Acquired stuttering after pallidal deep brain stimulation for dystonia

Nebel, Adelheid; Reese, René; Deuschl, Günther; Mehdorn, H. M.; Volkmann, Jens

doi:10.1007/s00702-008-0173-x

Cited by 45 publications

(25 citation statements)

References 10 publications

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“…The occurrence of stutteringlike behaviour may be due to involvement of the globus pallidus and primary motor cortex, which represent regions of the brain commonly affected in PSP [26]. In fact, stuttering was reported as a consequence of pallidal deep brain stimulation in patients with dystonia [27] and was widely present in manganese-induced ephedrone parkinsonism associated with toxic and neurodegenerative damage to globus pallidus [12]. In addition, motor planning responsible for control of fluency has recently been suggested to be coded in the left primary motor cortex whereas this speech motor-related asymmetry was missing in stuttering [28].…”

Section: Discussionmentioning

confidence: 99%

Speech disorders reflect differing pathophysiology in Parkinson’s disease, progressive supranuclear palsy and multiple system atrophy

et al. 2015

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Although speech disorder is frequently an early and prominent clinical feature of Parkinson's disease (PD) as well as atypical parkinsonian syndromes (APS) such as progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), there is a lack of objective and quantitative evidence to verify whether any specific speech characteristics allow differentiation between PD, PSP and MSA. Speech samples were acquired from 77 subjects including 15 PD, 12 PSP, 13 MSA and 37 healthy controls. The accurate differential diagnosis of dysarthria subtypes was based on the quantitative acoustic analysis of 16 speech dimensions. Dysarthria was uniformly present in all parkinsonian patients but was more severe in PSP and MSA than in PD. Whilst PD speakers manifested pure hypokinetic dysarthria, ataxic components were more affected in MSA whilst PSP subjects demonstrated severe deficits in hypokinetic and spastic elements of dysarthria. Dysarthria in PSP was dominated by increased dysfluency, decreased slow rate, inappropriate silences, deficits in vowel articulation and harsh voice quality whereas MSA by pitch fluctuations, excess intensity variations, prolonged phonemes, vocal tremor and strained-strangled voice quality. Objective speech measurements were able to discriminate between APS and PD with 95% accuracy and between PSP and MSA with 75% accuracy. Dysarthria severity in APS was related to overall disease severity (r = 0.54, p = 0.006). Dysarthria with various combinations of hypokinetic, spastic and ataxic components reflects differing pathophysiology in PD, PSP and MSA. Thus, motor speech examination may provide useful information in the evaluation of these diseases with similar manifestations.

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Section: Discussionmentioning

confidence: 99%

Speech disorders reflect differing pathophysiology in Parkinson’s disease, progressive supranuclear palsy and multiple system atrophy

et al. 2015

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“…Although the complete pathophysiological mechanism underlying developmental stuttering is still unknown, the key role of disturbed basal ganglia function has been thoroughly discussed (Alm 2004;Giraud et al 2008;Watkins et al 2008). Further support for involvement of the basal ganglia comes from recent studies (Burghaus et al 2006;Nebel et al 2009;Thiriez et al 2013) of surgical outcomes in patients with Parkinson's disease (PD) and dystonia. Deep brain stimulation of the subthalamic nucleus has been reported to worsen as well as to improve developmental stuttering in patients with PD (Burghaus et al 2006;Thiriez et al 2013), while stimulation of the globus pallidus internus has been shown to induce neurogenic stuttering in patients with dystonia (Nebel et al 2009).…”

Section: Introductionmentioning

confidence: 99%

Effect of dopaminergic medication on speech dysfluency in Parkinson’s disease: a longitudinal study

et al. 2015

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Although speech dysfluencies have been hypothesized to be associated with abnormal function of dopaminergic system, the effects of dopaminergic medication on speech fluency in Parkinson's disease (PD) have not been systematically studied. The aim of the present study was, therefore, to investigate the long-term effect of dopaminergic medication on speech fluency in PD. Fourteen de novo PD patients with no history of developmental stuttering and 14 age- and sex-matched healthy controls (HC) were recruited. PD subjects were examined three times; before the initiation of dopaminergic treatment and twice in following 6 years. The percentage of dysfluent words was calculated from reading passage and monolog. The amount of medication was expressed by cumulative doses of L-dopa equivalent. After 3-6 years of dopaminergic therapy, PD patients exhibited significantly more dysfluent events compared to healthy subjects as well as to their own speech performance before the introduction of dopaminergic therapy (p < 0.05). In addition, we found a strong positive correlation between the increased occurrence of dysfluent words and the total cumulative dose of L-dopa equivalent (r = 0.75, p = 0.002). Our findings indicate an adverse effect of prolonged dopaminergic therapy contributing to the development of stuttering-like dysfluencies in PD. These findings may have important implication in clinical practice, where speech fluency should be taken into account to optimize dopaminergic therapy.

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“…The acute effects of stimulation in this location resemble the effects of STN DBS, but long-term stimulation in this location is different, as positive and negative effects are only transient (unpublished observations). Stuttering has been described as an adverse effect of pallidal neurostimulation in dystonia (Nebel et al, 2009) …”

Section: Intrinsic Adverse Effectsmentioning

confidence: 99%