Deep brain stimulation fine-tuning in Parkinson's disease: Short pulse width effect on speech. (June 2021)

• Record Type: Journal Article
• Authors: Fabbri, Margherita; Natale, Federico; Artusi, Carlo Alberto; Romagnolo, Alberto; Bozzali, Marco; Giulietti, Giovanni; Guimaraes, Isabel; Rizzone, Mario Giorgio; Accornero, Anna; Lopiano, Leonardo; Zibetti, Maurizio
• Is Part Of: Parkinsonism & related disorders. Volume 87(2021)
• Page Start: 130
• Page End: 134
• Publication Date: 2021-06
• Subjects: Parkinson's disease -- Deep brain stimulation -- Short-pulse width -- Dysarthria; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2021.05.007
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Background: subthalamic nucleus deep brain stimulation (STN-DBS) may have a detrimental effect on speech in Parkinson's disease (PD) patients and new stimulation technologies may help in addressing this issue. Objective: to evaluate the STN-DBS acute effect of 30 μs pulse width (30PW) versus conventional 60 μs PW (60PW) on speech and identify the core features of voice modified by 30PW. Methods: seven STN-DBS treated PD patients participated into a pilot cross-sectional study. Motor and speech performances were tested by means of both automatic analysis and blinded clinical evaluations in four stimulation conditions: 30PW and 60PW both at the usual amplitude and at an amplitude just below the threshold for stimulation-related side effects. Results: at the threshold amplitude, 30PW stimulation improved speech intelligibility for both words (p = 0.02) and sentences (p = 0.04), without worsening motor performance. A lower but not statistically significant voice variability and instability and percentage of stuttering disfluencies was also observed. The beneficial effect of 30PW detected by automatic analysis, was confirmed by patients' perception. Conclusions: STN-DBS treated patients experiencing low speech intelligibility may benefit from a 30PW stimulation trial at a higher amplitude. Deep characterization of PD speech profiles may help in a better application of recent DBS hardware advances. Highlights: Dysarthria management is challenging among PD patients treated with STN-DBS. Hardware-related advances currently allows new and fine-tuning stimulation options. A lower PW can expand the therapeutic window of STN-DBS treated patients. Speech profiles characterization may help the application of DBS hardware-related advances.