguistics, Faculty of Arts and Humanities, Institue of Linguistics Phonetics, University of Cologne, Cologne, Germany
| | - Julia K Steffen
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Paul Reker
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Haidar S Dafsari
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Doris Mücke
- Department of Linguistics, Faculty of Arts and Humanities, Institue of Linguistics Phonetics, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Research Center Jülich, Institute of Neuroscience and Medicine (INM-3), Cognitive Neuroscience, Jülich, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Till A Dembek
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael T Barbe
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Wang N, Wang K, Wang Q, Fan S, Fu Z, Zhang F, Wang L, Meng F. Stimulation-Induced Dyskinesia After Subthalamic Nucleus Deep Brain Stimulation in Patients With Meige Syndrome. Neuromodulation 2020; 24:286-292. [PMID: 32964635 DOI: 10.1111/ner.13284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/08/2020] [Accepted: 08/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Deep brain stimulation of the subthalamic nucleus (STN-DBS) is increasingly used to treat Meige syndrome (MS) and markedly improves symptoms. Stimulation-induced dyskinesia (SID), which adversely affects surgical outcomes and patient satisfaction, may, however, occur in some patients. This study attempts to explore possible causes of SID. MATERIALS AND METHODS Retrospectively collected clinical data on 32 patients who underwent STN-DBS between October 2016 and April 2019 were analyzed. Clinical outcomes were assessed pre- and post-surgery, using the Burke-Fahn-Marsden dystonia rating scale (BFMDRS). Patients were divided into a dyskinesia group and a non-dyskinesia group, according to whether or not they experienced persistent SID during follow-up. The coordinates of the active contacts were calculated from post-operative computerized tomography or magnetic resonance imaging, using the inter-commissural line as a reference. At final follow-up, the main stimulatory parameters for further study included pulse width, voltage, and frequency. RESULTS At final follow-up (mean = 16.3 ± 7.2 months), MS patients had improved BFMDRS total scores compared with pre-surgical scores (mean improvement = 79.0%, p < 0.0001). The mean improvement in BFMDRS total scores in the dyskinesia (n = 10) and non-dyskinesia (n = 22) groups were 81.6 ± 8.8% and 77.9 ± 14.2%, respectively. The mean minimum voltage to induce dyskinesia was 1.7 ± 0.3 V. The programmed parameters of both groups were similar. When compared with the non-dyskinesia group, active stimulatory contact coordinates in the dyskinesia group were inferior (mean left side: z = -2.3 ± 1.7 mm vs. z = -1.2 ± 1.5 mm; p = 0.0282; mean right side: z = -2.7 ± 1.9 mm vs. z = -2.3 ± 1.7 mm; p = 0.0256). The x and y coordinates were similar. CONCLUSION STN-DBS is an effective intervention for MS, providing marked improvements in clinical symptoms; SID may, however occur in the subsequent programming control process. Comparing patients with/without dyskinesia, the active contacts were located closer to the inferior part of the STN in patients with dyskinesia, which may provide an explanation for the dyskinesia.
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Affiliation(s)
- Ning Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Kailiang Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Qiao Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Shiying Fan
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Zonghui Fu
- Department of Functional Neurosurgery, Aviation General Hospital, Beijing, China
| | - Feng Zhang
- Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Lin Wang
- Department of Functional Neurosurgery, Aviation General Hospital, Beijing, China
| | - Fangang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, The First Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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20
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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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21
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Acute effects of adaptive Deep Brain Stimulation in Parkinson's disease. Brain Stimul 2020; 13:1507-1516. [PMID: 32738409 PMCID: PMC7116216 DOI: 10.1016/j.brs.2020.07.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 07/19/2020] [Accepted: 07/23/2020] [Indexed: 02/08/2023] Open
Abstract
Background Beta-based adaptive Deep Brain Stimulation (aDBS) is effective in Parkinson’s disease (PD), when assessed in the immediate post-implantation phase. However, the potential benefits of aDBS in patients with electrodes chronically implanted, in whom changes due to the microlesion effect have disappeared, are yet to be assessed. Methods To determine the acute effectiveness and side-effect profile of aDBS in PD compared to conventional continuous DBS (cDBS) and no stimulation (NoStim), years after DBS implantation, 13 PD patients undergoing battery replacement were pseudo-randomised in a crossover fashion, into three conditions (NoStim, aDBS or cDBS), with a 2-min interval between them. Patient videos were blindly evaluated using a short version of the Unified Parkinson’s Disease Rating Scale (subUPDRS), and the Speech Intelligibility Test (SIT). Results Mean disease duration was 16 years, and the mean time since DBS-implantation was 6.9 years. subUPDRS scores (11 patients tested) were significantly lower both in aDBS (p = <.001), and cDBS (p = .001), when compared to NoStim. Bradykinesia subscores were significantly lower in aDBS (p = .002), and did not achieve significance during cDBS (p = .08), when compared to NoStim. Two patients demonstrated re-emerging tremor during aDBS. SIT scores of patients who presented stimulation-induced dysarthria significantly worsened in cDBS (p = .009), but not in aDBS (p = .407), when compared to NoStim. Overall, stimulation was applied 48.8% of the time during aDBS. Conclusion Beta-based aDBS is effective in PD patients with bradykinetic phenotypes, delivers less stimulation than cDBS, and potentially has a more favourable speech side-effect profile. Patients with prominent tremor may require a modified adaptive strategy.
