Baudouin Robin, Lechien Jérôme R, Carpentier Louise, Gurruchaga Jean-Marc, Lisan Quentin, Hans Stéphane
Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Université Paris Saclay), Versailles, France.
Department of Otolaryngology, Elsan Hospital, Paris, France.
Otolaryngol Head Neck Surg. 2023 Mar;168(3):307-318. doi: 10.1177/01945998221120189. Epub 2023 Jan 27.
Deep brain stimulation (DBS) has considerable efficacy for the motor dysfunction of idiopathic Parkinson's disease (PD) on patient quality of life. However, the benefit of DBS on voice and speech quality remains controversial. We carried out a systematic review to understand the influence of DBS on parkinsonian dysphonia and dysarthria.
A PubMed/MEDLINE and Cochrane systematic review was carried out following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Population, Intervention, Comparison, Outcome, Timing, and Setting (PICOTS) statements.
Three investigators screened studies published in the literature from inception to May 2022. The following data were retrieved: age, demographic, sex, disease duration, DBS duration, DBS location, speech, and voice quality measurements.
From the 180 studies identified, 44 publications met the inclusion criteria, accounting for 866 patients. Twenty-nine studies focused on voice/speech quality in subthalamic DBS patients, and 6 included patients with stimulation of pallidal, thalamic, and zona incerta regions. Most studies (4/6) reported a deterioration of the vocal parameters on subjective voice quality evaluation. For speech, the findings were more contrasted. There was an important heterogeneity between studies regarding the voice and speech quality outcomes used to evaluate the impact of DBS on voice/speech quality.
The impact of DBS on voice and speech quality significantly varies between studies. The stimulated anatomical region may have a significant role since the stimulation of the pallidal area was mainly associated with voice quality improvement, in contrast with other regions. Future controlled studies comparing all region stimulation are needed to get reliable findings.
Level III: evidence from evidence summaries developed from systematic reviews.
深部脑刺激（DBS）对特发性帕金森病（PD）患者的运动功能障碍及生活质量有显著疗效。然而，DBS对嗓音和言语质量的益处仍存在争议。我们进行了一项系统评价，以了解DBS对帕金森病性发音障碍和构音障碍的影响。
按照系统评价和Meta分析的首选报告项目（PRISMA）以及人群、干预措施、对照、结局、时间和环境（PICOTS）声明，进行了PubMed/MEDLINE和Cochrane系统评价。
三名研究人员筛选了从开始到2022年5月发表在文献中的研究。检索了以下数据：年龄、人口统计学特征、性别、病程、DBS持续时间、DBS位置、言语和嗓音质量测量。
在确定的180项研究中，44篇出版物符合纳入标准，共866例患者。29项研究关注丘脑底核DBS患者的嗓音/言语质量，6项研究纳入了苍白球、丘脑和未定带区域刺激的患者。大多数研究（4/6）在主观嗓音质量评估中报告了嗓音参数的恶化。对于言语，研究结果的差异更大。在用于评估DBS对嗓音/言语质量影响的嗓音和言语质量结局方面，研究之间存在重要的异质性。
DBS对嗓音和言语质量的影响在不同研究之间差异很大。刺激的解剖区域可能起重要作用，因为与其他区域相比，苍白球区域的刺激主要与嗓音质量改善相关。未来需要进行比较所有区域刺激的对照研究，以获得可靠的结果。
III级：来自系统评价证据总结的证据。
