Skip to main content Accessibility help
×
Home

Effects of Deep Brain Stimulation of the Subthalamic Nucleus Settings on Voice Quality, Intensity, and Prosody in Parkinson’s Disease: Preliminary Evidence for Speech Optimization

  • Anita Abeyesekera (a1), Scott Adams (a2), Cynthia Mancinelli (a1), Thea Knowles (a1), Greydon Gilmore (a3), Mehdi Delrobaei (a4) and Mandar Jog (a5)...

Abstract:

Objective: To systematically evaluate how different deep brain stimulation of the subthalamic nucleus (STN-DBS) amplitude, frequency, and pulse-width electrical parameter settings impact speech intensity, voice quality, and prosody of speech in Parkinson’s disease (PD). Methods: Ten individuals with PD receiving bilateral STN-DBS treatments were seen for three baseline and five treatment visits. The five treatment visits involved an examination of the standard clinical settings as well as manipulation of different combinations of frequency (low, mid, and high), pulse width (low, mid, and high), and voltage (low, mid, and high) of stimulation. Measures of speech intensity, jitter, shimmer, harmonics–noise ratio, semitone standard deviation, and listener ratings of voice quality and prosody were obtained for each STN-DBS manipulation. Results: The combinations of lower frequency, lower pulse width, and higher voltage settings were associated with improved speech outcomes compared to the current standard clinical settings. In addition, decreased total electrical energy delivered to the STN appears to be associated with speech improvements. Conclusions: This study provides preliminary evidence that STN-DBS may be optimized for Parkinson-related problems with voice quality, speech intensity, and prosody of speech.

Les effets de divers réglages de stimulation cérébrale profonde destinée au noyau sous-thalamique sur la qualité de la voix, sur l’intensité de la parole et sur la prosodie de la parole chez des patients atteints de la maladie de Parkinson. Objectif : Évaluer de façon systématique comment différents niveaux de stimulation cérébrale profonde (SCP) du noyau sous-thalamique peuvent avoir un impact sur l’intensité et la prosodie de la parole de patients atteints de la maladie de Parkinson (MP) de même que sur la qualité de leur voix. Pour ce faire, différents réglages de nature électrique ont été envisagés en ce qui a trait à l’amplitude, la fréquence et la durée des impulsions induites. Méthodes : Au total, 10 patients atteints de MP et bénéficiant de traitements de SCP destinés à leur noyau sous-thalamique ont été vus dans le cadre de 3 examens préliminaires et de 5 visites prévoyant un traitement. Ces 5 visites de nature thérapeutique ont sous-tendu un examen des réglages cliniques standards de même qu’une manipulation permettant de combiner, en matière de SCP, diverses fréquences (basses, moyennes, élevées), diverses durées des impulsions (courtes, moyennes, longues) et diverses tensions (basses, moyennes, élevées). Pour chaque intervention de SCP visant le noyau sous-thalamique, nous avons obtenu des mesures portant sur les aspects suivants : intensité, agitation et tremblement de la parole ; rapport harmoniques/bruits ; écart-type d’un demi-ton ; et finalement des notations d’auditeurs en ce qui regarde la qualité de la voix et la prosodie. Résultats : Le fait de combiner des réglages prévoyant des basses fréquences, des durées d’impulsion courtes et des tensions élevées a été associé, en comparaison avec les réglages cliniques standards actuels, à des résultats améliorés en matière de parole. Qui plus est, une diminution totale de l’énergie électrique destinée au noyau sous-thalamique semble aussi être associée à des résultats améliorés en matière de parole. Conclusions : Cette étude contient donc des preuves préliminaires suggérant que la SCP du noyau sous-thalamique pourrait être optimisée pour traiter des problèmes de qualité de la voix, mais également d’intensité et de prosodie de la parole, qui sont relatifs à la MP.