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22
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Zhang H, Bao Y, Feng Y, Hu H, Wang Y. Evidence for Reciprocal Structural Network Interactions Between Bilateral Crus Lobes and Broca's Complex. Front Neuroanat 2020; 14:27. [PMID: 32625067 PMCID: PMC7316155 DOI: 10.3389/fnana.2020.00027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/05/2020] [Indexed: 11/24/2022] Open
Abstract
While the proximal dentatothalamocortical tracts are considered pivotal in the occurrence of cerebellar mutism syndrome (CMS) after medulloblastoma resection, how the cerebellum participates in motor–speech networks through direct structural connectivity is still unclear. Via tractography, we provide evidence of cerebellar streamlines projecting into the left inferior frontal gyrus majorly connecting Broca’s complex and the bilateral Crus lobes. The streamlines, named Crus–Broca tracts, originated from the bilateral Crus lobes, synapsed onto the dentate nucleus, ascended into the superior cerebellar peduncle (where these streamlines were closely superior to the superior border of the supratonsillar cleft and the superolateral roof of the fourth ventricle), surprisingly bypassed the left red nucleus and the left thalamus, and ended at the subregions of Broca’s complex. The streamlines, named Broca–Crus tracts, originated from the subregions of Broca’s complex and ended predominantly at the right Crus lobes. If verified, the existence of these connections would support the notion of the bilateral cerebellums’ participation in motor–speech planning, and the anatomical relationship of Broca–Crus tracts with the supratonsillar cleft would merit consideration for further studies aimed at further elucidating CMS mechanisms.
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Affiliation(s)
- Hui Zhang
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, China.,Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yue Bao
- Department of Neurosurgery, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Yuan Feng
- Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Haijun Hu
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, China
| | - Yibao Wang
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, China
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23
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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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Coenen VA, Sajonz B, Prokop T, Reisert M, Piroth T, Urbach H, Jenkner C, Reinacher PC. The dentato-rubro-thalamic tract as the potential common deep brain stimulation target for tremor of various origin: an observational case series. Acta Neurochir (Wien) 2020; 162:1053-1066. [PMID: 31997069 PMCID: PMC7156360 DOI: 10.1007/s00701-020-04248-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/23/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Deep brain stimulation alleviates tremor of various origins. The dentato-rubro-thalamic tract (DRT) has been suspected as a common tremor-reducing structure. Statistical evidence has not been obtained. We here report the results of an uncontrolled case series of patients with refractory tremor who underwent deep brain stimulation under tractographic assistance. METHODS A total of 36 patients were enrolled (essential tremor (17), Parkinson's tremor (8), multiple sclerosis (7), dystonic head tremor (3), tardive dystonia (1)) and received 62 DBS electrodes (26 bilateral; 10 unilateral). Preoperatively, diffusion tensor magnetic resonance imaging sequences were acquired together with high-resolution anatomical T1W and T2W sequences. The DRT was individually tracked and used as a direct thalamic or subthalamic target. Intraoperative tremor reduction was graded on a 4-point scale (0 = no tremor reduction to 3 = full tremor control) and recorded together with the current amplitude, respectively. Stimulation point coordinates were recorded and compared to DRT. The relation of the current amplitude needed to reduce tremor was expressed as TiCR (tremor improvement per current ratio). RESULTS Stimulation points of 241 were available for analysis. A total of 68 trajectories were tested (62 dB leads, 1.1 trajectories tested per implanted lead). Tremor improvement was significantly decreasing (p < 0.01) if the distance to both the border and the center of the DRT was increasing. On the initial trajectory, 56 leads (90.3%) were finally placed. Long-term outcomes were not part of this analysis. DISCUSSION Tremor of various origins was acutely alleviated at different points along the DRT fiber tract (above and below the MCP plane) despite different tremor diseases. DRT is potentially a common tremor-reducing structure. Individual targeting helps to reduce brain penetrating tracts. TiCR characterizes stimulation efficacy and might help to identify an optimal stimulation point.
