K A M Pauls1, P J Bröckelmann2, S Hammesfahr3, J Becker2, A Hellerbach4, V Visser-Vandewalle4, T A Dembek2, I G Meister5, L Timmermann6. 1. Department of Neurology, University Hospital of Cologne, Cologne, Germany. Electronic address: amande.pauls@uk-koeln.de. 2. Department of Neurology, University Hospital of Cologne, Cologne, Germany. 3. Department of Neurology, University Hospital of Cologne, Cologne, Germany; Department for Diagnostic und Interventional Radiology, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany. 4. Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany. 5. Department of Neurology, University Hospital of Cologne, Cologne, Germany; Department of Neurology, Evangelisches Krankenhaus Lippstadt, Lippstadt, Germany. 6. Department of Neurology, University Hospital of Cologne, Cologne, Germany; Department of Neurology, University Hospital of Marburg, Marburg, Germany.
Abstract
BACKGROUND: Pallidal Deep Brain Stimulation (GPi-DBS) is an efficient treatment for primary dystonia. We investigated stimulation-induced dysarthria, which is the most frequent side-effect of GPi-DBS. METHODS: Speech was recorded while reading a standard text, and performing rapid syllable repetitions ON and OFF DBS in ten dystonia patients (6 men; 3 cervical, 4 segmental, 3 generalized, unselected for DBS-related speech impairments). Speech and articulation rate, pauses, and syllable repetition rates were extracted via acoustic analysis. Locations of active stimulation contacts and volumes of tissue activated (VTA) were calculated. RESULTS: The number of pauses increased significantly ON vs. OFF stimulation (Wilcoxon test, p < 0.05). More posteriorly localized active contacts were associated with slower syllable repetition (Pearson correlation, p < 0.05). VTA size did not correlate with any measure of dysarthria. CONCLUSION: Using quantitative acoustic signal analysis, this study demonstrates that GPi-DBS alters motor aspects of speech. Both inadvertent stimulation of parts of the internal capsule, or interference with GPi function and outflow are possible causes. Understanding causes of GPi-DBS-induced speech changes can improve DBS programming.
BACKGROUND: Pallidal Deep Brain Stimulation (GPi-DBS) is an efficient treatment for primary dystonia. We investigated stimulation-induced dysarthria, which is the most frequent side-effect of GPi-DBS. METHODS: Speech was recorded while reading a standard text, and performing rapid syllable repetitions ON and OFF DBS in ten dystoniapatients (6 men; 3 cervical, 4 segmental, 3 generalized, unselected for DBS-related speech impairments). Speech and articulation rate, pauses, and syllable repetition rates were extracted via acoustic analysis. Locations of active stimulation contacts and volumes of tissue activated (VTA) were calculated. RESULTS: The number of pauses increased significantly ON vs. OFF stimulation (Wilcoxon test, p < 0.05). More posteriorly localized active contacts were associated with slower syllable repetition (Pearson correlation, p < 0.05). VTA size did not correlate with any measure of dysarthria. CONCLUSION: Using quantitative acoustic signal analysis, this study demonstrates that GPi-DBS alters motor aspects of speech. Both inadvertent stimulation of parts of the internal capsule, or interference with GPi function and outflow are possible causes. Understanding causes of GPi-DBS-induced speech changes can improve DBS programming.
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