Differential effects of deep brain stimulation on verbal fluency

Ehlen, Felicitas; Schoenecker, Thomas; Kühn, Andrea A.; Klostermann, Fabian

doi:10.1016/j.bandl.2014.04.002

Cited by 42 publications

(60 citation statements)

References 104 publications

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“…We confirmed the findings of other research groups that VF declines in PD patients who undergo STN‐DBS, compared to PD patients who do not …”

Section: Discussionsupporting

confidence: 91%

“…We confirmed the findings of other research groups that VF declines in PD patients who undergo STN-DBS, compared to PD patients who do not. 3,4,7 VF decline is reportedly the most common type of executive cognitive decline post-DBS. [13][14][15][16] Marshall et al 17 found lower VF at 6 mo in a group of PD patients who underwent STN-DBS, compared to a control group that did not.…”

Section: Discussionmentioning

confidence: 99%

“…The mechanism of the DBS‐induced decline in VF is unclear . Some researchers suggest that it may be owing to a “microlesion” of the brain tissue, produced by the passage of the electrodes during implantation .…”

mentioning

confidence: 99%

“…3 The mechanism of the DBS-induced decline in VF is unclear. 4 Some researchers suggest that it may be owing to a "microlesion" of the brain tissue, produced by the passage of the electrodes during implantation. 5 Worsening fluency was associated with lower perfusion in the left dorsolateral prefrontal cortex, the anterior portion of the cingulate cortex, and the ventral portion of the caudate nucleus.…”

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confidence: 99%

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The Verbal Fluency Decline After Deep Brain Stimulation in Parkinson's Disease: Is There an Influence of Age?

Cozac

Schwarz

Bousleiman

et al. 2015

Movement Disord Clin Pract

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Background DBS is commonly used to treat Parkinson's disease (PD). DBS is not considered to cause major cognitive side effects, but some research groups have reported that it can cause decreased verbal fluency. The influence of age on DBS cognitive outcome is unclear. We investigated the possible influence of patients' age, level of education, disease duration, disease progression, depression, and levodopa equivalent dose (LED) on verbal fluency performance in patients with PD who underwent DBS of the subthalamic nucleus (STN‐DBS). In this article, we investigated the influence of demographic and clinical parameters, especially age, on cognitive performance post‐DBS in PD patients. Methods Forty‐three patients with PD and without major psychiatric illness (according to Diagnostic and Statistical Manual of Mental Disroders, Fourth Edition) were enrolled in the study. Median age was 64.0 years (range, 46–77). In 21 patients, the indication for DBS was established on clinical grounds in keeping with international guidelines; these patients underwent STN‐DBS, and the remaining 22 did not. Cognitive performance in both groups was assessed by standard neuropsychological test batteries at baseline and after median follow‐up of 7 months. Results A statistically significant decline in the semantic category of verbal fluency task was found in the STN‐DBS group (P < 0.01). Linear regression model revealed an influence of age (P < 0.01) and disease duration (P < 0.01) in relation to this decline. Conclusions This study confirms previous findings that verbal fluency declines after STN‐DBS in PD patients in comparison to PD patients without DBS. This decline is related to age and disease duration.

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“…We confirmed the findings of other research groups that VF declines in PD patients who undergo STN‐DBS, compared to PD patients who do not …”

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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The Verbal Fluency Decline After Deep Brain Stimulation in Parkinson's Disease: Is There an Influence of Age?

Cozac

Schwarz

Bousleiman

et al. 2015

Movement Disord Clin Pract

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“…While an involvement of the precentral gyrus and the cerebellar cortex is in close relation to stimulation-induced deterioration of the speech motor system (Astrom et al, 2010;Mahlknecht et al, 2017), consequences of a modulation of prefrontal, parietal, and temporal cortex remain more speculative. However, there might be a relation to auditory and somatosensory feedback mechanisms, located in the posterior end of the planum temporale and the supramarginal gyrus (Tourville et al, 2008;Golfinopoulos et al, 2011;Guenther and Vladusich, 2012), and to executive control, as assessed by verbal fluency, which has been reported to deteriorate under DBS in essential tremor patients (Ehlen et al, 2014;Pedrosa et al, 2014).…”

