The Effects of Deep Brain Stimulation on Speech Intelligibility in Persons With Essential Tremor

Sandström, Linda; Blomstedt, Patric; Karlsson, Fredrik; Hartelius, Lena

doi:10.1044/2019_jslhr-19-00014

Cited by 4 publications

(3 citation statements)

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“…2 Speech side effects were more frequent after left-sided lesions than after right-sided ones. Recent studies even considered the replacement of Vim by zona incerta as the target for DBS for ET 53,54 to reduce speech side effects.…”

Section: Discussionmentioning

confidence: 99%

Neuronal Encoding of Speech Features in the Human Thalamus in Parkinson's Disease and Essential Tremor Patients

Tankus,

Lustig-Barzelay,

Gurevitch

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: The human thalamus is known, from stimulation studies and functional imaging, to participate in high-level language tasks. The goal of this study is to find whether and how speech features, in particular, vowel phonemes, are encoded in the neuronal activity of the thalamus, and specifically of the left ventralis intermediate nucleus (Vim), during speech production, perception, and imagery. METHODS: In this cross-sectional study, we intraoperatively recorded single neuron activity in the left Vim of eight neurosurgical patients with Parkinson's disease (PD) (n = 4) or essential tremor (n = 4) undergoing implantation of deep brain stimulation (n = 3) or radiofrequency lesioning (n = 5) while patients articulated the five monophthongal vowel sounds. RESULTS: In this article, we report that single neurons in the left Vim encode individual vowel phonemes mainly during speech production but also during perception and imagery. They mainly use one of two encoding schemes: broad or sharp tuning, with a similar percentage of units each. Sinusoidal tuning has been demonstrated in almost half of the broadly tuned units. Patients with PD had a lower percentage of speech-related units in each aspect of speech (production, perception, and imagery), a significantly lower percentage of broadly tuned units, and significantly lower median firing rates during speech production and perception, but significantly higher rates during imagery, than patients with essential tremor. CONCLUSION: The results suggest that the left Vim uses mixed encoding schemes for speech features. Our findings explain, at the single neuron level, why deep brain stimulation and radiofrequency lesioning of the left Vim are likely to cause speech side effects. Moreover, they may indicate that speech-related units in the left Vim of patients with PD may be degraded even in the subclinical phase.

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Section: Discussionmentioning

confidence: 99%

Neuronal Encoding of Speech Features in the Human Thalamus in Parkinson's Disease and Essential Tremor Patients

Tankus,

Lustig-Barzelay,

Gurevitch

et al. 2023

Neurosurgery

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“…It should be noted that the regions of the brain where optical fibers are implanted are different from the regions where electrodes are implanted in the DBS procedure. In DBS, electrodes are usually implanted into the globus pallidus internus to improve the motor function [54] or into the subthalamic nucleus [55] or the caudal zona incerta to improve tremor [56]. The optical fibers in PD animal models have been implanted into the mid-brain, with the goal of delivering the light as close as possible to the SNc, to preserve the dopamine producing neurons.…”

Section: Discussionmentioning

confidence: 99%

Photobiomodulation for Parkinson’s Disease in Animal Models: A Systematic Review

Salehpour

Hamblin

2020

Biomolecules

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Photobiomodulation (PBM) might be an effective treatment for Parkinson's disease (PD) in human patients. PBM of the brain uses red or near infrared light delivered from a laser or an LED at relatively low power densities, onto the head (or other body parts) to stimulate the brain and prevent degeneration of neurons. PD is a progressive neurodegenerative disease involving the loss of dopamine-producing neurons in the substantia nigra deep within the brain. PD is a movement disorder that also shows various other symptoms affecting the brain and other organs. Treatment involves dopamine replacement therapy or electrical deep brain stimulation. The present systematic review covers reports describing the use of PBM to treat laboratory animal models of PD, in an attempt to draw conclusions about the best choice of parameters and irradiation techniques. There have already been clinical trials of PBM reported in patients, and more are expected in the coming years. PBM is particularly attractive as it is a non-pharmacological treatment, without any major adverse effects (and very few minor ones).

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“…The cZi is a small nucleus targeted in-between the red nucleus (Rn) and the posterior tip of the STN (pSTN) at the depth where the Rn has its maximal diameter (see Figure 1; Blomstedt, 2018), and this has been the DBS target of choice for ET at Umeå University Hospital since 2004. Previous investigations into the effects of DBS in the cZi have shown that unilateral cZi DBS can have a positive effect on voice tremor (Sandström et al, 2019b(Sandström et al, , 2018, also in the long term (Sandström et al, 2019a), and that habitual cZi DBS, optimized to treat the motor symptoms of ET, does not affect speech intelligibility (Sandström et al, 2020). However, in the same clinical population, it was also noted that speech intelligibility might deteriorate during highamplitude stimulation from electrode contacts higher up in the PSA (Sandström et al, 2020) and that successful voice tremor management may depend on the exact location of the electrode within the cZi (Sandström et al, 2019b); results that indicate that speech and voice outcomes could vary depending on targeting precision.…”

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confidence: 99%

Speech Function Following Deep Brain Stimulation of the Caudal Zona Incerta: Effects of Habitual and High-Amplitude Stimulation

Sandström

Schalling

Karlsson

et al. 2021

J Speech Lang Hear Res

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Purpose Deep brain stimulation (DBS) is often successful in alleviating motor symptoms of essential tremor (ET); however, DBS may also induce adverse speech effects. The caudal zona incerta (cZi) is a promising DBS target for tremor, but less is known about the consequences of cZi DBS for speech. This preliminary study examined how habitual cZi DBS and cZi stimulation at high amplitudes may affect speech function in persons with ET. Method Fourteen participants with ET were evaluated: off stimulation, on habitual cZi DBS, and with unilateral cZi stimulation at increasing stimulation amplitudes. At each stimulation condition, the participants read three 16-word sentences. Two speech-language pathologists made audio-perceptual consensus ratings of overall speech function, articulation, and voice using a visual sort and rate method. Rated functions when off stimulation, on habitual cZi DBS, and at maximal-amplitude stimulation were compared using Friedman nonparametric tests. For participants with bilateral habitual DBS ( n = 5), the effects of bilateral and unilateral stimulation were described in qualitative terms. Results Habitual cZi DBS had no significant group-level effect on any of the investigated speech parameters. Maximal-amplitude stimulation had a small but significant negative effect on articulation. Participants with reduced articulatory precision ( n = 9) had more medially placed electrodes than the nonaffected group ( n = 5). Bilateral and unilateral left stimulation had comparable effects on speech. Conclusions Findings from this preliminary study of cZi DBS indicate that speech is generally not affected by stimulation at habitual levels. High-amplitude cZi stimulation may, however, induce adverse effects, particularly on articulation. Instances of decreased articulatory function were associated with stimulation of more medial electrode contacts, which could suggest cerebello-rubrospinal involvement.

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The Effects of Deep Brain Stimulation on Speech Intelligibility in Persons With Essential Tremor

Cited by 4 publications

References 50 publications

Neuronal Encoding of Speech Features in the Human Thalamus in Parkinson's Disease and Essential Tremor Patients

Neuronal Encoding of Speech Features in the Human Thalamus in Parkinson's Disease and Essential Tremor Patients

Photobiomodulation for Parkinson’s Disease in Animal Models: A Systematic Review

Speech Function Following Deep Brain Stimulation of the Caudal Zona Incerta: Effects of Habitual and High-Amplitude Stimulation

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