Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Brain and Mind Research Center, Nagoya University, Showa-ku, Nagoya, 466-8550, Japan.
J Neural Transm (Vienna). 2017 Dec;124(12):1547-1556. doi: 10.1007/s00702-017-1804-x. Epub 2017 Nov 2.
We previously reported that Parkinson's disease (PD) patients treated with subthalamic nucleus deep brain stimulation (STN-DBS) had distinct phenotypes of speech and voice disorders: hypokinetic dysarthria, stuttering, breathy voice, strained voice, and spastic dysarthria. However, changes over time remain unclear. In the present study, 32 consecutive PD patients were assessed before and up to 1 year after surgery (PD-DBS). Eleven medically treated PD patients were also assessed (PD-Med). Speech, voice, motor, and cognitive functions were evaluated. At baseline, the incidence of hypokinetic dysarthria (63% of PD-DBS vs. 82% of PD-Med), stuttering (50% vs. 45%), breathy voice (66% vs. 73%), and strained voice (3% vs. 9%) was similar between groups. At 1 year, a slight but significant deterioration in speech intelligibility (p < 0.001) and grade of dysphonia (p = 0.001) were observed only in PD-DBS group compared with baseline. During the follow-up, stuttering (9% vs. 18%) and breathy voice (13% vs. 9%) emerged in PD-DBS and PD-Med, but strained voice (28%) and spastic dysarthria (44%) emerged only in PD-DBS. After the stimulation was stopped, strained voice and spastic dysarthria improved in most patients, while stuttering and breathy voice improved in a minority of patients. These findings indicate that the most common DBS-induced speech and voice disorders are strained voice and spastic dysarthria and that STN-DBS potentially aggravates stuttering and breathy voice. An improved understanding of these types of disorders may help detect speech and voice deteriorations during the early phase and lead to appropriate treatments.
我们之前报道过，接受丘脑底核深部脑刺激（STN-DBS）治疗的帕金森病（PD）患者存在明显的言语和语音障碍表型：运动徐缓性构音障碍、口吃、气息声、紧张性声音和痉挛性构音障碍。然而，其随时间的变化尚不清楚。在本研究中，我们对 32 例连续的 PD 患者在手术前（PD-DBS）和术后 1 年内（PD-DBS）进行了评估。我们还对 11 例接受药物治疗的 PD 患者（PD-Med）进行了评估。对言语、语音、运动和认知功能进行了评估。在基线时，PD-DBS 组出现运动徐缓性构音障碍（63% vs. PD-Med 组 82%）、口吃（50% vs. PD-Med 组 45%）、气息声（66% vs. PD-Med 组 73%）和紧张性声音（3% vs. PD-Med 组 9%）的发生率与 PD-Med 组相似。在 1 年时，仅在 PD-DBS 组与基线相比，发现言语清晰度（p<0.001）和语音障碍程度（p=0.001）有轻微但显著的恶化。在随访期间，PD-DBS 和 PD-Med 组出现了口吃（9% vs. 18%）和气息声（13% vs. 9%），而 PD-DBS 组仅出现了紧张性声音（28%）和痉挛性构音障碍（44%）。当刺激停止后，大多数患者的紧张性声音和痉挛性构音障碍得到改善，而少数患者的口吃和气息声得到改善。这些发现表明，最常见的 DBS 引起的言语和语音障碍是紧张性声音和痉挛性构音障碍，而 STN-DBS 可能会加重口吃和气息声。对这些类型的障碍的进一步了解可能有助于在早期阶段发现言语和语音的恶化，并导致适当的治疗。
