Dysarthria and Speech Intelligibility Following Parkinson’s Disease Globus Pallidus Internus Deep Brain Stimulation

Article type: Research Article

Authors: Chiu, Shannon Y.^{a; *} | Tsuboi, Takashi^{a; b} | Hegland, Karen W.^{c; d} | Herndon, Nicole E.^{c; d} | Shukla, Aparna Wagle^a | Patterson, Addie^a | Almeida, Leonardo^a | Foote, Kelly D.^e | Okun, Michael S.^a | Ramirez-Zamora, Adolfo^a

Affiliations: [a] Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA | [b] Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan | [c] UF Health Rehab Center at the Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA | [d] Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA | [e] Department of Neurosurgery, University of Florida, Gainesville, FL, USA

Correspondence: [*] Correspondence to: Shannon Y. Chiu, MD, MSc, Norman Fixel Institute for Neurological Diseases, 3009 SW Williston Rd, Gainesville, FL 32608, USA. Tel.: +1 352 294 5400; Fax: +1 352 627 4295; E-mail: Shannon.Chiu@neurology.ufl.edu.

Abstract: Background:Although earlier studies reported variable speech changes following subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson’s disease (PD) patients, the effects of globus pallidus internus (GPi) DBS on speech performance in PD remain largely unknown. Objective:We aimed to characterize speech changes following PD GPi-DBS. Methods:We retrospectively analyzed clinical and speech outcomes of 25 PD patients treated with bilateral GPi-DBS at a single center. Outcome measures included the Unified Parkinson’s Disease Rating Scale (UPDRS), speech subsystem domains (respiratory, laryngeal, resonance, orofacial, rate, prosody, rhythm, and naturalness), and overall speech intelligibility. Scores at baseline were compared with those at 6 months, 1 year, and the longest clinical follow-up available. Results:In the off-medication state, activities of daily living and motor function based on UPDRS II and III significantly improved postoperatively. We observed unique patterns of speech changes in patients with PD following GPi-DBS in the short- (n = 25) and longer-term (n = 8) follow-up periods. Velopharyngeal (resonance), laryngeal components, and prosody worsened after bilateral GPi-DBS (p < 0.015). Speech intelligibility did not worsen after GPi-DBS in the short-term, but there was a trend to deteriorate at long-term follow-up (e.g., one year and beyond). We observed worsening of hypokinetic dysarthria in individual patients. Also, a minority of patients developed stuttering, spastic dysarthria, or ataxic dysarthria. Conclusion:Bilateral GPi-DBS worsened several modalities of parkinsonian speech without compromising overall speech intelligibility. GPi-DBS can potentially worsen or induce hypokinetic dysarthria, stuttering, spastic dysarthria, or ataxic dysarthria. GPi-DBS may have different and variable effects on speech function when compared to STN-DBS.

Keywords: Parkinson’s disease, globus pallidus, deep brain stimulation, dysarthria, speech intelligibility

DOI: 10.3233/JPD-202246

Journal: Journal of Parkinson's Disease, vol. 10, no. 4, pp. 1493-1502, 2020