Predictive factors of speech intelligibility following subthalamic nucleus stimulation in consecutive patients with Parkinson's disease
Elina TripolitiPatricia LimousinThomas FoltynieJoseph CandelarioIcíar Avilés-OlmosMarwan HarizLudvic Zrinzo
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ABSTRACT 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. © 2014 International Parkinson and Movement Disorder SocietyKeywords:
Subthalamic Nucleus
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Intelligibility (philosophy)
Deep brain stimulation (DBS) of the Subthalamic Nucleus (STN) is widely used in advanced stages of Parkinson's disease(PD) and has proven to be an effective treatment of the various motor symptoms. The therapy involves implanting a lead consisting of multiple electrodes in the STN through which continues high frequency electric pulses are delivered. The clinical outcome highly depends on the location of the electrodes within the STN. However, despite careful planning
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Deep brain stimulation (DBS) represents a major advance in the treatment of Parkinson’s disease (PD). As more neurosurgeons enter this field, technical descriptions of implantation techniques are needed. Here we present our technical approach to subthalamic nucleus (STN) and globus pallidus internus (GPi) DBS implantation, based on 180 STN implants and 75 GPi implants. The essential steps in DBS implantation are magnetic resonance imaging (MRI)-guided stereotactic localization, confirmation of the motor territory of the target nucleus with microelectrode mapping, and intra-operative test stimulation to determine voltage thresholds for stimulation-induced adverse effects. Lead locations are documented by postoperative MRI in all cases.
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Abstract Deep brain stimulation of the subthalamic nucleus is an effective treatment for the motor symptoms of Parkinson's disease. Although a range of psychiatric and behavioral problems have been documented following deep brain stimulation, the short‐term effects of subthalamic nucleus stimulation on patients' mood have only been investigated in a few studies. Our aim was to compare self‐reported mood in Parkinson's patients with deep brain stimulation of the subthalamic nucleus ON versus OFF. Twenty‐three Parkinson's patients with bilateral deep brain stimulation of the subthalamic nucleus and 11 unoperated Parkinson's patients completed a mood visual analogue scale twice. Operated patients were tested with deep brain stimulation of the subthalamic nucleus both ON and OFF. All were assessed on medication. The operated Parkinson's group reported feeling significantly better coordinated, stronger, and more contented with deep brain stimulation ON compared to OFF. Fourteen of the 16 mood scales changed in a positive direction when deep brain stimulation of the subthalamic nucleus was ON. When changes in motor scores were taken into account, the operated patients still reported feeling better‐coordinated, but also less gregarious with stimulation ON. Unoperated Parkinson's patients showed no differences on any of these measures between their 2 ratings. Short‐term changes in deep brain stimulation of the subthalamic nucleus have a small and mostly positive effect on mood, which may be partly related to improvements in motor symptoms. The implications for day‐to‐day management of patients with deep brain stimulation of the subthalamic nucleus are discussed. © 2012 Movement Disorder Society
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S. H. Wong*a, P. R. Eldridgeb, A. Duffya, S. H. Fox*c, T. R. K. Varmab & N. A. Fletcheraa Departments of Neurology1b Neurosurgery2, The Walton Centre, Liverpool, UKc Movement Disorders Clinic, University of Toronto, Toronto Western Hospital, Ontario, Canada
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The current popularity and widespread acceptance of deep brain stimulation (DBS) for Parkinson's disease (PD) began in the early 1990s after publications from teams in Grenoble and Lille introduced the concept of DBS to ameliorate abnormal movements without destroying tissue. The most common targets for DBS in PD are the ventral intermediate nucleus (Vim), globus pallidus internus (GPi), and subthalamic nucleus (STN). Currently, DBS of the STN is the most common surgical procedure for PD. This chapter highlights this operation and discusses (i) the rationale for neurostimulation of the STN, (ii) referral criteria to select the ideal patient, (iii) outcome, (iv) stimulation parameters, and (v) potential side effects and complications.
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