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Affiliation(s)
- Volker Arnd Coenen
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg (i.Br.), Germany.
- Faculty of Medicine, Freiburg University, Freiburg (i.Br.), Germany.
- Brain Links/Brain Tools Cluster of Excellence, Freiburg University, Freiburg (i.Br.), Germany.
- NeuroModul Basics (Center for Basics in NeuroModulation), Freiburg University, Freiburg (i.Br.), Germany.
| | - Bastian Sajonz
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg (i.Br.), Germany
- Faculty of Medicine, Freiburg University, Freiburg (i.Br.), Germany
| | - Thomas Prokop
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg (i.Br.), Germany
- Faculty of Medicine, Freiburg University, Freiburg (i.Br.), Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg (i.Br.), Germany
- Faculty of Medicine, Freiburg University, Freiburg (i.Br.), Germany
| | - Tobias Piroth
- Faculty of Medicine, Freiburg University, Freiburg (i.Br.), Germany
- Brain Links/Brain Tools Cluster of Excellence, Freiburg University, Freiburg (i.Br.), Germany
- Department of Neurology and Neurophysiology, Freiburg University Medical Center, Freiburg (i.Br.), Germany
| | - Horst Urbach
- Faculty of Medicine, Freiburg University, Freiburg (i.Br.), Germany
- Department of Neuroradiology, Freiburg University Medical Center, Freiburg (i.Br.), Germany
| | - Carolin Jenkner
- Faculty of Medicine, Freiburg University, Freiburg (i.Br.), Germany
- Clinical Trials Unit, Freiburg University Medical Center, Freiburg, Germany
| | - Peter Christoph Reinacher
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg (i.Br.), Germany
- Faculty of Medicine, Freiburg University, Freiburg (i.Br.), Germany
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Sandström L, Blomstedt P, Karlsson F, Hartelius L. The Effects of Deep Brain Stimulation on Speech Intelligibility in Persons With Essential Tremor. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:456-471. [PMID: 32091953 DOI: 10.1044/2019_jslhr-19-00014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The aim of this study was to investigate how deep brain stimulation (DBS) of the caudal zona incerta (cZi) affects speech intelligibility in persons with essential tremor. Method Thirty-five participants were evaluated: off stimulation, on chronic stimulation optimized to alleviate tremor, and during unilateral stimulation at increasing amplitude levels. At each stimulation condition, the participants read 10 unique nonsense sentences from the Swedish Test of Intelligibility. Two listeners, blinded to stimulation condition, transcribed all recorded sentences orthographically in a randomized procedure. A mean speech intelligibility score for each patient and stimulation condition was computed, and comparisons were made between scores off and on stimulation. Results Chronic cZi-DBS had no significant effect on speech intelligibility, and there was no difference in outcome between bilateral and unilateral treatments. During unilateral stimulation at increasing amplitudes, nine participants demonstrated deteriorating speech intelligibility. These nine participants were on average older and had more superior contacts activated during the evaluation compared with the participants without deterioration. Conclusions Chronic cZi-DBS, optimized for tremor suppression, does not generally affect speech intelligibility in persons with essential tremor. Furthermore, speech intelligibility may be preserved in many individuals, even when stimulated at high amplitudes. Adverse effects of high-amplitude unilateral stimulation observed in this study were associated with stimulation originating from a more superior location, as well as with the participants' age. These results, highlighting age and stimulation location as contributing to speech intelligibility outcomes, were, however, based on a limited number of individuals experiencing adverse effects with high-amplitude stimulation and should, therefore, be interpreted with caution.
