Verena Risch1, Anja Staiger1, Wolfram Ziegler1, Katharina Ott2, Theresa Schölderle1, Olena Pelykh3, Kai Bötzel4. 1. Clinical Neuropsychology Research Group (EKN), Städtisches Klinikum München GmbH, Klinikum Schwabing (Haus 19, 2. Stock), Kölner Platz 1, 80804 München, Germany(1). 2. Department of Neurology, Ludwig-Maximilians-University Munich, Klinikum Großhadern, Marchioninistrasse 15, 81366 Munich, Germany(2). 3. Department of Orthopedics, Ludwig-Maximilians-University Munich, Klinikum Großhadern, Marchioninistrasse 15, 81366 Munich, Germany(3). 4. Department of Neurology, Ludwig-Maximilians-University Munich, Klinikum Großhadern, Marchioninistrasse 15, 81366 Munich, Germany(2). Electronic address: kboetzel@med.uni-muenchen.de.
Abstract
BACKGROUND: Globus pallidus internus deep brain stimulation (GPi-DBS) can be an effective treatment for primary dystonia. However, speech disorders have previously been reported as a common possible side effect of the treatment. OBJECTIVES: To study possible deterioration of speech after GPi-DBS and describe this in different dimensions. METHODS: Speech was systematically evaluated in 15 patients with predominant torticollis and GPi-DBS. Each patient was tested twice within one day in two stimulation conditions: ON-DBS vs. OFF-DBS. Speech analyses comprised both function-oriented (perceptual scales, acoustic analyses) and communication-related measures (intelligibility, naturalness). A control sample of 15 healthy speakers underwent the same speech assessment. RESULTS: On the group level, patients with dystonia showed mild but significant impairment on the overall dysarthria scale, the intelligibility score, and the naturalness ratings in both stimulation conditions (Mann-Whitney, P < .05). No stimulation-induced deterioration was found. A slight increase in articulation rate was measured in the ON condition. On the single-case level, effects of GPi-DBS on speech were heterogenous. In one patient we observed a deterioration of speech (dysarthria), in a second patient with a history of childhood stuttering we found an aggravation of dysfluency. Impressive benefits could be documented in another patient who also suffered from spasmodic dysphonia. CONCLUSIONS: The study provides evidence that speech impairment is not a necessary side-effect of GPi-DBS in primary dystonia. Both, recurring of stuttering and a worsening of dysarthria may be seen in individual patients. The positive effects of GPi-DBS on the symptoms of spasmodic dysphonia merits further research as DBS is not commonly applied in this population.
BACKGROUND: Globus pallidus internus deep brain stimulation (GPi-DBS) can be an effective treatment for primary dystonia. However, speech disorders have previously been reported as a common possible side effect of the treatment. OBJECTIVES: To study possible deterioration of speech after GPi-DBS and describe this in different dimensions. METHODS: Speech was systematically evaluated in 15 patients with predominant torticollis and GPi-DBS. Each patient was tested twice within one day in two stimulation conditions: ON-DBS vs. OFF-DBS. Speech analyses comprised both function-oriented (perceptual scales, acoustic analyses) and communication-related measures (intelligibility, naturalness). A control sample of 15 healthy speakers underwent the same speech assessment. RESULTS: On the group level, patients with dystonia showed mild but significant impairment on the overall dysarthria scale, the intelligibility score, and the naturalness ratings in both stimulation conditions (Mann-Whitney, P < .05). No stimulation-induced deterioration was found. A slight increase in articulation rate was measured in the ON condition. On the single-case level, effects of GPi-DBS on speech were heterogenous. In one patient we observed a deterioration of speech (dysarthria), in a second patient with a history of childhood stuttering we found an aggravation of dysfluency. Impressive benefits could be documented in another patient who also suffered from spasmodic dysphonia. CONCLUSIONS: The study provides evidence that speech impairment is not a necessary side-effect of GPi-DBS in primary dystonia. Both, recurring of stuttering and a worsening of dysarthria may be seen in individual patients. The positive effects of GPi-DBS on the symptoms of spasmodic dysphonia merits further research as DBS is not commonly applied in this population.
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