Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease
Identifieur interne : 000515 ( Pmc/Corpus ); précédent : 000514; suivant : 000516Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease
Auteurs : E. Tripoliti ; L. Zrinzo ; I. Martinez-Torres ; E. Frost ; S. Pinto ; T. Foltynie ; E. Holl ; E. Petersen ; M. Roughton ; M. I. Hariz ; P. LimousinSource :
- Neurology [ 0028-3878 ] ; 2010.
Abstract
Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for advanced Parkinson disease (PD). Following STN-DBS, speech intelligibility can deteriorate, limiting its beneficial effect. Here we prospectively examined the short- and long-term speech response to STN-DBS in a consecutive series of patients to identify clinical and surgical factors associated with speech change.
Thirty-two consecutive patients were assessed before surgery, then 1 month, 6 months, and 1 year after STN-DBS in 4 conditions on- and off-medication with on- and off-stimulation using established and validated speech and movement scales. Fifteen of these patients were followed up for 3 years. A control group of 12 patients with PD were followed up for 1 year.
Within the surgical group, speech intelligibility significantly deteriorated by an average of 14.2% ± 20.15% off-medication and 16.9% ± 21.8% on-medication 1 year after STN-DBS. The medical group deteriorated by 3.6% ± 5.5% and 4.5% ± 8.8%, respectively. Seven patients showed speech amelioration after surgery. Loudness increased significantly in all tasks with stimulation. A less severe preoperative on-medication motor score was associated with a more favorable speech response to STN-DBS after 1 year. Medially located electrodes on the left STN were associated with a significantly higher risk of speech deterioration than electrodes within the nucleus. There was a strong relationship between high voltage in the left electrode and poor speech outcome at 1 year.
The effect of STN-DBS on speech is variable and multifactorial, with most patients exhibiting decline of speech intelligibility. Both medical and surgical issues contribute to deterioration of speech in STN-DBS patients.
This study provides Class III evidence that STN-DBS for PD results in deterioration in speech intelligibility in all combinations of medication and stimulation states at 1 month, 6 months, and 1 year compared to baseline and to control subjects treated with best medical therapy.
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DOI: 10.1212/WNL.0b013e318203e7d0
PubMed: 21068426
PubMed Central: 3262409
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease</title><author><name sortKey="Tripoliti, E" sort="Tripoliti, E" uniqKey="Tripoliti E" first="E." last="Tripoliti">E. Tripoliti</name></author><author><name sortKey="Zrinzo, L" sort="Zrinzo, L" uniqKey="Zrinzo L" first="L." last="Zrinzo">L. Zrinzo</name></author><author><name sortKey="Martinez Torres, I" sort="Martinez Torres, I" uniqKey="Martinez Torres I" first="I." last="Martinez-Torres">I. Martinez-Torres</name></author><author><name sortKey="Frost, E" sort="Frost, E" uniqKey="Frost E" first="E." last="Frost">E. Frost</name></author><author><name sortKey="Pinto, S" sort="Pinto, S" uniqKey="Pinto S" first="S." last="Pinto">S. Pinto</name></author><author><name sortKey="Foltynie, T" sort="Foltynie, T" uniqKey="Foltynie T" first="T." last="Foltynie">T. Foltynie</name></author><author><name sortKey="Holl, E" sort="Holl, E" uniqKey="Holl E" first="E." last="Holl">E. Holl</name></author><author><name sortKey="Petersen, E" sort="Petersen, E" uniqKey="Petersen E" first="E." last="Petersen">E. Petersen</name></author><author><name sortKey="Roughton, M" sort="Roughton, M" uniqKey="Roughton M" first="M." last="Roughton">M. Roughton</name></author><author><name sortKey="Hariz, M I" sort="Hariz, M I" uniqKey="Hariz M" first="M. I." last="Hariz">M. I. Hariz</name></author><author><name sortKey="Limousin, P" sort="Limousin, P" uniqKey="Limousin P" first="P." last="Limousin">P. Limousin</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21068426</idno><idno type="pmc">3262409</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262409</idno><idno type="RBID">PMC:3262409</idno><idno type="doi">10.1212/WNL.0b013e318203e7d0</idno><date when="2010">2010</date><idno type="wicri:Area/Pmc/Corpus">000515</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000515</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease</title><author><name sortKey="Tripoliti, E" sort="Tripoliti, E" uniqKey="Tripoliti E" first="E." last="Tripoliti">E. Tripoliti</name></author><author><name sortKey="Zrinzo, L" sort="Zrinzo, L" uniqKey="Zrinzo L" first="L." last="Zrinzo">L. Zrinzo</name></author><author><name sortKey="Martinez Torres, I" sort="Martinez Torres, I" uniqKey="Martinez Torres I" first="I." last="Martinez-Torres">I. Martinez-Torres</name></author><author><name sortKey="Frost, E" sort="Frost, E" uniqKey="Frost E" first="E." last="Frost">E. Frost</name></author><author><name