Aggravated stuttering following subthalamic deep brain stimulation in Parkinson's disease - two cases

Abstract

Stuttering is a speech disorder with disruption of verbal fluency which is occasionally present in patients with Parkinson's disease (PD). Long-term medical management of PD is frequently complicated by fluctuating motor functions and dyskinesias. High-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment of motor fluctuations and is the most common surgical procedure in PD. Here we report the re-occurrence and aggravation of stuttering following STN-DBS in two male patients treated for advanced PD. In both patients the speech fluency improved considerably when the neurostimulator was turned off, indicating that stuttering aggravation was related to neurostimulation of the STN itself, its afferent or efferent projections and/or to structures localized in the immediate proximity. This report supports previous studies demonstrating that lesions of the basal ganglia-thalamocortical motor circuit, including the STN, is involved in the development of stuttering. In advanced PD STN-DBS is generally an effective and safe treatment. However, patients with PD and stuttering should be informed about the risk of aggravated symptoms following surgical therapy.

Incidence of Developmental Speech Dysfluencies in Individuals with Parkinson's Disease

“…Depression and mania also seem to have the same relationship with dopamine concentration and are often associated with slow and rapid speech, respectively [17]. It was also noted that one of the cases in the study by Toft and Dietrichs [12] was a man with emerging stuttering caused by DBS-STN. He had no history of stuttering but reported a history of an abnormally fast speech since childhood.…”

“…In fact, presurgical dysarthria can be aggravated by DBS and dysarthria may emerge as a side effect. Re-occurring and aggravated stuttering has been reported in 2 cases of DBS-STN where speech fluency improved considerably when the stimulator was turned off [10,11,12]. However, unilateral DBS-STN to the language-dominant hemisphere has been reported to improve acquired stuttering associated with PD in a case study [13], and bilateral DBS-STN has recently been reported to improve developmental stuttering in another case study [14].…”

“…One of the treatments of PD is DBS-STN, which has been shown to cause increased dysfluencies in non-stuttering individuals and re-emerging stuttering in individuals with recovered developmental stuttering. Other studies have shown that DBS-STN decreased existing stuttering [10,11,12,13,14]. …”

Aspectos de comunicação oral em pacientes com doença de Parkinson submetidos à Estimulação Cerebral Profunda

“…Regarding fluency, a study of two cases evaluated the speech fluency in the DBS at the 'on' and 'off' moments and concluded that the speech fluency improved in both patients when the stimulator was turned off, suggesting that DBS may negatively affect speech fluency (20) . Articulation is directly affected by the PD motor symptoms and, therefore, a post-DBS improvement is expected, even though other variables may interfere in these results, such as disease progression and use of dopaminergic medication.…”

Fabrication and initial testing of the μDBS: a novel Deep Brain Stimulation electrode with thousands of individually controllable contacts

“…In DBS for parkinsonism, immediately presenting side effects include paresthesia (Roggendorf et al 2008), eyelid apraxia (Tommasi et al 2012), stuttering (Toft and Dietrichs 2011), and many others. The other category includes side effects that are often psychological in presentation and may take weeks or months to properly diagnose.…”