RT Journal Article
SR Electronic
T1 Distinct phenotypes of speech and voice disorders in Parkinson's disease after subthalamic nucleus deep brain stimulation
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 856
OP 864
DO 10.1136/jnnp-2014-308043
VO 86
IS 8
A1 Takashi Tsuboi
A1 Hirohisa Watanabe
A1 Yasuhiro Tanaka
A1 Reiko Ohdake
A1 Noritaka Yoneyama
A1 Kazuhiro Hara
A1 Ryoichi Nakamura
A1 Hazuki Watanabe
A1 Jo Senda
A1 Naoki Atsuta
A1 Mizuki Ito
A1 Masaaki Hirayama
A1 Masahiko Yamamoto
A1 Yasushi Fujimoto
A1 Yasukazu Kajita
A1 Toshihiko Wakabayashi
A1 Gen Sobue
YR 2015
UL http://jnnp.bmj.com/content/86/8/856.abstract
AB Objectives To elucidate the phenotypes and pathophysiology of speech and voice disorders in Parkinson's disease (PD) with subthalamic nucleus deep brain stimulation (STN-DBS).Methods We conducted a cross-sectional study on 76 PD patients treated with bilateral STN-DBS (PD-DBS) and 33 medically treated PD patients (PD-Med). Speech and voice functions, electrode positions, motor function and cognitive function were comprehensively assessed. Moreover, speech and voice functions were compared between the on-stimulation and off-stimulation conditions in 42 PD-DBS patients.Results Speech and voice disorders in PD-DBS patients were significantly worse than those in PD-Med patients. Factor analysis and subsequent cluster analysis classified PD-DBS patients into five clusters: relatively good speech and voice function type, 25%; stuttering type, 24%; breathy voice type, 16%; strained voice type, 18%; and spastic dysarthria type, 17%. STN-DBS ameliorated voice tremor or low volume; however, it deteriorated the overall speech intelligibility in most patients. Breathy voice did not show significant changes and stuttering exhibited slight improvement after stopping stimulation. In contrast, patients with strained voice type or spastic dysarthria type showed a greater improvement after stopping stimulation. Spastic dysarthria type patients showed speech disorders similar to spastic dysarthria, which is associated with bilateral upper motor neuron involvement. Strained voice type and spastic dysarthria type appeared to be related to current diffusion to the corticobulbar fibres.Conclusions Stuttering and breathy voice can be aggravated by STN-DBS, but are mainly due to aging or PD itself. Strained voice and spastic dysarthria are considered corticobulbar side effects.