Effects of subthalamic deep brain stimulation on dysarthrophonia in Parkinson’s disease

¹ Charité - University Medicine Berlin, Department of Neurology, Germany
² University Clinic of Freiburg, Department of Stereotactic Neurosurgery, Germany
³ Charité - University Medicine Berlin, Deparment of Audiology and Phoniatrics, Germany

^* To whom correspondence should be addressed. E-mail: fabian.klostermann{at}charite.de.

Accepted 13 August 2007

	Abstract

Background: Motor deficits in Parkinson’s disease (PD) are reduced by Deep Brain Stimulation (DBS) of the subthalamic nucleus (STN), but the impact of this therapy on dysarthrophonic problems in PD remains controversial. We, therefore, aimed at disentangling the effects of STN DBS on the speech skills of long-term treated patients.

Methods: Under continued medication, speech and motor functions of 19 PD patients with bilateral STN DBS were studied when their therapeutic stimulation was active (STIM-ON) versus switched off (STIM-OFF). Per condition, perceptual speech ratings were given by (i) the patients themselves, (ii) the treating physician and (iii) professional speech therapists. Further, single speech parameters were measured with a battery of technical exams in both STIM-ON and STIM-OFF.

Results: STN DBS significantly worsened speech performance according to all perceptual rating methods applied. Contrarily, technical measures showed DBS-induced improvements of single speech dimensions affected by the PD-specific motor disorder. These changes occurred independently of the reduction of motor impairment, consistently effectuated by STN DBS.

Conclusion: In parallel to the beneficial effects of STN DBS on the motor symptoms of PD, it reduces designated disease-inherent dysarthrophonic symptoms, such as glottic tremor. However, these actions on speech are predominantly outweighed by general dysarthrogenic effects of STN DBS, probably based on a decline of complex, e.g., prosodic functions. Thus, on condition of the reduced antiparkinsonian medication under DBS STN, stimulation-induced speech impairment should be considered a likely problem in the course of the treatment.

Keywords: Deep Brain Stimulation, Dysarthrophonia, Parkinson's disease, STN