van Brenk Frits, Stipancic Kaila L, Rohl Andrea H, Corcos Daniel M, Tjaden Kris, Greenlee Jeremy D W
Motor Speech Laboratory, Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, USA.
Department of Neurosurgery, University of Iowa, Iowa City, IA, USA.
IBRO Neurosci Rep. 2024 Feb 3;16:361-367. doi: 10.1016/j.ibneur.2024.01.015. eCollection 2024 Jun.
Deep Brain Stimulation (DBS) in the Subthalamic Nucleus (STN) or the Globus Pallidus Interna (GPI) is well-established as a surgical technique for improving global motor function in patients with idiopathic Parkinson's Disease (PD). Previous research has indicated speech deterioration in more than 30% of patients after STN-DBS implantation, whilst speech outcomes following GPI-DBS have received far less attention. Research comparing speech outcomes for patients with PD receiving STN-DBS and GPI-DBS can inform pre-surgical counseling and assist with clinician and patient decision-making when considering the neural targets selected for DBS-implantation. The aims of this pilot study were (1) to compare perceptual and acoustic speech outcomes for a group of patients with PD receiving bilateral DBS in the STN or the GPI with DBS stimulation both ON and OFF, and (2) examine associations between acoustic and perceptual speech measures and clinical characteristics.
Ten individuals with PD receiving STN-DBS and eight individuals receiving GPI-DBS were audio-recorded reading a passage. Three listeners blinded to neural target and stimulation condition provided perceptual judgments of intelligibility and overall speech severity. Speech acoustic measures were obtained from the recordings. Acoustic and perceptual measures and clinical characteristics were compared for the two neural targets and stimulation conditions.
Intelligibility and speech severity were not significantly different across neural target or stimulation conditions. Generally, acoustic measures were also not statistically different for the two neural targets or stimulation conditions. Acoustic measures reflecting more varied speech prosody were associated with improved intelligibility and lessened severity. Convergent correlations were found between UPDRS-III speech scores and perceptual measures of intelligibility and severity.
This study reports a systematic comparison of perceptual and acoustic speech outcomes following STN-DBS and GPI-DBS. Statistically significant differences in acoustic measures for the two neural targets were small in magnitude and did not yield group differences in perceptual measures. The absence of robust differences in speech outcomes for the two neural targets has implications for pre-surgical counseling. Results provide preliminary support for reliance on considerations other than speech when selecting the target for DBS in patients with PD.
丘脑底核（STN）或苍白球内侧部（GPI）的深部脑刺激（DBS）作为一种改善特发性帕金森病（PD）患者整体运动功能的外科技术已得到广泛认可。先前的研究表明，超过30%的患者在植入STN-DBS后出现言语恶化，而GPI-DBS后的言语结果受到的关注要少得多。比较接受STN-DBS和GPI-DBS的PD患者的言语结果的研究，可以为术前咨询提供参考，并在考虑选择DBS植入的神经靶点时协助临床医生和患者做出决策。这项初步研究的目的是：（1）比较一组接受双侧STN或GPI-DBS且刺激开关均打开的PD患者的言语感知和声学结果；（2）研究声学和感知言语指标与临床特征之间的关联。
对10名接受STN-DBS的PD患者和8名接受GPI-DBS的患者进行朗读文章时的音频录制。3名对神经靶点和刺激状态不知情的听众对可懂度和整体言语严重程度进行感知判断。从录音中获取言语声学指标。比较两个神经靶点和刺激状态下的声学和感知指标以及临床特征。
在神经靶点或刺激状态之间，可懂度和言语严重程度没有显著差异。一般来说，两个神经靶点或刺激状态下的声学指标在统计学上也没有差异。反映更多样化言语韵律的声学指标与更好的可懂度和减轻的严重程度相关。统一帕金森病评定量表第三部分（UPDRS-III）言语评分与可懂度和严重程度的感知指标之间存在趋同相关性。
本研究报告了STN-DBS和GPI-DBS后言语感知和声学结果的系统比较。两个神经靶点的声学指标在统计学上的显著差异幅度较小，并未在感知指标上产生组间差异。两个神经靶点在言语结果上缺乏明显差异对术前咨询有影响。研究结果为PD患者选择DBS靶点时依赖言语以外的因素提供了初步支持。
