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Abstract

Objective:

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.

Methods:

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.

Results:

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.

Conclusion:

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.

Classification of evidence:

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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Supplementary Material

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Information & Authors

Information

Published In

Neurology®
Volume 76Number 1January 4, 2011
Pages: 80-86
PubMed: 21068426

Publication History

Received: December 14, 2009
Accepted: September 3, 2010
Published online: November 10, 2010
Published in print: January 4, 2011

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Disclosure

E. Tripoliti has received research support from Medtronic, Inc. and the Parkinson's Disease Society. Dr. Zrinzo has received funding for travel and speaker honoraria from Medtronic, Inc. and St. Jude Medical and has received research support from Parkinson's Appeal. Dr. Martinez-Torres has received research support from the Fondo de Inversion Sanitaria (FIS), Health Institute Carlos III, Spanish Department of Science and Innovation (FI08/00108), and the Fundacion Caja Madrid. E. Frost reports no disclosures. Dr. Pinto receives research support from Fondation Fyssen (France). Dr. Foltynie has served on a scientific advisory board for Solvay Pharmaceuticals, Inc.; has received funding for travel from Teva Pharmaceutical Industries Ltd.; has received speaker honoraria from Teva Pharmaceutical Industries Ltd., GlaxoSmithKline, and Orion Corporation; and has received research support from the Parkinson's Disease Society and the Brain Research Trust. Dr. Holl has received funding for travel and speaker honoraria from Medtronic, Inc. Dr. Petersen and M. Roughton report no disclosures. Prof. Hariz has received funding for travel and speaker honoraria from Medtronic, Inc. Dr. Limousin served on the editorial board of Movement Disorders.

Authors

Affiliations & Disclosures

E. Tripoliti, MPhil
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.
L. Zrinzo, MD, MSc
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.
I. Martinez-Torres, MD
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.
E. Frost, MSc
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.
S. Pinto, PhD
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.
T. Foltynie, MRCP, PhD
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.
E. Holl, MD
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.
E. Petersen, MD
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.
M. Roughton, MSc
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.
M.I. Hariz, MD, PhD
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.
P. Limousin, MD, PhD
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.

Notes

Address correspondence and reprint requests to Dr. Elina Tripoliti, Unit of Functional Neurosurgery, UCL Institute of Neurology, Box 146, Queen Square, London, WC1N 3BG, UK [email protected]
Study funding: 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.

Author Contributions

Statistical analysis was conducted by Michael Roughton.

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