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Affiliation(s)
- Linda Sandström
- Division of Speech and Language Pathology, Department of Clinical Sciences, Umeå University, Sweden
| | - Patric Blomstedt
- Division of Clinical Neuroscience, Department of Clinical Sciences, Umeå University, Sweden
| | - Fredrik Karlsson
- Division of Speech and Language Pathology, Department of Clinical Sciences, Umeå University, Sweden
| | - Lena Hartelius
- Division of Speech and Language Pathology, Department of Health and Rehabilitation, Sahlgrenska Academy at the University of Gothenburg, Sweden
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Vassal F, Dilly D, Boutet C, Bertholon F, Charier D, Pommier B. White matter tracts involved by deep brain stimulation of the subthalamic nucleus in Parkinson's disease: a connectivity study based on preoperative diffusion tensor imaging tractography. Br J Neurosurg 2019; 34:187-195. [PMID: 31833430 DOI: 10.1080/02688697.2019.1701630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To depict the specific brain networks that are modulated by deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD), using diffusion tensor imaging-based fibre tractography (DTI-FT).Materials and methods: Nine patients who received bilateral STN-DBS for PD were included. Electrodes were localized by co-registering preoperative magnetic resonance imaging and postoperative computed tomography. The volume of tissue activated (VTA) was estimated as an isotropic, spherical electric field distribution centred at each effective electrode contact's centroid coordinates, taking into account individual stimulation parameters (i.e. voltage, impedance). Brain connectivity analysis was undertaken using a deterministic DTI-FT method, seeded from a single region of interest corresponding to the VTA. The labelling of the reconstructed white matter fibre tracts relied on their path and (sub)cortical termination territories.Results: Six months after surgery, we observed a statistically significant reduction in both the Unified Parkinson Disease Rating Scale part III and L-dopa equivalent daily dose. Areas consistently connected to the VTA included the brainstem (100%), cerebellum (94%), dorsal (i.e. supplementary motor area) and lateral premotor cortex (94%), and primary motor cortex (72%). An involvement of the hyperdirect pathway (HDP) connecting the STN and the (pre)motor cortex was demonstrated.Conclusions: The connectivity patterns observed in this study suggest that the therapeutic effects of STN-DBS are mediated through the modulation of distributed, large-scale motor networks. Specifically, the depiction of projection neurons connecting the stimulated area/STN to the (pre)motor cortex, reinforce the growing evidence that the HDP might be a potential therapeutic target in PD. If further replicated, these findings could raise the possibility that DTI-FT reconstruction of the HDP may critically improve DBS targeting and stimulation parameters selection, through the development of programming tools that incorporate VTA modelling and patient-specific DTI-FT data.
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Affiliation(s)
- François Vassal
- Department of Neurosurgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Domitille Dilly
- Department of Neurology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Claire Boutet
- Department of Neuroradiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Frédérique Bertholon
- Department of Clinical Neurophysiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - David Charier
- Department of Anesthesiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Benjamin Pommier
- Department of Neurosurgery, University Hospital of Saint-Etienne, Saint-Etienne, France
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Nordin T, Zsigmond P, Pujol S, Westin CF, Wårdell K. White matter tracing combined with electric field simulation - A patient-specific approach for deep brain stimulation. Neuroimage Clin 2019; 24:102026. [PMID: 31795055 PMCID: PMC6880013 DOI: 10.1016/j.nicl.2019.102026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/04/2019] [Accepted: 10/02/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) in zona incerta (Zi) is used for symptom alleviation in essential tremor (ET). Zi is positioned along the dentato-rubro-thalamic tract (DRT). Electric field simulations with the finite element method (FEM) can be used for estimation of a volume where the stimulation affects the tissue by applying a fixed isolevel (VDBS). This work aims to develop a workflow for combined patient-specific electric field simulation and white matter tracing of the DRT, and to investigate the influence on the VDBS from different brain tissue models, lead design and stimulation modes. The novelty of this work lies in the combination of all these components. METHOD Patients with ET were implanted in Zi (lead 3389, n = 3, voltage mode; directional lead 6172, n = 1, current mode). Probabilistic reconstruction from diffusion MRI (dMRI) of the DRT (n = 8) was computed with FSL Toolbox. Brain tissue models were created for each patient (two homogenous, one heterogenous isotropic, one heterogenous anisotropic) and the respective VDBS (n = 