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Deep brain stimulation and speech


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#1 Dr. Mahler

Dr. Mahler

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Posted 06 December 2011 - 12:34 PM

Changes in speech intelligibility frequently occur in PD affecting approximately 75-90% of the population (Ho et al., 1994; Logemann et al., 1978). Levodopa has been used as an effective treatment for some symptoms of PD but in contrast to other motor symptoms of PD, speech has been poorly responsive to pharmacological treatments (D’Alatri et al., 2007). Recently, DBS has been applied to the subthalamic nucleus (STN) to alleviate symptoms of PD. However, DBS for PD patients may have little effect on speech intelligibility and in some instances it may result in worsening of dysarthria and hypophonia (Dromey et al., 2000). There are a limited number of studies reported in the literature that have specifically addressed voice and speech behaviors after DBS and very few have used quantitative measures to analyze communication variables (D’Alatri et al., 2007). There is an article in the New England Journal of Medicine (Krack, et al. 2003, pgs 1925-1934), on a five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. In the article it was documented that speech was one symptom resistant to improvement in patients post-surgery. Tripoliti et al., (2010) have identified stimulator placements and high stimulator settings that have a greater likelihood of a negative impact on speech.

We need to complete more research with speech measures being taken pre- and post-surgery to provide information for patients and families regarding the impact surgery on speech. Discuss potential speech changes following surgery with your medical team and consider completing speech treatment prior to the surgery. If you have already received the surgery and are experiencing difficulty with speech, you might discuss your stimulator settings with your neurologist and see if there are setting adjustments that can be made to maximize movement and communication. Then get a referral for speech treatment.

If you have any specific questions about deep brain stimulation and speech or swallowing, please write to us at this forum.

Sincerely,

Leslie Mahler, PhD, CCC-SLP
Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island




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