Section: Modulation Of the Functional Connectome Of Speech Productionmentioning

confidence: 99%

Network fingerprint of stimulation-induced speech impairment in essential tremor

Petry‐Schmelzer

Jergas

Thies

et al. 2020

Preprint

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Word count abstract: 384/400Word count introduction: 440 Word count discussion: 1769Word count text: 4769/6000 Abstract Thalamic deep brain stimulation (DBS) is an effective treatment for patients with medically refractory essential tremor. However, stimulation-induced side-effects, especially stimulationinduced dysarthria (SID), interfere severely with quality of life and postoperative tremor control. Here, we present a functional and structural network approach to SID to gain insights into the associated brain areas and to predict stimulation-induced worsening of intelligibility. Monopolar reviews were conducted in 14 essential tremor patients with bilateral thalamic DBS by increasing the stimulation amplitude contact-wise until (i) a maximum of 10mA, (ii) the occurrence of intolerable side effects, or (iii) the onset of SID. Speech assessments included intelligibility ratings when reading a German standard text and a fast syllable repetition task.To detect brain areas associated with SID, a functional connectivity difference image of volumes of tissue activated (VTAs) causing SID, and VTAs not causing SID was created employing a state-of-the-art functional connectome, Lead-DBS, as well as the SPM toolbox.Additionally, discriminative fibers for stimulation-induced worsening of intelligibility were identified in a structural connectome using linear mixed effect models and validated in a leaveone-out design. A total of 111 contact assessments were included for further analysis. The functional connectivity difference image indicated stronger connectivity of VTAs causing SID (N = 51) to the precentral gyrus with a positive medio-lateral gradient, parts of the inferior and medial frontal gyrus, the supramarginal gyrus, the superior temporal gyrus, as well as the superior and the inferior cerebellar lobules, and the vermis. In the thalamic region, discriminative fibers for stimulation-induced worsening of intelligibility were located anterolaterally to fibers associated with tremor control as published by Al-Fatly et al. (2019). The overlap of the respective clinical stimulation setting's VTAs with these fibers explained 33.2% of the variance of individual change in intelligibility compared to "OFF stimulation" in a leaveone-out design. This study demonstrates that SID in essential tremor patients is related to a modulation of the functional connectome of speech production by thalamic DBS. In spite of the Running head: Networks in DBS-induced dysarthria proximity of functional and structural connectivity patterns for tremor control, as identified by Al-Fatly et al. (2019), and deterioration of speech, as identified in the present study, we were able to derive a fiber-based atlas structure, that could help to avoid SID in essential tremor patients. These findings might contribute to future lead placement and postoperative programming strategies.Keywords: thalamic deep brain stimulation, speech motor system, intelligibility, dysarthria, volume of tissue activated Abbreviations DBS = deep brain stimulation, DDK = diadoc...

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Deep brain stimulation effects on verbal fluency dissociated by target and active contact location

John

Wylie

Dawant

et al. 2021

Ann Clin Transl Neurol

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Objective Deep brain stimulation (DBS) improves motor symptoms in Parkinson’s disease (PD), but it can also disrupt verbal fluency with significant costs to quality of life. The current study investigated how variability of bilateral active electrode coordinates along the superior/inferior, anterior/posterior, and lateral/medial axes in the subthalamic nucleus (STN) or the globus pallidus interna (GPi) contribute to changes in verbal fluency. We predicted that electrode location in the left hemisphere would be linked to changes in fluency, especially in the STN. Methods Forty PD participants treated with bilateral DBS targeting STN (n = 23) or GPi (n = 17) completed verbal fluency testing in their optimally treated state before and after DBS therapy. Normalized atlas coordinates from left and right active electrode positions along superior/inferior, anterior/posterior, and lateral/medial axes were used to predict changes in fluency postoperatively, separately for patients with STN and GPi targets. Results Consistent with prior studies, fluency significantly declined pre‐ to postsurgery (in both DBS targets). In STN‐DBS patients, electrode position along the inferior to superior axis in the left STN was a significant predictor of fluency changes; relatively more superior left active electrode was associated with the largest fluency declines in STN. Electrode coordinates in right STN or GPi (left or right) did not predict fluency changes. Interpretation We discuss these findings in light of putative mechanisms and potential clinical impact.

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Differential effects of deep brain stimulation on verbal fluency

Cited by 42 publications

References 104 publications

The Verbal Fluency Decline After Deep Brain Stimulation in Parkinson's Disease: Is There an Influence of Age?

The Verbal Fluency Decline After Deep Brain Stimulation in Parkinson's Disease: Is There an Influence of Age?

Network fingerprint of stimulation-induced speech impairment in essential tremor

Deep brain stimulation effects on verbal fluency dissociated by target and active contact location

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