Motor speech effects in subthalamic deep brain stimulation for Parkinson’s disease

Karen J. Kluin MS, CCC, BC-ANCDS1,2, James M. Mossner MD, MS3, Joseph T. Costello BS4, Kelvin L. Chou MD2, and Parag G. Patil MD, PhD2,3,5
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  • 1 Departments of Speech-Language Pathology,
  • | 2 Neurology,
  • | 3 Neurosurgery,
  • | 4 Electrical Engineering, and
  • | 5 Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
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OBJECTIVE

A motor speech disorder or dysarthria commonly arises in patients with Parkinson’s disease (PD). The impact of subthalamic nucleus (STN) deep brain stimulation (DBS) on motor speech and the potential of intraoperative motor speech testing to predict outcomes are unknown. This study examined 1) the types and prevalence of motor speech changes observed with STN DBS and their relation to the preoperative condition, 2) the ability of intraoperative testing to predict postoperative changes in motor speech, and 3) the spatial relationship between stimulation sites producing maximal motor improvement, as measured by the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), and maximal motor speech deterioration.

METHODS

Comprehensive preoperative, intraoperative, and postoperative motor speech/dysarthria evaluations were performed in consecutive patients with advanced idiopathic PD who underwent STN DBS surgery in the period from 2011 to 2016. Preoperative type of dysarthria and overall dysarthria severity rating along with intraoperative motor speech testing results were evaluated as predictors of postoperative change. Atlas-independent, fully individualized field modeling was used to identify stimulation sites associated with maximal MDS-UPDRS motor improvement and motor speech deterioration.

RESULTS

Forty-three patients with PD treated with STN DBS were prospectively studied. Improved MDS-UPDRS motor scores and worsened dysarthria were demonstrated by a subset of patients (16/43). Preoperative dysarthria characteristics did not predict postoperative deterioration. Intraoperative assessment of motor speech strongly predicted postoperative outcomes (OR 4.4, p = 0.02). Sites of maximal MDS-UPDRS motor improvement and worsened dysarthria were distinct. Worsened dysarthria was associated with capsular stimulation, anterior and ventral to the site of maximal MDS-UPDRS motor improvement.

CONCLUSIONS

The predictive reliability of intraoperative motor speech testing, together with the identification of distinct stimulation sites for motor speech impairment and improved MDS-UPDRS motor function, raise the possibility that DBS lead repositioning or reprogramming could reduce adverse effects on motor speech without impacting MDS-UPDRS motor outcomes in patients undergoing STN DBS.

ABBREVIATIONS

BDAE = Boston Diagnostic Aphasia Examination; DBS = deep brain stimulation; DR = dysarthria rating; MDS-UPDRS = Movement Disorder Society Unified Parkinson’s Disease Rating Scale; MDS-UPDRSIII = MDS-UPDRS Part III; PD = Parkinson’s disease; STN = subthalamic nucleus.

Supplementary Materials

    • Supplementary Table 1 (PDF 388 KB)

Schematics of transseptal interforniceal resection of a superiorly recessed colloid cyst. ©Mark Souweidane, published with permission. See the article by Tosi et al. (pp 813–819).

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