Effect of Bilateral Deep-Brain Stimulation on Oral Control of Patients with Parkinsonism

Gentil, Michèle; Garcı́a-Ruiz, Pedro Antonio; Pollak, Pierre; Benabid, Alim‐Louis

doi:10.1159/000008224

Cited by 44 publications

(30 citation statements)

References 21 publications

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“…In general, the effects of DBS closely parallel previous reports of the effects of dopaminergic medication. 55 In contrast to bilateral Vim DBS, 56 speech and handwriting 57 can be moderately improved in some patients [58][59][60] but not in others. Both rest and action tremors are almost totally abolished.…”

Section: Results Of Stn Dbsmentioning

confidence: 98%

Treatment results: Parkinson's disease

et al. 2002

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Deep brain stimulation (DBS) is a neurosurgical treatment of Parkinson's disease that is applied to three targets: the ventral intermediate nucleus of the thalamus (Vim), the globus pallidus internas (GPi) and the subthalamic nucleus (STN). Vim DBS mainly improves contralateral tremor and, therefore, is being supplanted by DBS of the two other targets, even in patients with tremor dominant disease. STN and GPi DBS improve off-motor phases and dyskinesias. There is little comparative data between these procedures. The magnitude of the motor improvement seems more constant with STN than GPi DBS. STN DBS allows a decrease in antiparkinsonian drug doses and consumes moderate current. These advantages of STN over GPi DBS are offset by the need for more intensive postoperative management. The DBS procedure has the unique advantage of reversibility and adjustability over time. Patients with young-onset Parkinson's disease suffering from levodopa-induced motor complications but still responding well to levodopa and who exhibit no behavioral, mood, or cognitive impairment benefit the most from STN DBS. Adverse effects more specific of the DBS procedure are infection, cutaneous erosion, and lead breaking or disconnection. Intracranial electrode implantation can induce a hematoma or contusion. Most authors agree that the benefit to risk ratio of DBS is favorable.

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Section: Results Of Stn Dbsmentioning

confidence: 98%

Treatment results: Parkinson's disease

et al. 2002

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“…Deep brain stimulation (DBS) of the thalamus was introduced to avoid the side effects 20,21 induced by the lesion, 22 but VIM stimulation has also been shown to induce a worsening of speech. 23 As stimulation parameters can be adjusted, exacerbation of dysarthria following VIM stimulation would generally not be severe. However, some speech impairment might be accepted by patients as a compromise for a better tremor control.…”

Section: Abstract: Levodopa (L-dopa) and Subthalamic Nucleus (Stn) Stmentioning

confidence: 99%

Changes induced by levodopa and subthalamic nucleus stimulation on parkinsonian speech

et al. 2005

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Levodopa (L‐dopa) and subthalamic nucleus (STN) stimulation treatments have been associated with both improvement and exacerbation of dysarthria in Parkinson's disease (PD). We report four cases illustrating variant responses of dysarthria to dopaminergic and STN stimulation therapies. Patients' motor disability and dysarthria were perceptually rated by the Unified Parkinson's Disease Rating Scale (UPDRS) in four conditions according to medication and STN stimulation. Dedicated software packages allowed acquisition and analysis of acoustic recordings. Case 1, who had a severe off period aphonia, experienced improvement of speech induced by both levodopa and STN stimulation. In Case 2, both treatments worsened speech due to the appearance of dyskinesias. Case 3 had a dysarthria exacerbation induced by STN stimulation with parameters above optimal levels, interpreted as current diffusion from the STN to corticobulbar fibers. In Case 4, dysarthria exacerbation occurred with stimulation at an electrode contact located caudally to the target, also arguing for current diffusion as a potential mechanism of speech worsening. The presented cases demonstrated variant effects in relation to L‐dopa and STN stimulation on speech. It seems that motor speech subcomponents can be improved like other limb motor aspect, but that complex coordination of all speech anatomical substrates is not responsive to STN stimulation. These hypotheses may be helpful for better understanding and management of STN stimulation effects on motor speech and skeleton–motor subsystems. © 2005 Movement Disorder Society

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“…This finding may explain, why on average speech is not much improved with STN DBS, 7 although it has been shown that oral control is improved with STN DBS to a greater extent than with levodopa, 47 whereas it is worsened with Vim DBS. 48 However, in single patients, whose parkinsonian hypophonia is highly levodopa-sensitive, STN DBS may induce a major improvement in speech. 49 Worsening of speech related to STN DBS and especially with DBS outside of the STN has also been reported.…”

Section: Corticobulbar Fibersmentioning

confidence: 99%

Postoperative management of subthalamic nucleus stimulation for Parkinson's disease

et al. 2002

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Abstract:The postoperative neurologic management of patients with deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson' s disease is a complex dynamic process that involves a progressive increase in stimulation intensity and a parallel decrease in antiparkinsonian medication while assessing the interactions of both treatments. Neurologists responsible for postoperative management of patients receiving STN DBS must have expert knowledge of the electroanatomy of the subthalamic area and be familiar with the medical treatment of motor and nonmotor symptoms, including the management of long-term complications of levodopa treatment. Neurosurgeons who perform DBS need to understand the principles that guide the postoperative adaptation of treatment. This article defines guidelines for setting stimulation parameters, adapting drugs and managing adverse effects.

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Effect of Bilateral Deep-Brain Stimulation on Oral Control of Patients with Parkinsonism

Cited by 44 publications

References 21 publications

Treatment results: Parkinson's disease

Treatment results: Parkinson's disease

Changes induced by levodopa and subthalamic nucleus stimulation on parkinsonian speech

Postoperative management of subthalamic nucleus stimulation for Parkinson's disease

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