Tripoliti Elina, Limousin Patricia, Foltynie Tom, Candelario Joseph, Aviles-Olmos Iciar, Hariz Marwan I, Zrinzo Ludvic
Unit of Functional Neurosurgery, University College London (UCL) Institute of Neurology, London, United Kingdom.
Mov Disord. 2014 Apr;29(4):532-8. doi: 10.1002/mds.25816. Epub 2014 Feb 14.
Speech changes after bilateral subthalamic nucleus deep brain stimulation (STN-DBS) can be variable, with the majority of patients experiencing speech deterioration over time. The aim of this study was to describe the perceptual characteristics of speech following chronic STN-DBS and to analyze clinical and surgical factors that could predict speech change. Fifty-four consecutive patients (34 men; mean age ± standard deviation (SD), 58.8 ± 6.3 years; mean ± SD disease duration, 12.5 ± 4.7 years; mean ± SD levodopa equivalent, 1556 ± 671 mg/day; mean ± SD Unified Parkinson's Disease Rating Scale motor part (UPDRS-III) off-medication score, 48.1 ± 17.9 [range, 20-89]; and mean ± SD UPDRS-III on-medication score, 12.4 ± 7.8 [range, 2-31]) participated in this study. They were assessed before and at 1 year after surgery using the Assessment of Intelligibility for the Dysarthric Speech, the perceptual scale from Darley et al., and the UPDRS-III. Speech intelligibility deteriorated on average by 14.4% (P = 0.0006) after 1 year of STN-DBS when off-medication and by 12.3% (P = 0.001) when on-medication. The effect on speech was not linked to age at surgery, unlike the effect on motor outcome. The most significant predictive factors for deterioration of speech intelligibility when patients were off-medication/on-stimulation were lower preoperative speech intelligibility on-medication, longer disease duration, and medially placed left hemisphere active electrode contact. Speech change after STN-DBS is variable and multifactorial. Consistent preoperative speech evaluation would help inform patients about the possible effects of surgery. Appropriate consideration of speech deficits might assist surgical targeting, particularly of the left electrode.
双侧丘脑底核脑深部电刺激（STN-DBS）后的言语变化可能各不相同，大多数患者的言语功能会随着时间推移而恶化。本研究的目的是描述慢性STN-DBS后言语的感知特征，并分析可预测言语变化的临床和手术因素。连续54例患者（34例男性；平均年龄±标准差[SD]，58.8±6.3岁；平均±SD病程，12.5±4.7年；平均±SD左旋多巴等效剂量，1556±671毫克/天；平均±SD帕金森病统一评分量表运动部分[UPDRS-III]未服药时得分，48.1±17.9[范围，20-89]；平均±SD UPDRS-III服药时得分，12.4±7.8[范围，2-31]）参与了本研究。在手术前和术后1年，使用构音障碍言语清晰度评估、达利等人的感知量表以及UPDRS-III对他们进行评估。STN-DBS治疗1年后，未服药时言语清晰度平均下降14.4%（P = 0.0006），服药时下降12.3%（P = 0.001）。与对运动结果的影响不同，对言语的影响与手术时的年龄无关。当患者未服药/处于刺激状态时，言语清晰度恶化的最显著预测因素是术前服药时较低的言语清晰度、较长的病程以及放置在左侧半球内侧的有源电极触点。STN-DBS后的言语变化是可变的且多因素的。术前进行一致的言语评估将有助于告知患者手术可能产生的影响。适当考虑言语缺陷可能有助于手术靶点的确定，特别是左侧电极的靶点确定。
