Additional evidence for a therapeutic effect of dextromethorphan/quinidine on bulbar motor function in patients with amyotrophic lateral sclerosis: A quantitative speech analysis
Additional evidence for a therapeutic effect of dextromethorphan/quinidine on bulbar motor function in patients with amyotrophic lateral sclerosis: A quantitative speech analysis
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DOI：
10.1111/bcp.13745
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发表时间：
2018-12-01
影响因子：
3.4
通讯作者：
Smith, Richard A.
中科院分区：
文献类型：
--
作者：
Green, Jordan R.;Allison, Kristen M.;Smith, Richard A.
方法最近一项为期70天的双盲安慰剂对照交叉试验表明，右美沙芬和奎尼丁（DM/Q）的固定组合可改善大多数肌萎缩性侧索硬化症患者的语言和吞咽功能。在这项研究中，研究人员使用基于计算机的语言分析和专家临床医生对语言障碍总体严重程度的评分，对一部分参与者进行了重新评估，其中许多人在DM/Q上没有实质性的改善。每隔大约30天进行四次访问，记录10名患者的语音样本。这些录音是通过基于语音停顿模式的自动计算机分析来分析的。语言障碍的严重程度由三名经验丰富的语言病理学家使用直接幅度估计来评定。在每次访问时，获得患者报告和临床管理的球运动受累量表的分数。结论DM/Q对几个客观言语测量的影响被检测到，包括总停顿时间(s) (Cohen’s d = 0.73, 95%可信区间(CI) -1.70, 0.24)，停顿时间（%）（d = 0.77, 95% CI -1.75, 0.21）和平均言语事件持续时间（d = 0.52, 95% CI -0.44, 1.47），但对临床医生的言语评分或自我报告或临床医生管理量表的言语成分没有影响。这些发现表明，当使用敏感和客观的测量方法进行评估时，即使患者在DM/Q上有适度的改善，也可能会经历可量化的语言改善。这项研究为DM/Q对一个或多个控制球运动功能和语言产生的神经系统的积极影响提供了额外的证据。
Aims Methods A recent double-blind placebo-controlled crossover 70-day trial demonstrated that a fixed combination of dextromethorphan and quinidine (DM/Q) improves speech and swallowing function in most patients with amyotrophic lateral sclerosis. In this study, a subset of participants, many of whom did not substantially improve while on DM/Q, were re-evaluated using computer-based speech analyses and expert clinician ratings of the overall severity of speech impairment. Speech samples were recorded from the subset of 10 patients at four visits made at approximately 30-day intervals. The recordings were analysed by automated computer-based analysis of speech pausing patterns. Severity of speech impairment was rated by three experienced speech-language pathologists using direct magnitude estimation. Scores on patient-reported and clinician-administered scales of bulbar motor involvement were obtained at each visit. Results Conclusions The effects of DM/Q were detected on several of the objective speech measures, including total pause duration (s) (Cohen's d = 0.73, 95% confidence interval (CI) -1.70, 0.24), pause time (%) (d = 0.77, 95% CI -1.75, 0.21), and mean speech event duration (s) (d = 0.52, 95% CI -0.44, 1.47), but not on clinician ratings of speech or the speech components of the self-report or clinician-administered scales. These findings suggest that even patients with modest improvement while on DM/Q may experience quantifiable improvements in speech when assessed using sensitive and objective measures. This study provides additional evidence of the positive impact of DM/Q on one or more of the neural systems that control bulbar motor function and production of speech.