48) calculated from the Comsol Multiphysics FEM simulations. The DRT and VDBS were visualized with 3DSlicer and superimposed on the preoperative T2 MRI, and the common volumes calculated. Dice Coefficient (DC) and level of anisotropy were used to evaluate and compare the brain models. RESULT Combined patient-specific tractography and electric field simulation was designed and evaluated, and all patients showed benefit from DBS. All VDBS overlapped the reconstructed DRT. Current stimulation showed prominent difference between the tissue models, where the homogenous grey matter deviated most (67 < DC < 69). Result from heterogenous isotropic and anisotropic models were similar (DC > 0.95), however the anisotropic model consistently generated larger volumes related to a greater extension of the electric field along the DBS lead. Independent of tissue model, the steering effect of the directional lead was evident and consistent. CONCLUSION A workflow for patient-specific electric field simulations in combination with reconstruction of DRT was successfully implemented. Accurate tissue classification is essential for electric field simulations, especially when using the current control stimulation. With an accurate targeting and tractography reconstruction, directional leads have the potential to tailor the electric field into the desired region.
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Affiliation(s)
- Teresa Nordin
- Department of Biomedical Engineering, Linköping University, Sweden.
| | - Peter Zsigmond
- Department of Neurosurgery and Clinical and Experimental Medicine, Linköping University, Sweden
| | - Sonia Pujol
- Laboratory of Mathematics in Imaging, Brigham and Women's Hospital, Harvard Medical School, USA; Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Carl-Fredrik Westin
- Laboratory of Mathematics in Imaging, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Karin Wårdell
- Department of Biomedical Engineering, Linköping University, Sweden
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Strotzer QD, Anthofer JM, Faltermeier R, Brawanski AT, Torka E, Waldthaler JA, Kohl Z, Fellner C, Beer AL, Schlaier JR. Deep brain stimulation: Connectivity profile for bradykinesia alleviation. Ann Neurol 2019; 85:852-864. [DOI: 10.1002/ana.25475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 03/01/2019] [Accepted: 03/31/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Quirin D. Strotzer
- Department of Neurosurgery, Medical CenterUniversity of Regensburg Regensburg Germany
- Center for Deep Brain Stimulation, Medical CenterUniversity of Regensburg Regensburg Germany
| | - Judith M. Anthofer
- Department of Neurosurgery, Medical CenterUniversity of Regensburg Regensburg Germany
- Center for Deep Brain Stimulation, Medical CenterUniversity of Regensburg Regensburg Germany
| | - Rupert Faltermeier
- Department of Neurosurgery, Medical CenterUniversity of Regensburg Regensburg Germany
| | | | - Elisabeth Torka
- Department of Neurology, Medical CenterUniversity of Regensburg Regensburg Germany
| | | | - Zacharias Kohl
- Department of Molecular NeurologyFriedrich Alexander University Erlangen‐Nuremberg Erlangen Germany
| | - Claudia Fellner
- Institute of Radiology, Medical CenterUniversity of Regensburg Regensburg Germany
| | - Anton L. Beer
- Institute of PsychologyUniversity of Regensburg Regensburg Germany
| | - Juergen R. Schlaier
- Department of Neurosurgery, Medical CenterUniversity of Regensburg Regensburg Germany
- Center for Deep Brain Stimulation, Medical CenterUniversity of Regensburg Regensburg Germany
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Effects of Deep Brain Stimulation of the Subthalamic Nucleus Settings on Voice Quality, Intensity, and Prosody in Parkinson’s Disease: Preliminary Evidence for Speech Optimization. Can J Neurol Sci 2019; 46:287-294. [DOI: 10.1017/cjn.2019.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT:Objective: To systematically evaluate how different deep brain stimulation of the subthalamic nucleus (STN-DBS) amplitude, frequency, and pulse-width electrical parameter settings impact speech intensity, voice quality, and prosody of speech in Parkinson’s disease (PD). Methods: Ten individuals with PD receiving bilateral STN-DBS treatments were seen for three baseline and five treatment visits. The five treatment visits involved an examination of the standard clinical settings as well as manipulation of different combinations of frequency (low, mid, and high), pulse width (low, mid, and high), and voltage (low, mid, and high) of stimulation. Measures of speech intensity, jitter, shimmer, harmonics–noise ratio, semitone standard deviation, and listener ratings of voice quality and prosody were obtained for each STN-DBS manipulation. Results: The combinations of lower frequency, lower pulse width, and higher voltage settings were associated with improved speech outcomes compared to the current standard clinical settings. In addition, decreased total electrical energy delivered to the STN appears to be associated with speech improvements. Conclusions: This study provides preliminary evidence that STN-DBS may be optimized for Parkinson-related problems with voice quality, speech intensity, and prosody of speech.
