Effect of Low versus High Frequency Subthalamic Deep Brain Stimulation on Speech Intelligibility and Verbal Fluency in Parkinson’s Disease: A Double-Blind Study (original) (raw)
Related papers
2019
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become an effective and widely used tool in the treatment of Parkinson’s disease (PD). STN-DBS has varied effects on speech. Clinical speech ratings suggest worsening following STN-DBS, but quantitative intelligibility, perceptual, and acoustic studies have produced mixed and inconsistent results. Improvements in phonation and declines in articulation have frequently been reported during different speech tasks under different stimulation conditions. Questions remain about preferred STN-DBS stimulation settings. Seven right-handed, native speakers of English with PD treated with bilateral STN-DBS were studied off medication at three stimulation conditions: stimulators off, 60 Hz (low frequency stimulation - LFS), and the typical clinical setting of 185 Hz (High frequency - HFS). Spontaneous speech was recorded in each condition and excerpts were prepared for transcription (intelligibility) and difficulty judgements. Se...
Voice and fluency changes as a function of speech task and deep brain stimulation
2010
Purpose: Speaking, which naturally occurs in different modes or "tasks" such as conversation and repetition, relies on intact basal ganglia nuclei. Recent studies suggest that voice and fluency parameters are differentially affected by speech task. In this study, the authors examine the effects of subcortical functionality on voice and fluency, comparing measures obtained from spontaneous and matched repeated speech samples. Method: Subjects with Parkinson's disease who were being treated with bilateral deep brain stimulation (DBS) of the subthalamic nuclei were tested with stimulators ON and OFF. Results: The study found that a voice measure, harmonic to noise ratio, is improved in repetition and in the DBS-ON condition and that dysfluencies are more plentiful in conversation with little or variable influence of DBS condition. Conclusions: These findings suggest that voice and fluency are differentially affected by DBS treatment and that task conditions, interacting with subcortical functionality, influence motor speech performance.
Movement Disorders, 2014
Speech changes after bilateral subthalamic nucleus deep brain stimulation (STN-DBS) can be variable, with the majority of patients experiencing speech deterioration over time. The aim of this study was to describe the perceptual characteristics of speech following chronic STN-DBS and to analyze clinical and surgical factors that could predict speech change. Fiftyfour consecutive patients (34 men; mean age 6 standard deviation (SD), 58.8 6 6.3 years; mean 6 SD disease duration, 12.5 6 4.7 years; mean 6 SD levodopa equivalent, 1556 6 671 mg/day; mean 6 SD Unified Parkinson's Disease Rating Scale motor part (UPDRS-III) offmedication score, 48.1 6 17.9 [range, 20-89]; and mean 6 SD UPDRS-III on-medication score, 12.4 6 7.8 [range, 2-31]) participated in this study. They were assessed before and at 1 year after surgery using the Assessment of Intelligibility for the Dysarthric Speech, the perceptual scale from Darley et al., and the UPDRS-III. Speech intelligibility deteriorated on average by 14.4% (P 5 0.0006
Long-term effects of subthalamic nucleus deep brain stimulation on speech in Parkinson’s disease
Scientific Reports, 2023
Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment in advanced Parkinson's Disease (PD). However, the effects of STN-DBS on speech are still debated, particularly in the long-term follow-up. The objective of this study was to evaluate the long-term effects of bilateral STN-DBS on speech in a cohort of advanced PD patients treated with bilateral STN-DBS. Each patient was assessed before surgery through a neurological evaluation and a perceptual-acoustic analysis of speech and reassessed in the long-term in different stimulation and drug conditions. The primary outcome was the percentage change of speech intelligibility obtained by comparing the postoperative on-stimulation/off-medication condition with the preoperative off-medication condition. Twentyfive PD patients treated with bilateral STN-DBS with a 5-year follow-up were included. In the longterm, speech intelligibility stayed at the same level as preoperative values when compared with preoperative values. STN-DBS induced a significant acute improvement of speech intelligibility (p < 0.005) in the postoperative assessment when compared to the on-stimulation/off-medication and off-stimulation/off-medication conditions. These results highlight that STN-DBS may handle speech intelligibility even in the long-term. Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) represents a short and long-term effective treatment in advanced Parkinson's Disease (PD) 1,2. However, the long-term effects of bilateral STN-DBS on axial features 3,4 and different speech variables are still debated. After surgery, PD patients may develop heterogeneous profiles of dysarthria related to the possible spreading of current to cerebellothalamic, cortico-bulbar, corticospinal and pallido-fugal levels 5,6. Moreover, it has been previously reported that speech intelligibility may worsen 1 year after surgery when compared with those under a control group under optimal medical treatment 7. The majority of the studies regarding the effects of STN-DBS on speech focused on short-term follow-up 7-11 while few studies have assessed the long-term effects 2,12-14. In particular, a previous study reported a worsening of speech intelligibility at five and eight years after surgery in the off-medication condition 12 , while another acoustic study reported variation of the long-term averaged spectrum (LTAS) descriptors for reading and monologue in different stimulation conditions in the long-term after surgery 14. The objective of this study was to evaluate
Arquivos de Neuro-Psiquiatria, 2017
Subthalamic nucleus deep brain stimulation (STN-DBS) is a surgical technique to treat motor symptoms in patients with Parkinson’s disease (PD). Studies have shown that STN-DBS may cause a decline in verbal fluency performance. We aimed to verify the effects of STN-DBS on the performance of phonemic verbal fluency in Brazilian PD patients. Sixteen participants were evaluated on the Unified Parkinson’s Disease Rating Scale - Part III and for phonemic fluency (“FAS” version) in the conditions of on- and off-stimulation. We identified two different patterns of phonemic verbal fluency outcomes. The results indicate that there may be no expected pattern of effect of bilateral STN-DBS in the phonemic fluency, and patients may present with different outcomes for some reason not well understood.
Speech intelligibility in Parkinson's disease patients with zona incerta deep brain stimulation
Brain and Behavior, 2015
Objectives: To investigate the effects of L-dopa (Levodopa) and cZi-DBS (deep brain stimulation in caudal zona incerta) on spontaneous speech intelligibility in patients with PD (Parkinson's disease). Materials and Methods: Spontaneous utterances were extracted from anechoic recordings from 11 patients with PD preoperatively (off and on L-dopa medication) and 6 and 12 months post bilateral cZi-DBS operation (off and on stimulation, with simultaneous L-dopa medication). Background noise with an amplitude corresponding to a clinical setting was added to the recordings. Intelligibility was assessed through a transcription task performed by 41 listeners in a randomized and blinded procedure. Results: A group-level worsening in spontaneous speech intelligibility was observed on cZi stimulation compared to off 6 months postoperatively (8 adverse, 1 positive, 2 no change). Twelve months postoperatively, adverse effects of cZi-DBS were not frequently observed (2 positive, 3 adverse, 6 no change). L-dopa administered preoperatively as part of the evaluation for DBS operation provided the overall best treatment outcome (1 adverse, 4 positive, 6 no change). Conclusions: cZi-DBS was shown to have smaller negative effects when evaluated from spontaneous speech compared to speech effects reported previously. The previously reported reduction in word-level intelligibility 12 months postoperatively was not transferred to spontaneous speech for most patients. Reduced intelligibility due to cZi stimulation was much more prominent 6 months postoperatively than at 12 months.
