Müller Frank, Nienstedt Julie Cläre, Buhmann Carsten, Hidding Ute, Gulberti Alessandro, Pötter-Nerger Monika, Pflug Christina
Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
J Neural Transm (Vienna). 2025 Mar;132(3):419-429. doi: 10.1007/s00702-024-02860-5. Epub 2024 Nov 28.
Deep brain stimulation can influence the speech and voice quality in Parkinson´s disease (PD). This controlled, randomized, double-blind, cross-over clinical trial was conducted in 15 PD patients with bilateral subthalamic deep brain stimulation (DBS) to compare the effects of STN-DBS with combined subthalamic and nigral stimulation (STN + SNr-DBS) and DBS OFF on speech and voice parameters in PD patients. Speech and voice were analyzed subjectively using questionnaires (voice/pronunciation quality VAS, VHI, SHI) and objectively using audio analysis (maximum phonation time, AVQI, mean F0, intonation, syllable rate, reading time). Both stimulation conditions, STN + SNr-DBS and STN-DBS, revealed heterogeneous effects on speech and voice production with a slight beneficial effect on the voice quality of individual patients compared to DBS OFF, but not in the whole group. Small, but not significant effects were seen only in subjective voice quality on the VAS and intonation (both stimulation conditions compared to DBS OFF). No significant changes of the objective speech parameters during the audio analysis could be observed (both stimulation conditions compared to DBS OFF). There were no significant differences between STN + SNr-DBS and STN-DBS in any speech and voice domain. The beneficial effects on speech and voice production are minor in most patients compared to the motor improvements by DBS. Both STN-DBS and STN + SNr-DBS were safe, with comparable effects between both DBS modes, and represent no contraindications from the perspective of the voice specialist.
深部脑刺激可影响帕金森病（PD）患者的言语和语音质量。这项对照、随机、双盲、交叉临床试验纳入了15例接受双侧丘脑底核深部脑刺激（DBS）的PD患者，以比较丘脑底核刺激（STN-DBS）与丘脑底核和黑质联合刺激（STN + SNr-DBS）以及DBS关闭状态对PD患者言语和语音参数的影响。使用问卷（嗓音/发音质量视觉模拟评分、嗓音障碍指数、言语困难指数）对言语和语音进行主观分析，并使用音频分析（最大发声时间、嗓音质量指数、平均基频、语调、音节率、朗读时间）进行客观分析。与DBS关闭状态相比，STN + SNr-DBS和STN-DBS这两种刺激状态均对言语和语音产生有不同的影响，对个别患者的嗓音质量有轻微有益影响，但对整个组无此影响。仅在主观嗓音质量的视觉模拟评分和语调方面观察到小但不显著的影响（两种刺激状态与DBS关闭状态相比）。在音频分析过程中未观察到客观言语参数有显著变化（两种刺激状态与DBS关闭状态相比）。在任何言语和语音领域，STN + SNr-DBS和STN-DBS之间均无显著差异。与DBS带来的运动改善相比，大多数患者在言语和语音产生方面的有益影响较小。STN-DBS和STN + SNr-DBS均安全，两种DBS模式的效果相当，从嗓音专家的角度来看均无禁忌证。
