Effects of contact location and voltage amplitude on speech and movement in bilateral subthalamic nucleus deep brain stimulation.
Identifieur interne : 002338 ( Ncbi/Merge ); précédent : 002337; suivant : 002339Effects of contact location and voltage amplitude on speech and movement in bilateral subthalamic nucleus deep brain stimulation.
Auteurs : Elina Tripoliti [Royaume-Uni] ; Ludvic Zrinzo ; Irene Martinez-Torres ; Stephen Tisch ; Eleanor Frost ; Ellie Borrell ; Marwan I. Hariz ; Patricia LimousinSource :
- Movement disorders : official journal of the Movement Disorder Society [ 1531-8257 ] ; 2008.
English descriptors
- KwdEn :
- Acoustics, Aged, Analysis of Variance, Antibodies, Monoclonal, Biophysical Processes, Deep Brain Stimulation (methods), Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Movement (physiology), Neurologic Examination, Neuropsychological Tests, Parkinson Disease (physiopathology), Parkinson Disease (therapy), Recombinant Fusion Proteins, Severity of Illness Index, Speech (physiology), Subthalamic Nucleus (physiology).
- MESH :
- chemical : Antibodies, Monoclonal, Recombinant Fusion Proteins.
- methods : Deep Brain Stimulation.
- physiology : Movement, Speech, Subthalamic Nucleus.
- physiopathology : Parkinson Disease.
- therapy : Parkinson Disease.
- Acoustics, Aged, Analysis of Variance, Biophysical Processes, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neurologic Examination, Neuropsychological Tests, Severity of Illness Index.
Abstract
Subthalamic nucleus deep brain stimulation (STN-DBS) is particularly effective in improving limb symptoms in Parkinson's disease. However, speech shows a variable response. Contact site and amplitude of stimulation have been suggested as possible factors influencing speech. In this double blind study, we assessed 14 patients post bilateral STN-DBS, without medication. Six conditions were studied in random order as follows: stimulation inside the STN at low voltage (2 V) and at high voltage (4 V); above the STN at 2 V and at 4 V, at usual clinical parameters, and off-stimulation. The site of stimulation was defined on the postoperative stereotactic MRI data. Speech protocol consisted of the assessment of intelligibility of the dysarthric speech, maximum sustained phonation, and a 1-minute monologue. Movement was assessed using the UPDRS-III. Stimulation at 4 V significantly reduced the speech intelligibility (P = 0.004) independently from the site of stimulation. Stimulation at 4 V significantly improved the motor function. Stimulation inside the nucleus was significantly more effective than outside the nucleus (P = 0.0006). The significant improvement in movement coupled with significant deterioration in speech intelligibility when patients are stimulated inside the nucleus at high voltage indicates a critical role for electrical stimulation parameters in speech motor control.
DOI: 10.1002/mds.22296
PubMed: 18785648
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pubmed:18785648Le document en format XML
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<term>Deep Brain Stimulation (methods)</term>
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<term>Humans</term>
<term>Magnetic Resonance Imaging</term>
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<term>Movement (physiology)</term>
<term>Neurologic Examination</term>
<term>Neuropsychological Tests</term>
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<front><div type="abstract" xml:lang="en">Subthalamic nucleus deep brain stimulation (STN-DBS) is particularly effective in improving limb symptoms in Parkinson's disease. However, speech shows a variable response. Contact site and amplitude of stimulation have been suggested as possible factors influencing speech. In this double blind study, we assessed 14 patients post bilateral STN-DBS, without medication. Six conditions were studied in random order as follows: stimulation inside the STN at low voltage (2 V) and at high voltage (4 V); above the STN at 2 V and at 4 V, at usual clinical parameters, and off-stimulation. The site of stimulation was defined on the postoperative stereotactic MRI data. Speech protocol consisted of the assessment of intelligibility of the dysarthric speech, maximum sustained phonation, and a 1-minute monologue. Movement was assessed using the UPDRS-III. Stimulation at 4 V significantly reduced the speech intelligibility (P = 0.004) independently from the site of stimulation. Stimulation at 4 V significantly improved the motor function. Stimulation inside the nucleus was significantly more effective than outside the nucleus (P = 0.0006). The significant improvement in movement coupled with significant deterioration in speech intelligibility when patients are stimulated inside the nucleus at high voltage indicates a critical role for electrical stimulation parameters in speech motor control.</div>
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