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Behroozmand R, Johari K, Kelley RM, Kapnoula EC, Narayanan NS, Greenlee JDW. Effect of deep brain stimulation on vocal motor control mechanisms in Parkinson's disease. Parkinsonism Relat Disord 2019; 63:46-53. [PMID: 30871801 DOI: 10.1016/j.parkreldis.2019.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 02/20/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for limb motor symptoms in Parkinson's disease (PD); however, its effect on vocal motor function has yielded conflicted and highly variable results. The present study investigated the effects of STN-DBS on the mechanisms of vocal production and motor control. METHODS A total of 10 PD subjects with bilateral STN-DBS implantation were tested with DBS ON and OFF while they performed steady vowel vocalizations and received randomized upward or downward pitch-shift stimuli (±100 cents) in their voice auditory feedback. RESULTS Data showed that the magnitude of vocal compensation responses to pitch-shift stimuli was significantly attenuated during DBS ON vs. OFF (p = 0.012). This effect was direction-specific and was only observed when subjects raised their voice fundamental frequency (F0) in the opposite direction to downward stimuli (p = 0.019). In addition, we found that voice F0 perturbation (i.e. jitter) was significantly reduced during DBS ON vs. OFF (p = 0.022), and this DBS-induced modulation was positively correlated with the attenuation of vocal compensation responses to downward pitch-shift stimuli (r = +0.57, p = 0.028). CONCLUSIONS These findings provide the first data supporting the role of STN in vocal F0 motor control in response to altered auditory feedback. The DBS-induced attenuation of vocal compensation responses may result from increased inhibitory effects of the subcortical hyperdirect (fronto-subthalamic) pathways on the vocal motor cortex, which can help stabilize voice F0 and ameliorate vocal motor symptoms by impeding PD subjects' abnormal (i.e. overshooting) vocal responses to alterations in the auditory feedback.
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Affiliation(s)
- Roozbeh Behroozmand
- Speech Neuroscience Lab, Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29028, USA.
| | - Karim Johari
- Speech Neuroscience Lab, Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29028, USA
| | - Ryan M Kelley
- Medical Scientist Training Program, University of Iowa, Iowa City, IA 52242, USA; Program in Neuroscience, University of Iowa, Iowa City, IA 52242, USA
| | | | | | - Jeremy D W Greenlee
- Human Brain Research Lab, Department of Neurosurgery, University of Iowa, Iowa City, IA 52242, USA
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Morello ANDC, Beber BC, Fagundes VC, Cielo CA, Rieder CRM. Dysphonia and Dysarthria in People With Parkinson's Disease After Subthalamic Nucleus Deep Brain Stimulation: Effect of Frequency Modulation. J Voice 2018; 34:477-484. [PMID: 30454944 DOI: 10.1016/j.jvoice.2018.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE Subthalamic nucleus deep brain stimulation (STN-DBS) parameters, for example the frequency of stimulation, seem to affect speech and voice aspects. However, this influence is not well understood. This study aimed to investigate the impact of low- and high-frequency STN-DBS on voice and speech for people with Parkinson's disease. METHODS Nineteen individuals with Parkinson's disease who received bilateral STN-DBS were assessed for motor performance (Unified Parkinson's Disease Rating Scale-III), perceptual evaluation of voice (grade, roughness, breathiness, asthenia, strain, and instability [GRBASI]), dysarthria assessment, and computerized acoustic analysis of voice upon receiving low-frequency (60 Hz) and high-frequency (130 Hz) STN-DBS. RESULTS In the GRBASI protocol, asthenia, and instability were significantly better at 130 Hz of stimulation. In the dysarthria evaluation, the phonation aspect, articulation, and grade of dysarthria showed deterioration at the same high-frequency condition. There was no significant difference for any vocal acoustic measures. CONCLUSION The high-frequency of STN-DBS may affect speech and voice differently, leading to an amelioration of the vocal production, but with adverse effects in the speech control.
