How Does GPi-DBS Affect Speech in Primary Dystonia?
How Does GPi-DBS Affect Speech in Primary Dystonia?
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DOI：
10.1016/j.brs.2015.04.009
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发表时间：
2015-09-01
影响因子：
7.7
通讯作者：
Boetzel, Kai
中科院分区：
文献类型：
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作者：
Risch, Verena;Staiger, Anja;Boetzel, Kai
背景：苍白球脑深部电刺激（GPi-DBS）是治疗原发性肌张力障碍的有效方法。然而，言语障碍以前曾被报道为一个共同的可能的副作用的treatment.Objectives：要研究可能恶化的讲话后GPi-DBS和描述这在不同dimensions.Methods：语音进行了系统的评价，在15例患者的主要斜颈和GPi-DBS。在两种刺激条件下，每例患者在一天内接受两次测试：ON-DBS与OFF-DBS。语音分析包括面向功能（感知尺度，声学分析）和通信相关的措施（可理解性，自然）。15个健康的扬声器进行了相同的语音assessment.Results：在组的水平上，肌张力障碍患者表现出轻微的，但显着的损害的整体构音障碍规模，清晰度评分，和自然度评级在两种刺激条件下（曼惠特尼，P <0.05）。没有发现刺激引起的恶化。在ON条件下测得的清晰度略有增加。在单个病例水平上，GPi-DBS对语音的影响是异质的。在一名患者中，我们观察到言语恶化（构音障碍），在第二名有儿童口吃史的患者中，我们发现流利性障碍加重。令人印象深刻的好处可以记录在另一个病人谁也患有痉挛性dysphonia.Conclusions：这项研究提供的证据表明，言语障碍是不是一个必要的副作用GPi-DBS在原发性肌张力障碍。口吃的复发和构音障碍的恶化都可以在个别患者中看到。GPi-DBS对痉挛性发声障碍症状的积极影响值得进一步研究，因为DBS在该人群中并不常见。(C)2015 Elsevier Inc. All rights reserved.
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. (C) 2015 Elsevier Inc. All rights reserved.