Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Parkinsonism Relat Disord. 2019 Sep;66:110-116. doi: 10.1016/j.parkreldis.2019.07.020. Epub 2019 Jul 16.
Speech disorders, including stuttering and hypophonia, have been reported in patients with Parkinson's disease (PD) after subthalamic deep brain stimulation (STN-DBS).
To evaluate the effect of stimulation frequency or electrode contact location on speech disorders in PD patients with STN-DBS.
In this case-controlled study, we enrolled 50 PD patients with, and 100 PD patients without STN-DBS to compare their vocal intensities, measured by a sound pressure meter, and perceptual speech ratings, obtained from the speech sections of the United Parkinson's Disease Rating Scale (UPDRS) and subjective ratings regarding the impediment of functional communication by stuttering. For patients with STN-DBS, comparisons were made between high-frequency (HFS; 130 Hz), low-frequency (LFS; 80 Hz), and off-stimulation. We also evaluated the effect of electrode contact locations on speech function.
Patients with STN-DBS had decreased vocal intensities and UPDRS scores compared to those without (p < 0.05). Vocal intensity was significantly lower during HFS than during LFS and off-stimulation (both, p < 0.05). Stuttering impeded STN-DBS patients' communication to greater extent than for those without (p < 0.001). Vocal intensity was lower when active contacts were in the dorsal zone compared to those in the ventral zone (p < 0.05). Only STN-DBS treatment was a predictive factor for low vocal intensity (OR = 9.53, p = 0.04).
High-frequency STN-DBS with dorsal zone contacts can aggravate certain speech problems in PD patients. Therefore, it is important to balance between motor control and speech impairments in these patients.
深部脑刺激术（DBS）治疗丘脑底核（STN）后，帕金森病（PD）患者可能出现言语障碍，包括口吃和发声障碍。
评估 STN-DBS 治疗 PD 患者的刺激频率或电极接触位置对言语障碍的影响。
本病例对照研究纳入了 50 例 PD 伴 STN-DBS 患者和 100 例 PD 不伴 STN-DBS 患者，通过声压计比较两组患者的语音强度，并采用帕金森病评定量表（UPDRS）中的言语部分和口吃引起的功能性交流障碍的主观评分评估两组患者的言语感知评分。对于接受 STN-DBS 治疗的患者，比较高频刺激（HFS；130 Hz）、低频刺激（LFS；80 Hz）和关闭刺激时的语音强度。我们还评估了电极接触位置对言语功能的影响。
与不伴 STN-DBS 的患者相比，伴 STN-DBS 的患者的语音强度和 UPDRS 评分降低（p<0.05）。与 LFS 和关闭刺激相比，HFS 时患者的语音强度明显更低（均 p<0.05）。与不伴 STN-DBS 的患者相比，口吃更严重地阻碍了 STN-DBS 患者的交流（p<0.001）。与腹侧区相比，活跃接触位于背侧区时语音强度更低（p<0.05）。只有 STN-DBS 治疗是语音强度降低的预测因素（OR=9.53，p=0.04）。
与腹侧区相比，背侧区接触的高频 STN-DBS 可能会加重 PD 患者的某些言语问题。因此，在这些患者中，平衡运动控制和言语障碍非常重要。
