Long-term effects of subthalamic nucleus deep brain stimulation on speech in Parkinson's disease.

Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment in advanced Parkinson's Disease (PD). However, the effects of STN-DBS on speech are still debated, particularly in the long-term follow-up. The objective of this study was to evaluate the long-term effects of bilateral STN-DBS on speech in a cohort of advanced PD patients treated with bilateral STN-DBS. Each patient was assessed before surgery through a neurological evaluation and a perceptual-acoustic analysis of speech and re-assessed in the long-term in different stimulation and drug conditions. The primary outcome was the percentage change of speech intelligibility obtained by comparing the postoperative on-stimulation/off-medication condition with the preoperative off-medication condition. Twenty-five PD patients treated with bilateral STN-DBS with a 5-year follow-up were included. In the long-term, speech intelligibility stayed at the same level as preoperative values when compared with preoperative values. STN-DBS induced a significant acute improvement of speech intelligibility (p < 0.005) in the postoperative assessment when compared to the on-stimulation/off-medication and off-stimulation/off-medication conditions. These results highlight that STN-DBS may handle speech intelligibility even in the long-term.

Gessani A ，Cavallieri F ，Fioravanti V ，Campanini I ，Merlo A ，Di Rauso G ，Damiano B ，Scaltriti S ，Bardi E ，Corni MG ，Antonelli F ，Cavalleri F ，Molinari MA ，Contardi S ，Menozzi E ，Fraternali A ，Versari A ，Biagini G ，Fraix V ，Pinto S ，Moro E ，Budriesi C ，Valzania F ... -  《Scientific Reports》

Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease.

Tripoliti E ，Zrinzo L ，Martinez-Torres I ，Frost E ，Pinto S ，Foltynie T ，Holl E ，Petersen E ，Roughton M ，Hariz MI ，Limousin P ... -  《-》

Articulation Features of Parkinson's Disease Patients with Subthalamic Nucleus Deep Brain Stimulation.

Tanaka Y ，Tsuboi T ，Watanabe H ，Kajita Y ，Nakatsubo D ，Fujimoto Y ，Ohdake R ，Ito M ，Atsuta N ，Yamamoto M ，Wakabayashi T ，Katsuno M ，Sobue G ... -  《-》

Results of a Randomized Clinical Trial of Speech After Early Neurostimulation in Parkinson's Disease.

The EARLYSTIM trial demonstrated for Parkinson's disease patients with early motor complications that deep brain stimulation of the subthalamic nucleus (STN-DBS) and best medical treatment (BMT) was superior to BMT alone. This prospective, ancillary study on EARLYSTIM compared changes in blinded speech intelligibility assessment between STN-DBS and BMT over 2 years, and secondary outcomes included non-speech oral movements (maximum phonation time [MPT], oral diadochokinesis), physician- and patient-reported assessments. STN-DBS (n = 102) and BMT (n = 99) groups underwent assessments on/off medication at baseline and 24 months (in four conditions: on/off medication, ON/OFF stimulation-for STN-DBS). Words and sentences were randomly presented to blinded listeners, and speech intelligibility rate was measured. Statistical analyses compared changes between the STN-DBS and BMT groups from baseline to 24 months. Over the 2-year period, changes in speech intelligibility and MPT, as well as patient-reported outcomes, were not different between groups, either off or on medication or OFF or ON stimulation, but most outcomes showed a nonsignificant trend toward worsening in both groups. Change in oral diadochokinesis was significantly different between STN-DBS and BMT groups, on medication and OFF STN-DBS, with patients in the STN-DBS group performing slightly worse than patients under BMT only. A signal for clinical worsening with STN-DBS was found for the individual speech item of the Unified Parkinson's Disease Rating Scale, Part III. At this early stage of the patients' disease, STN-DBS did not result in a consistent deterioration in blinded speech intelligibility assessment and patient-reported communication, as observed in studies of advanced Parkinson's Disease. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Pinto S ，Nebel A ，Rau J ，Espesser R ，Maillochon P ，Niebuhr O ，Krack P ，Witjas T ，Ghio A ，Cuartero MC ，Timmermann L ，Schnitzler A ，Hesekamp H ，Meier N ，Müllner J ，Hälbig TD ，Möller B ，Paschen S ，Paschen L ，Volkmann J ，Barbe MT ，Fink GR ，Becker J ，Reker P ，Kühn AA ，Schneider GH ，Fraix V ，Seigneuret E ，Kistner A ，Rascol O ，Brefel-Courbon C ，Ory-Magne F ，Hartmann CJ ，Wojtecki L ，Fradet A ，Maltête D ，Damier P ，Le Dily S ，Sixel-Döring F ，Benecke P ，Weiss D ，Wächter T ，Pinsker MO ，Régis J ，Thobois S ，Polo G ，Houeto JL ，Hartmann A ，Knudsen K ，Vidailhet M ，Schüpbach M ，Deuschl G ，EARLYSTIM Study Group ... -  《-》

Predictive factors of speech intelligibility following subthalamic nucleus stimulation in consecutive patients with Parkinson's disease.

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. Fifty-four consecutive patients (34 men; mean age ± standard deviation (SD), 58.8 ± 6.3 years; mean ± SD disease duration, 12.5 ± 4.7 years; mean ± SD levodopa equivalent, 1556 ± 671 mg/day; mean ± SD Unified Parkinson's Disease Rating Scale motor part (UPDRS-III) off-medication score, 48.1 ± 17.9 [range, 20-89]; and mean ± SD UPDRS-III on-medication score, 12.4 ± 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 = 0.0006) after 1 year of STN-DBS when off-medication and by 12.3% (P = 0.001) when on-medication. The effect on speech was not linked to age at surgery, unlike the effect on motor outcome. The most significant predictive factors for deterioration of speech intelligibility when patients were off-medication/on-stimulation were lower preoperative speech intelligibility on-medication, longer disease duration, and medially placed left hemisphere active electrode contact. Speech change after STN-DBS is variable and multifactorial. Consistent preoperative speech evaluation would help inform patients about the possible effects of surgery. Appropriate consideration of speech deficits might assist surgical targeting, particularly of the left electrode.

Tripoliti E ，Limousin P ，Foltynie T ，Candelario J ，Aviles-Olmos I ，Hariz MI ，Zrinzo L ... -  《-》