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Affiliation(s)
- Aline Nunes Da Cruz Morello
- Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Bárbara Costa Beber
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Valéria Carvalho Fagundes
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Carlos R M Rieder
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Investigating the effect of STN-DBS stimulation and different frequency settings on the acoustic-articulatory features of vowels. Neurol Sci 2018; 39:1683-1689. [PMID: 29938340 DOI: 10.1007/s10072-018-3479-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is the second most frequent progressive neuro-degenerative disorder. In addition to motor symptoms, nonmotor symptoms and voice and speech disorders can also develop in 90% of PD patients. The aim of our study was to investigate the effects of DBS and different DBS frequencies on speech acoustics of vowels in PD patients. METHODS The study included 16 patients who underwent STN-DBS surgery due to PD. The voice recordings for the vowels including [a], [e], [i], and [o] were performed at frequencies including 230, 130, 90, and 60 Hz and off-stimulation. The voice recordings were gathered and evaluated by the Praat software, and the effects on the first (F1), second (F2), and third formant (F3) frequencies were analyzed. RESULTS A significant difference was found for the F1 value of the vowel [a] at 130 Hz compared to off-stimulation. However, no significant difference was found between the three formant frequencies with regard to the stimulation frequencies and off-stimulation. In addition, though not statistically significant, stimulation at 60 and 230 Hz led to several differences in the formant frequencies of other three vowels. CONCLUSION Our results indicated that STN-DBS stimulation at 130 Hz had a significant positive effect on articulation of [a] compared to off-stimulation. Although there is not any statistical significant stimulation at 60 and 230 Hz may also have an effect on the articulation of [e], [i], and [o] but this effect needs to be investigated in future studies with higher numbers of participants.
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Nozaki T, Asakawa T, Sugiyama K, Koda Y, Shimoda A, Mizushima T, Sameshima T, Namba H. Effect of Subthalamic Deep Brain Stimulation on Upper Limb Dexterity in Patients with Parkinson Disease. World Neurosurg 2018; 115:e206-e217. [PMID: 29654953 DOI: 10.1016/j.wneu.2018.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The efficacy of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on dexterity remains controversial despite its recognition as an effective strategy for Parkinson disease. The present study investigated the efficacy of STN-DBS for ameliorating bradykinesia and dexterity compared with dopaminergic medications. METHODS Part III of the Unified Parkinson's Disease Rating Scale was used for the evaluation of bradykinesia, whereas the Purdue Pegboard Test and the Box and Block test were selected for dexterity. RESULTS Our findings indicate that bradykinesia is significantly improved with both DBS and dopaminergic medication, whereas dexterity is improved only with DBS. Dopaminergic medication did not show a satisfactory efficacy on dexterity, and there was little synergistic effect of dopaminergic medication and STN-DBS for improving dexterity associated with Parkinson disease. CONCLUSIONS Our results suggest that DBS is potentially more effective than dopaminergic medications for improving dexterity. The disparities in efficacy for bradykinesia and dexterity between DBS and dopaminergic medication hint at the potential mechanisms of STN-DBS. We speculate that DBS follows at least 2 different mechanisms for improving parkinsonian symptoms: 1) the dopaminergic system, primarily for the improvement of bradykinesia and 2) the nondopaminergic system, for the improvement of dexterity. This hypothesis requires further verification and investigation.