sortKey="Pinto, S" sort="Pinto, S" uniqKey="Pinto S" first="S." last="Pinto">S. Pinto</name></author><author><name sortKey="Foltynie, T" sort="Foltynie, T" uniqKey="Foltynie T" first="T." last="Foltynie">T. Foltynie</name></author><author><name sortKey="Holl, E" sort="Holl, E" uniqKey="Holl E" first="E." last="Holl">E. Holl</name></author><author><name sortKey="Petersen, E" sort="Petersen, E" uniqKey="Petersen E" first="E." last="Petersen">E. Petersen</name></author><author><name sortKey="Roughton, M" sort="Roughton, M" uniqKey="Roughton M" first="M." last="Roughton">M. Roughton</name></author><author><name sortKey="Hariz, M I" sort="Hariz, M I" uniqKey="Hariz M" first="M. I." last="Hariz">M. I. Hariz</name></author><author><name sortKey="Limousin, P" sort="Limousin, P" uniqKey="Limousin P" first="P." last="Limousin">P. Limousin</name></author></analytic><series><title level="j">Neurology</title><idno type="ISSN">0028-3878</idno><idno type="eISSN">1526-632X</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective:</title><p>Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for advanced Parkinson disease (PD). Following STN-DBS, speech intelligibility can deteriorate, limiting its beneficial effect. Here we prospectively examined the short- and long-term speech response to STN-DBS in a consecutive series of patients to identify clinical and surgical factors associated with speech change.</p></sec><sec><title>Methods:</title><p>Thirty-two consecutive patients were assessed before surgery, then 1 month, 6 months, and 1 year after STN-DBS in 4 conditions on- and off-medication with on- and off-stimulation using established and validated speech and movement scales. Fifteen of these patients were followed up for 3 years. A control group of 12 patients with PD were followed up for 1 year.</p></sec><sec><title>Results:</title><p>Within the surgical group, speech intelligibility significantly deteriorated by an average of 14.2% ± 20.15% off-medication and 16.9% ± 21.8% on-medication 1 year after STN-DBS. The medical group deteriorated by 3.6% ± 5.5% and 4.5% ± 8.8%, respectively. Seven patients showed speech amelioration after surgery. Loudness increased significantly in all tasks with stimulation. A less severe preoperative on-medication motor score was associated with a more favorable speech response to STN-DBS after 1 year. Medially located electrodes on the left STN were associated with a significantly higher risk of speech deterioration than electrodes within the nucleus. There was a strong relationship between high voltage in the left electrode and poor speech outcome at 1 year.</p></sec><sec><title>Conclusion:</title><p>The effect of STN-DBS on speech is variable and multifactorial, with most patients exhibiting decline of speech intelligibility. Both medical and surgical issues contribute to deterioration of speech in STN-DBS patients.</p></sec><sec><title>Classification of evidence:</title><p>This study provides Class III evidence that STN-DBS for PD results in deterioration in speech intelligibility in all combinations of medication and stimulation states at 1 month, 6 months, and 1 year compared to baseline and to control subjects treated with best medical therapy.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Neurology</journal-id><journal-id journal-id-type="hwp">neurology</journal-id><journal-id journal-id-type="publisher-id">neur</journal-id><journal-id journal-id-type="pmc">neurology</journal-id><journal-id journal-id-type="publisher-id">WNL</journal-id><journal-title-group><journal-title>Neurology</journal-title></journal-title-group><issn pub-type="ppub">0028-3878</issn><issn pub-type="epub">1526-632X</issn><publisher><publisher-name>Lippincott Williams & Wilkins</publisher-name><publisher-loc>Hagerstown, MD</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21068426</article-id><article-id pub-id-type="pmc">3262409</article-id><article-id pub-id-type="publisher-id">WNL202074</article-id><article-id pub-id-type="doi">10.1212/WNL.0b013e318203e7d0</article-id><article-categories><subj-group subj-group-type="hwp-journal-coll"><subject>313</subject><subject>165</subject></subj-group><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Tripoliti</surname><given-names>E.</given-names></name><degrees>MPhil</degrees></contrib><contrib contrib-type="author"><name><surname>Zrinzo</surname><given-names>L.</given-names></name><degrees>MD, MSc</degrees></contrib><contrib contrib-type="author"><name><surname>Martinez-Torres</surname><given-names>I.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Frost</surname><given-names>E.</given-names></name><degrees>MSc</degrees></contrib><contrib contrib-type="author"><name><surname>Pinto</surname><given-names>S.</given-names></name><degrees>PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Foltynie</surname><given-names>T.</given-names></name><degrees>MRCP, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Holl</surname><given-names>E.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Petersen</surname><given-names>E.