title: Stimulation of the pedunculopontine nucleus area in Parkinson's disease: effects on speech and intelligibility.
abstract: Improvement of gait disorders following pedunculopontine nucleus area stimulation in patients with Parkinson's disease has previously been reported and led us to propose this surgical treatment to patients who progressively developed severe gait disorders and freezing despite optimal dopaminergic drug treatment and subthalamic nucleus stimulation. The outcome of our prospective study on the first six patients was somewhat mitigated, as freezing of gait and falls related to freezing were improved by low frequency electrical stimulation of the pedunculopontine nucleus area in some, but not all, patients. Here, we report the speech data prospectively collected in these patients with Parkinson's disease. Indeed, because subthalamic nucleus surgery may lead to speech impairment and a worsening of dysarthria in some patients with Parkinson's disease, we felt it was important to precisely examine any possible modulations of speech for a novel target for deep brain stimulation. Our results suggested a trend towards speech degradation related to the pedunculopontine nucleus area surgery (off stimulation) for aero-phonatory control (maximum phonation time), phono-articulatory coordination (oral diadochokinesis) and speech intelligibility. Possibly, the observed speech degradation may also be linked to the clinical characteristics of the group of patients. The influence of pedunculopontine nucleus area stimulation per se was more complex, depending on the nature of the task: it had a deleterious effect on maximum phonation time and oral diadochokinesis, and mixed effects on speech intelligibility. Whereas levodopa intake and subthalamic nucleus stimulation alone had no and positive effects on speech dimensions, respectively, a negative interaction between the two treatments was observed both before and after pedunculopontine nucleus area surgery. This combination effect did not seem to be modulated by pedunculopontine nucleus area stimulation. Although limited in our group of patients, speech impairment following pedunculopontine nucleus area stimulation is a possible outcome that should be considered before undertaking such surgery. Deleterious effects could be dependent on electrode insertion in this brainstem structure, more than on current spread to nearby structures involved in speech control. The effect of deep brain stimulation on speech in patients with Parkinson's disease remains a challenging and exploratory research area.
authors: 1 Aix-Marseille Université/CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France serge.pinto@lpl-aix.fr.
authors: Serge
authors: S
authors: Pinto
authors: 2 Université Grenoble-Alpes, 38000, Grenoble, France 3 INSERM U836 - Grenoble Institut des Neurosciences, 38000, Grenoble, France 4 Donders Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands.
authors: Murielle
authors: M
authors: Ferraye
authors: 1 Aix-Marseille Université/CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France.
authors: Robert
authors: R
authors: Espesser
authors: 3 INSERM U836 - Grenoble Institut des Neurosciences, 38000, Grenoble, France 5 Centre Hospitalier Universitaire de Grenoble, 38000, Grenoble, France.
authors: Valérie
authors: V
authors: Fraix
authors: 2 Université Grenoble-Alpes, 38000, Grenoble, France 3 INSERM U836 - Grenoble Institut des Neurosciences, 38000, Grenoble, France 6 Université Lyon I/CNRS, Centre de Neurosciences Cognitives, UMR 5229, Lyon, France.
authors: Audrey
authors: A
authors: Maillet
authors: 1 Aix-Marseille Université/CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France.
authors: Jennifer
authors: J
authors: Guirchoum
authors: 1 Aix-Marseille Université/CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France.
authors: Deborah
authors: D
authors: Layani-Zemour
authors: 1 Aix-Marseille Université/CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France.
authors: Alain
authors: A
authors: Ghio
authors: 5 Centre Hospitalier Universitaire de Grenoble, 38000, Grenoble, France.
authors: Stéphan
authors: S
authors: Chabardès
authors: 5 Centre Hospitalier Universitaire de Grenoble, 38000, Grenoble, France 7 Hôpitaux Universitaires, Genève, Switzerland.
authors: Pierre
authors: P
authors: Pollak
authors: 2 Université Grenoble-Alpes, 38000, Grenoble, France 3 INSERM U836 - Grenoble Institut des Neurosciences, 38000, Grenoble, France.
authors: Bettina
authors: B
authors: Debû
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use; D003627:Data Interpretation, Statistical; D046690:Deep Brain Stimulation; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007980:Levodopa / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000503:physiopathology / Q000628:therapy; D010300:Parkinson Disease / Q000503:physiopathology*; D045042:Pedunculopontine Tegmental Nucleus / Q000503:physiopathology*; D057234:Preoperative Period; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000502:physiology; D012119:Respiration; D012660:Semantics; D013060:Speech / Q000502:physiology*; D013065:Speech Intelligibility / Q000502:physiology*; D020531:Subthalamic Nucleus / Q000502:physiology
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa
keywords: Parkinson’s disease; l-DOPA; pedunculopontine nucleus area; speech; subthalamic nucleus