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Affiliation(s)
- Takao Nozaki
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
| | - Tetsuya Asakawa
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
| | - Kenji Sugiyama
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yuki Koda
- Department of Rehabilitation, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Ayumi Shimoda
- Department of Rehabilitation, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Takashi Mizushima
- Department of Rehabilitation, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tetsuro Sameshima
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Knowles T, Adams S, Abeyesekera A, Mancinelli C, Gilmore G, Jog M. Deep Brain Stimulation of the Subthalamic Nucleus Parameter Optimization for Vowel Acoustics and Speech Intelligibility in Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:510-524. [PMID: 29471373 DOI: 10.1044/2017_jslhr-s-17-0157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 11/16/2017] [Indexed: 06/08/2023]
Abstract
PURPOSE The settings of 3 electrical stimulation parameters were adjusted in 12 speakers with Parkinson's disease (PD) with deep brain stimulation of the subthalamic nucleus (STN-DBS) to examine their effects on vowel acoustics and speech intelligibility. METHOD Participants were tested under permutations of low, mid, and high STN-DBS frequency, voltage, and pulse width settings. At each session, participants recited a sentence. Acoustic characteristics of vowel production were extracted, and naive listeners provided estimates of speech intelligibility. RESULTS Overall, lower-frequency STN-DBS stimulation (60 Hz) was found to lead to improvements in intelligibility and acoustic vowel expansion. An interaction between speaker sex and STN-DBS stimulation was found for vowel measures. The combination of low frequency, mid to high voltage, and low to mid pulse width led to optimal speech outcomes; however, these settings did not demonstrate significant speech outcome differences compared with the standard clinical STN-DBS settings, likely due to substantial individual variability. CONCLUSIONS Although lower-frequency STN-DBS stimulation was found to yield consistent improvements in speech outcomes, it was not found to necessarily lead to the best speech outcomes for all participants. Nevertheless, frequency may serve as a starting point to explore settings that will optimize an individual's speech outcomes following STN-DBS surgery. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.5899228.
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Affiliation(s)
- Thea Knowles
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Scott 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
| | - Anita Abeyesekera
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Cynthia Mancinelli
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Greydon Gilmore
- Department of Biomedical Engineering, Western University, London, Ontario, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, University Hospital, London, Ontario, Canada
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Tsuboi T, Watanabe H, Tanaka Y, Ohdake R, Hattori M, Kawabata K, Hara K, Ito M, Fujimoto Y, Nakatsubo D, Maesawa S, Kajita Y, Katsuno M, Sobue G. Early detection of speech and voice disorders in Parkinson's disease patients treated with subthalamic nucleus deep brain stimulation: a 1-year follow-up study. J Neural Transm (Vienna) 2017; 124:1547-1556. [PMID: 29098450 DOI: 10.1007/s00702-017-1804-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
We previously reported that Parkinson's disease (PD) patients treated with subthalamic nucleus deep brain stimulation (STN-DBS) had distinct phenotypes of speech and voice disorders: hypokinetic dysarthria, stuttering, breathy voice, strained voice, and spastic dysarthria. However, changes over time remain unclear. In the present study, 32 consecutive PD patients were assessed before and up to 1 year after surgery (PD-DBS). Eleven medically treated PD patients were also assessed (PD-Med). Speech, voice, motor, and cognitive functions were evaluated. At baseline, the incidence of hypokinetic dysarthria (63% of PD-DBS vs. 82% of PD-Med), stuttering (50% vs. 45%), breathy voice (66% vs. 73%), and strained voice (3% vs. 9%) was similar between groups. At 1 year, a slight but significant deterioration in speech intelligibility (p < 0.001) and grade of dysphonia (p = 0.001) were observed only in PD-DBS group compared with baseline. During the follow-up, stuttering (9% vs. 18%) and breathy voice (13% vs. 9%) emerged in PD-DBS and PD-Med, but strained voice (28%) and spastic dysarthria (44%) emerged only in PD-DBS. After the stimulation was stopped, strained voice and spastic dysarthria improved in most patients, while stuttering and breathy voice improved in a minority of patients. These findings indicate that the most common DBS-induced speech and voice disorders are strained voice and spastic dysarthria and that STN-DBS potentially aggravates stuttering and breathy voice. An improved understanding of these types of disorders may help detect speech and voice deteriorations during the early phase and lead to appropriate treatments.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Brain and Mind Research Center, Nagoya University, Showa-ku, Nagoya, 466-8550, Japan
| | - Yasuhiro Tanaka
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Reiko Ohdake
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Makoto Hattori
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuya Kawabata
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Hara
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mizuki Ito
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daisuke Nakatsubo
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Maesawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasukazu Kajita
- Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Gen Sobue
- Brain and Mind Research Center, Nagoya University, Showa-ku, Nagoya, 466-8550, Japan.
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