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Roughton</surname><given-names>M.</given-names></name><degrees>MSc</degrees></contrib><contrib contrib-type="author"><name><surname>Hariz</surname><given-names>M.I.</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Limousin</surname><given-names>P.</given-names></name><degrees>MD, PhD</degrees></contrib><aff>From the UCL (E.T., L.Z., E.F., T.F., M.I.H., P.L.), Institute of Neurology, Sobell Department, Unit of Functional Neurosurgery, Queen Square, London, UK; Neurological Department (I.M.-T.), University Hospital La Fe, Valencia, Spain; Laboratoire Parole et Langage (S.P.), CNRS/Aix-Marseille Universite, France; Medical University Graz (E.H.), Austria; Department of Neurosurgery (E.P.), University of Texas Southwestern Medical Center, Dallas; and Cancer Research UK & UCL Cancer Trials Centre (M.R.), UCL, London, UK.</aff></contrib-group><author-notes><corresp>Address correspondence and reprint requests to Dr. Elina Tripoliti, <addr-line>Unit of Functional Neurosurgery, UCL Institute of Neurology, Box 146, Queen Square, London, WC1N 3BG, UK</addr-line><email>e.tripoliti@ion.ucl.ac.uk</email></corresp><fn fn-type="other"><p><italic>Study funding:</italic> Supported by the Parkinson's Disease Society UK (grant 4070), Parkinson's Appeal, Brain Research Trust, Medtronic, and the NIH (R01-NS40902). This work was undertaken at UCLH/UCL, which received a proportion of funding from the UK Department of Health's NIHR Biomedical Research Centres funding scheme.</p></fn></author-notes><pub-date pub-type="ppub"><day>4</day><month>1</month><year>2011</year></pub-date><pub-date pub-type="epub"><day>10</day><month>11</month><year>2010</year></pub-date><pub-date pub-type="pmc-release"><day>4</day><month>1</month><year>2012</year></pub-date><pmc-comment> PMC Release delay is 12 months and 0 days and was based on the
<volume>76</volume><issue>1</issue><fpage>80</fpage><lpage>86</lpage><history><date date-type="received"><day>14</day><month>12</month><year>2009</year></date><date date-type="accepted"><day>3</day><month>9</month><year>2010</year></date></history><permissions><copyright-statement>Copyright © 2010 by AAN Enterprises, Inc.</copyright-statement><copyright-year>2010</copyright-year><copyright-holder>AAN Enterprises, Inc.</copyright-holder></permissions><self-uri xlink:title="pdf" xlink:type="simple" xlink:href="znl00111000080.pdf"></self-uri><abstract><sec><title>Objective:</title><p>Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for advanced Parkinson disease (PD). Following STN-DBS, speech intelligibility can deteriorate, limiting its beneficial effect. Here we prospectively examined the short- and long-term speech response to STN-DBS in a consecutive series of patients to identify clinical and surgical factors associated with speech change.</p></sec><sec><title>Methods:</title><p>Thirty-two consecutive patients were assessed before surgery, then 1 month, 6 months, and 1 year after STN-DBS in 4 conditions on- and off-medication with on- and off-stimulation using established and validated speech and movement scales. Fifteen of these patients were followed up for 3 years. A control group of 12 patients with PD were followed up for 1 year.</p></sec><sec><title>Results:</title><p>Within the surgical group, speech intelligibility significantly deteriorated by an average of 14.2% ± 20.15% off-medication and 16.9% ± 21.8% on-medication 1 year after STN-DBS. The medical group deteriorated by 3.6% ± 5.5% and 4.5% ± 8.8%, respectively. Seven patients showed speech amelioration after surgery. Loudness increased significantly in all tasks with stimulation. A less severe preoperative on-medication motor score was associated with a more favorable speech response to STN-DBS after 1 year. Medially located electrodes on the left STN were associated with a significantly higher risk of speech deterioration than electrodes within the nucleus. There was a strong relationship between high voltage in the left electrode and poor speech outcome at 1 year.</p></sec><sec><title>Conclusion:</title><p>The effect of STN-DBS on speech is variable and multifactorial, with most patients exhibiting decline of speech intelligibility. Both medical and surgical issues contribute to deterioration of speech in STN-DBS patients.</p></sec><sec><title>Classification of evidence:</title><p>This study provides Class III evidence that STN-DBS for PD results in deterioration in speech intelligibility in all combinations of medication and stimulation states at 1 month, 6 months, and 1 year compared to baseline and to control subjects treated with best medical therapy.</p></sec></abstract><custom-meta-group><custom-meta><meta-name>special-property</meta-name><meta-value>pap</meta-value></custom-meta><custom-meta><meta-name>special-property</meta-name><meta-value>triangle</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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