连续帕金森病患者丘脑底核刺激对言语的影响。
Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease.
机构信息
Sobell Department, Unit of Functional Neurosurgery, UCL Institute of Neurology, Box 146, Queen Square, London, WC1N 3BG, UK.
出版信息
Neurology. 2011 Jan 4;76(1):80-6. doi: 10.1212/WNL.0b013e318203e7d0. Epub 2010 Nov 10.
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.
目的
丘脑底核深部脑刺激（STN-DBS）是治疗晚期帕金森病（PD）的有效方法。在 STN-DBS 之后，言语清晰度可能会恶化，从而限制其有益效果。在这里，我们前瞻性地检查了一系列连续患者在接受 STN-DBS 治疗后的短期和长期言语反应，以确定与言语变化相关的临床和手术因素。
方法
32 例连续患者在手术前、手术后 1 个月、6 个月和 1 年进行评估，在 4 种条件下进行评估，即在药物治疗和药物治疗下进行评估，在刺激和非刺激下进行评估，使用已建立和验证的言语和运动量表。其中 15 例患者随访 3 年。12 例 PD 患者作为对照组，随访 1 年。
结果
在手术组中，与术前相比，在药物治疗和药物治疗下，1 年后言语清晰度分别平均恶化 14.2%±20.15%和 16.9%±21.8%。药物组分别恶化了 3.6%±5.5%和 4.5%±8.8%。手术后有 7 例患者的言语得到改善。在所有任务中，随着刺激的增加，音量显著增加。术前药物治疗时运动评分较低与 1 年后 STN-DBS 对言语的反应更有利相关。左侧 STN 上位于内侧的电极与电极位于核内相比，与言语恶化的风险显著增加相关。在左侧电极的高电压与 1 年后的言语不良结局之间存在很强的关系。
结论
STN-DBS 对言语的影响是多因素的，大多数患者的言语清晰度下降。药物和手术问题都导致 STN-DBS 患者的言语恶化。
证据分类
本研究提供了 III 级证据，表明与基线相比，与接受最佳药物治疗的对照组相比，在所有药物和刺激状态的组合中，STN-DBS 治疗 PD 可导致在 1 个月、6 个月和 1 年时言语清晰度恶化。
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