Copyright

Corresponding author

Correspondence to: Anita Abeyesekera, Department of Health and Rehabilitation Sciences, School of Communication Sciences and Disorders, Western University, Elborn College, 1201 Western Road, London, ON, N6G 1H1, Canada. Email: aabeyese@uwo.ca

References

Hide All
1.Duffy, JR. Motor speech disorders: substrates, differential diagnosis, and management, 3rd ed. St. Louis, MO: Elsevier, Mosby; 2013.
2.Tewari, A, Jog, R, Jog, M. The striatum and subthalamic nucleus as independent and collaborative structures in motor control. Front Syst Neurosci. 2016;10:17.10.3389/fnsys.2016.00017
3.Benabid, AL, Chabardes, S, Mitrofanis, J, Pollak, P. Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson’s disease. Lancet Neurol. 2009;8(1):6781.10.1016/S1474-4422(08)70291-6
4.Kern, DS, Kumar, R. Deep brain stimulation. Neurologist. 2007;13(5):237–52.10.1097/NRL.0b013e3181492c48
5.Mazzone, P, Lozano, A, Stanzione, P, et al. Implantation of human pedunculopontine nucleus: a safe and clinically relevant target in Parkinson’s disease. Neuroreport. 2005;16:1877–81.10.1097/01.wnr.0000187629.38010.12
6.Pinto, S, Gentil, M, Krack, P, et al. Changes induced by levodopa and subthalamic nucleus stimulation on Parkinsonian speech. Mov Disord. 2005;20:1507–15.10.1002/mds.20601
7.Moreau, C, Pennel-Ployart, O, Pinto, S, et al. Modulation of dysarthropneumophonia by low-frequency STN DBS in advanced Parkinson’s disease. Mov Disord. 2011;26(4):659–63.10.1002/mds.23538
8.Sidiropoulos, C, Walsh, R, Meaney, C, Poon, YY, Fallis, M, Moro, E. Low-frequency subthalamic nucleus deep brain stimulation for axial symptoms in advanced Parkinson’s disease. J Neurol. 2013;260(9):2306–11.10.1007/s00415-013-6983-2
9.Klostermann, F, Ehlen, F, Vesper, J, et al. Effects of subthalamic deep brain stimulation on dysarthrophonia in Parkinson’s disease. J Neurol Neurosurg Psychiatr. 2008;79:522–9.10.1136/jnnp.2007.123323
10.D’Alatri, L, Paludetti, G, Contarino, MF, Galla, S, Marchese, MR, Bentivoglio, AR. Effects of bilateral subthalamic nucleus stimulation and medication on Parkinsonian speech impairment. J Voice. 2008;22:365–72.
11.Dromey, C, Kumar, R, Lang, A, Lozano, A. An investigation of the effects of subthalamic nucleus stimulation on acoustic measures of voice. Mov Disord. 2000;15:1132–8.10.1002/1531-8257(200011)15:6<1132::AID-MDS1011>3.0.CO;2-O
12.Gentil, M, Pinto, S, Pollak, P,, et al. Effect of bilateral stimulation of the subthalamic nucleus on Parkinsonian dysarthria. Brain Lang. 2003;85:190–6.10.1016/S0093-934X(02)00590-4
13.Goetz, CG, Fahn, S, Martinez-Martin, P, et al. Movement Disorder Society–sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): process, format, and clinimetric testing plan. Mov Disord. 2007;22(1):41–7.
14.Krause, M, Fogel, W, Mayer, P, Kloss, M, Tronnier, V. Chronic inhibition of the subthalamic nucleus in Parkinson’s disease. J Neurol Sci. 2004;219:119–24.10.1016/j.jns.2004.01.004
15.Mate, MA, Cobeta, I, Jiménez-Jiménez, FJ, Figueiras, R. Digital voice analysis in patients with advanced Parkinson’s disease undergoing deep brain stimulation therapy. J Voice. 2012;26:496501.10.1016/j.jvoice.2011.03.006
16.Santens, P, De Letter, M, Van Borsel, J, De Reuck, J, Caemaert, J. Lateralized effects of subthalamic nucleus stimulation on different aspects of speech in Parkinson’s disease. Brain Lang. 2003;87:253–58.10.1016/S0093-934X(03)00142-1
17.Skodda, S, Gronheit, W, Schlegel, U, Sudmeyer, M, Schnitzler, A, Wojtecki, L. Effect of subthalamic stimulation on voice and speech in Parkinson’s disease: for the better or worse? Front Neurol. 2014;4:218.10.3389/fneur.2013.00218
