Stuttering in Parkinson’s disease after deep brain stimulation: A note on dystonia and low-frequency stimulation

Mendonça, Marcelo; Barbosa, Raquel; Seromenho-Santos, Alexandra; Reizinho, Carla; Bugalho, Paulo

doi:10.1016/j.jocn.2018.01.042

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…The increase in activity from the MTG and output from Cereb7‐L may cause stuttering in PD patients after DBS stimulation 52‐55 . This finding of stuttering in PD patients may correlate with our clinical observation (UPDRS‐Ⅱ) of decreased language fluency post‐DBS 56 …”

Section: Discussionsupporting

confidence: 58%

Effect of deep brain stimulation on brain network and white matter integrity in Parkinson's disease

Huang

Chen²,

Wu³

et al. 2021

CNS Neurosci Ther

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Aims The effects of subthalamic nucleus (STN)‐deep brain stimulation (DBS) on brain topological metrics, functional connectivity (FC), and white matter integrity were studied in levodopa‐treated Parkinson’s disease (PD) patients before and after DBS. Methods Clinical assessment, resting‐state functional MRI (rs‐fMRI), and diffusion tensor imaging (DTI) were performed pre‐ and post‐DBS in 15 PD patients, using a within‐subject design. The rs‐fMRI identified brain network topological metric and FC changes using graph‐theory‐ and seed‐based methods. White matter integrity was determined by DTI and tract‐based spatial statistics. Results Unified Parkinson's Disease Rating Scale III (UPDRS‐ III) scores were significantly improved by 35.3% (p < 0.01) after DBS in PD patients, compared with pre‐DBS patients without medication. Post‐DBS PD patients showed a significant decrease in the graph‐theory‐based degree and cost in the middle temporal gyrus and temporo‐occipital part‐Right. Changes in FC were seen in four brain regions, and a decrease in white matter integrity was seen in the left anterior corona radiata. The topological metrics changes were correlated with Beck Depression Inventory II (BDI‐II) and the FC changes with UPDRS‐III scores. Conclusion STN‐DBS modulated graph‐theoretical metrics, FC, and white matter integrity. Brain connectivity changes observed with multi‐modal imaging were also associated with postoperative clinical improvement. These findings suggest that the effects of STN‐DBS are caused by brain network alterations.

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Section: Discussionsupporting

confidence: 58%

Effect of deep brain stimulation on brain network and white matter integrity in Parkinson's disease

Huang

Chen²,

Wu³

et al. 2021

CNS Neurosci Ther

View full text Add to dashboard Cite

show abstract

“…They indicate that as the neurodegeneration progresses over time and a higher dosage of dopaminergic medication is needed to manage symptoms, the frequency of stuttered disfluencies also increases. However, we cannot infer that this is a direct causal relationship as previous research has shown both increases and decreases in stuttered disfluencies in PD cases following adjustments in dopaminergic medications, 29 and with deep brain stimulation 54,55 . Additional symptom severity variables also contribute to this correlation 4 .…”

Section: Discussionmentioning

confidence: 81%

“…However, we cannot infer that this is a direct causal relationship as previous research has shown both increases and decreases in stuttered disfluencies in PD cases following adjustments in dopaminergic medications, 29 and with deep brain stimulation. 54,55 Additional symptom severity variables also contribute to this correlation. 4 Of those, we set out to investigate the influence of motor and cognitive functioning.…”

Section: Discussionmentioning

confidence: 99%

Acquired Stuttering in Parkinson's Disease

Gooch

Horne

Melzer

et al. 2023

Movement Disord Clin Pract

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Background Parkinson's disease frequently causes communication impairments, but knowledge about the occurrence of new‐onset stuttering is limited. Objectives To determine the presence of acquired neurogenic stuttering and its relationship with cognitive and motor functioning in individuals with Parkinson's disease. Method Conversation, picture description, and reading samples were collected from 100 people with Parkinson's disease and 25 controls to identify the presence of stuttered disfluencies (SD) and their association with neuropsychological test performance and motor function. Results Participants with Parkinson's disease presented with twice as many stuttered disfluencies during conversation (2.2% ± 1.8%SD) compared to control participants (1.2% ± 1.2%SD; P < 0.01). 21% of people with Parkinson's disease (n = 20/94) met the diagnostic criterion for stuttering, compared with 1/25 controls. Stuttered disfluencies also differed significantly across speech tasks, with more disfluencies during conversation compared to reading (P < 0.01). Stuttered disfluencies in those with Parkinson's disease were associated with longer time since disease onset (P < 0.01), higher levodopa equivalent dosage (P < 0.01), and lower cognitive (P < 0.01) and motor scores (P < 0.01). Conclusion One in five participants with Parkinson's disease presented with acquired neurogenic stuttering, suggesting that speech disfluency assessment, monitoring and intervention should be part of standard care. Conversation was the most informative task for identifying stuttered disfluencies. The frequency of stuttered disfluencies was higher in participants with worse motor functioning, and lower cognitive functioning. This challenges previous suggestions that the development of stuttered disfluencies in Parkinson's disease has purely a motoric basis.

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Non-Motor Effects of Low-Frequency Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson’s Disease: A Systematic Review

Ong,

Schmidt,

Tosefsky

et al. 2024

Stereotact Funct Neurosurg

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Introduction: Deep brain stimulation of the subthalamic nucleus is an effective therapy for the motor symptoms of Parkinson’s disease (PD). Typically, stimulation is applied at a high frequency (≥100 Hz) to alleviate motor symptoms. However, the effects on non-motor symptoms can be variable. Low-frequency oscillations are increasingly recognized as playing an important role in the non-motor functions of the subthalamic nucleus. Therefore, it has been hypothesized that low-frequency stimulation of the subthalamic nucleus (<100 Hz) may have a direct effect on these non-motor functions, thereby preferentially impacting non-motor symptoms of PD. Despite important therapeutic implications, the literature on this topic has not been summarized. Method: To understand the current state of the field, we performed a comprehensive systematic review of the literature assessing the non-motor effects of low-frequency stimulation of the subthalamic nucleus in PD. We performed a supplementary meta-analysis to assess the effects of low- versus high-frequency stimulation on verbal fluency outcomes. Results: Our search returned 7,009 results, of which we screened 4,199 results. A total of 145 studies were further assessed for eligibility, and a total of 21 studies met our inclusion criteria, representing 297 patients. These studies were a mix of case reports and control trials. The four clinical outcomes measured were sleep, sensory perception, cognition, and mood. A supplementary meta-analysis of six studies investigating the impact of low-frequency stimulation on verbal fluency did not find any significant results when pooling across subgroups. Conclusion: LFS of the STN may have benefits on a range of cognitive and affective symptoms in PD. However, current studies in this space are heterogeneous, and the effect sizes are small. Factors that impact outcomes can be divided into stimulation and patient factors. Future work should consider the interactions between stimulation location and stimulation frequency as well as how these interact depending on the specific non-motor phenotype.

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Stuttering in Parkinson’s disease after deep brain stimulation: A note on dystonia and low-frequency stimulation

Cited by 3 publications

References 6 publications

Effect of deep brain stimulation on brain network and white matter integrity in Parkinson's disease

Effect of deep brain stimulation on brain network and white matter integrity in Parkinson's disease

Acquired Stuttering in Parkinson's Disease

Non-Motor Effects of Low-Frequency Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson’s Disease: A Systematic Review

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