eClinicalMedicine, 2020
Background: More than 6,000,000 individuals worldwide are diagnosed with Parkinson's disease (PD). Nearly 90% develop speech signs that may substantially impair their speech intelligibility, resulting in losses in their communication and quality of life. Benefits of intensive speech treatment have been documented for a range of speech signs. However, the critical question of whether speech is more intelligible after treatment has not been investigated in a randomised controlled trial (RCT). We hypothesised that intensive speech treatment would improve speech intelligibility in PD. Method: Sixty-four patients with hypokinetic dysarthria secondary to PD participated in this single-centre, parallel arm, statistically-powered RCT. Reporting follows CONSORT guidelines for non-pharmacological treatment. Patients were recruited from US clinics and randomised using a statistician-derived minimisation algorithm, to intensive speech treatment (16 1-hour sessions/1 month) targeting voice (voice group) or targeting articulation (articulation group) or to an untreated group (no treatment group). Speech treatments were delivered by speech clinicians who specialised in treating patients with PD. Trial design minimised bias and supported equipoise. For intelligibility assessment, blinded listeners (n = 117) orthographically transcribed 57 patients' recorded, self-generated narrative speech samples, randomly presented in multi-talker babble noise. Listeners were American-English speakers, ages 18À35 years, with normal hearing. The primary outcome was baseline (pre-treatment) to post-treatment change in transcription accuracy (TA), recognised as the most objective measure of intelligibility. TA was defined as the percentage of words transcribed correctly. Listeners, data collectors, and data managers were blinded to treatment conditions and groups. Reliability was evaluated using intraclass correlation coefficients and differences amongst groups were evaluated by mixed-effects models, in accordance with the intention-to-treat approach. This trial was registered with ClinicalTrials.gov Identifier: NCT00123084. Findings: Between June 23, 2016 and August 14, 2017, blinded listeners transcribed baseline and post-treatment speech samples for intelligibility assessment of 57 patients in the voice (n = 19), articulation (n = 19) and no treatment (n = 19) groups. Between-group differences (d) in changes from baseline to post-treatment in TA indicated significantly greater increases following treatment targeting voice than treatment targeting articulation (d = 26¢2%, 95% CI 1¢5 À 51¢0; p = 0¢04; ES=1¢0). Differences between TA changes in the treatment targeting voice and in the no treatment group were significant (d = 42¢8%, 95% CI 22¢4 À 63¢2; p = 0¢0002; ES=1¢8). Differences between TA changes in the treatment targeting articulation and in the no treatment group were not significant (d = 16¢5%, 95% CI-6¢1 À 39¢2; p = 0¢147; ES=0¢9).
Journal of Neurolinguistics, 2012
< Hypokinetic dysarthria in Parkinson's disease has reduced intelligibility. < Speech intelligibility measures must control for linguistic variables. < Deep brain treatment (DBS) for Parkinson's disease affects speech in various ways. < Speech task (conversation or repetition) affects speech intelligibility. < Task, DBS ON state, and duration of stimuli affected intelligibility of Parkinsonian speech.
European Journal of Neurology, 2012
Background and purpose: Despite common occurrences of verbal fluency declines following bilateral subthalamic nucleus deep brain stimulation (STN-DBS) for the treatment of Parkinson's disease (PD), alternating fluency measures using cued and uncued paradigms have not been evaluated. Methods: Twenty-three STN-DBS patients were compared with 20 non-surgical (PD) patients on a comprehensive neuropsychological assessment, including cued and uncued intradimensional (phonemic/phonemic and semantic/semantic) and extra-dimensional (phonemic/semantic) alternating fluency measures at baseline and 6-month follow-up. Results: STN-DBS patients demonstrated a greater decline on the cued phonemic/ phonemic fluency and the uncued phonemic/semantic fluency tasks as compared to the PD patients. For STN-DBS patients, verbal learning and information processing speed accounted for a significant proportion of the variance in declines in alternating phonemic/phonemic and phonemic/semantic fluency scores, respectively, whilst only naming was related to uncued phonemic/semantic performance for the PD patients. Both groups were aided by cueing for the extra-dimensional task at baseline and follow-up, and the PD patients were also aided by cueing for the phonemic/phonemic task on follow-up. Conclusions: These findings suggest that changes in alternating fluency are not related to disease progression alone as STN-DBS patients demonstrated greater declines over time than the PD patients, and this change was related to declines in information processing speed.