18.Tanaka, Y, Tsuboi, T, Watanabe, H, et al. Voice features of Parkinson’s disease patients with subthalamic nucleus deep brain stimulation. J Neurol. 2015;262:1173–81.10.1007/s00415-015-7681-z
19.Tripoliti, E, Zrinzo, L, Martinez-Torres, I, et al. Effects of contact location and voltage amplitude on speech and movement in bilateral subthalamic nucleus deep brain stimulation. Mov Disord. 2008;23:2377–83.10.1002/mds.22296
20.Valalik, I, Smehak, G, Bognar, L, Csokay, A. Voice acoustic changes during bilateral subthalamic stimulation in patients with Parkinson’s disease. Clin Neurol Neurosurg. 2011;113:188–95.10.1016/j.clineuro.2010.11.002
21.Xie, Y, Zhang, Y, Zheng, Z, et al. Changes in speech characters of patients with Parkinson’s disease after bilateral subthalamic nucleus stimulation. J Voice. 2011; 25:751–8.10.1016/j.jvoice.2010.08.002
22.Isaias, IU, Tagliati, M. Deep brain stimulation programming for movement disorders. In: Tarsy, D, Vitek, JL, Starr, P, Okun, M, editors. Current clinical neurology: deep brain stimulation in neurological and psychiatric disorders. Totowa, NJ: Springer; 2008, pp. 361–97.
23.Groiss, SJ, Wojtecki, L, Südmeyer, M, Schnitzler, A. Deep brain stimulation in Parkinson’s disease. Ther Adv Neurol Disord. 2009;2(6):20–8.
24.Tomlinson, CL, Stowe, R, Patel, S, Rick, C, Gray, R, Clarke, CE. Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord. 2010;25(15):2649–53.10.1002/mds.23429
25.Horn, A, Kühn, A. Lead-DBS: a toolbox for deep brain stimulation electrode localizations and visualizations. NeuroImage. 2014;107:127–35.10.1016/j.neuroimage.2014.12.002
26.Ashburner, J. A fast diffeomorphic image registration algorithm. Neuroimage. 2007;38:95113.10.1016/j.neuroimage.2007.07.007
27.Claire, F, Ranoux, D, Guehl, D, Burbaud, P, Cuny, E. A systematic review of studies on anatomical position of electrode contacts used for chronic subthalamic stimulation in Parkinson’s disease. Acta Neurochirurg. 2013;155:1647–54.
28.Boersma, P, Weenink, D. PRAAT (version 5.0.20) [Software]; 2008. Available at: http://www.fon.hum.uva.nl/praat/.
29.Jech, R, Mueller, K, Urgosik, D, et al. The subthalamic microlesion story in Parkinson’s disease: electrode insertion-related motor improvement with relative cortico-subcortical hypoactivation in fMRI. PLoS ONE. 2012;7(11):e49056.10.1371/journal.pone.0049056
30.Koss, AM, Alterman, RL, Tagliati, M, Shils, JL. Calculating total electrical energy delivered by deep brain stimulation systems. Ann Neurol. 2005;58:168.10.1002/ana.20525
31.di Biase, L, Fasano, A. Low-frequency deep brain stimulation for Parkinson’s disease: great expectation or false hope? Mov Disord. 2016;31:962–7.10.1002/mds.26658
32.Tommasi, G, Krack, P, Fraix, V, et al. Pyramidal tract side effects induced by deep brain stimulation of the subthalamic nucleus. J Neurol Neurosurg Psychiatr. 2008;79:813–19.10.1136/jnnp.2007.117507
33.Fenoy, AJ, McHenry, MA, Schiess, MC. Speech changes induced by deep brain stimulation of the subthalamic nucleus in Parkinson disease: involvement of the dentatorubrothalamic tract. J Neurosurg. 2016;126(6):2017–27.10.3171/2016.5.JNS16243
34.Carpenter, MB. Core text of neuroanatomy. Baltimore: Williams and Wilkins; 1991.
35.Kumar, R, Johnson, L. Managing Parkinson’s disease patients treated with deep brain stimulation. In: Marks, WJ, editor. Deep brain stimulation management. New York: Cambridge University Press; 2011.
36.Moro, E, Esselink, RJA, Xie, J, et al. The impact on Parkinson’s disease of electrical parameter settings in subthalamic nucleus stimulation. Neurology. 2002;59:706713.10.1212/WNL.59.5.706

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed