Patient-specific model-based investigation of speech intelligibility and movement during deep brain stimulation.
OBJECTIVE
Deep brain stimulation (DBS) is widely used to treat motor symptoms in patients with advanced Parkinson's disease. The aim of this study was to investigate the anatomical aspects of the electric field in relation to effects on speech and movement during DBS in the subthalamic nucleus.


METHODS
Patient-specific finite element models of DBS were developed for simulation of the electric field in 10 patients. In each patient, speech intelligibility and movement were assessed during 2 electrical settings, i.e. 4 V (high) and 2 V (low). The electric field was simulated for each electrical setting.


RESULTS
Movement was improved in all patients for both high and low electrical settings. In general, high-amplitude stimulation was more consistent in improving the motor scores than low-amplitude stimulation. In 6 cases, speech intelligibility was impaired during high-amplitude electrical settings. Stimulation of part of the fasciculus cerebellothalamicus from electrodes positioned medial and/or posterior to the center of the subthalamic nucleus was recognized as a possible cause of the stimulation-induced dysarthria.


CONCLUSIONS
Special attention to stimulation-induced speech impairments should be taken in cases when active electrodes are positioned medial and/or posterior to the center of the subthalamic nucleus.
Aström
Mattias
M
Department of Biomedical Engineering, Linköping University, Linköping, Sweden. matas@imt.liu.se
Tripoliti
Elina
E
Hariz
Marwan I
MI
Zrinzo
Ludvic U
LU
Martinez-Torres
Irene
I
Limousin
Patricia
P
Wårdell
Karin
K
D000368:Aged; D001931:Brain Mapping; D046690:Deep Brain Stimulation; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D009068:Movement / Q000502:physiology*; D010300:Parkinson Disease / Q000628:therapy*; D013065:Speech Intelligibility / Q000502:physiology*; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000503:physiopathology* / Q000601:surgery
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