title: How Does GPi-DBS Affect Speech in Primary Dystonia?
abstract: BACKGROUND
  Globus pallidus internus deep brain stimulation (GPi-DBS) can be an effective treatment for primary dystonia. However, speech disorders have previously been reported as a common possible side effect of the treatment.
  
  
  OBJECTIVE
  To study possible deterioration of speech after GPi-DBS and describe this in different dimensions.
  
  
  METHODS
  Speech was systematically evaluated in 15 patients with predominant torticollis and GPi-DBS. Each patient was tested twice within one day in two stimulation conditions: ON-DBS vs. OFF-DBS. Speech analyses comprised both function-oriented (perceptual scales, acoustic analyses) and communication-related measures (intelligibility, naturalness). A control sample of 15 healthy speakers underwent the same speech assessment.
  
  
  RESULTS
  On the group level, patients with dystonia showed mild but significant impairment on the overall dysarthria scale, the intelligibility score, and the naturalness ratings in both stimulation conditions (Mann-Whitney, P < .05). No stimulation-induced deterioration was found. A slight increase in articulation rate was measured in the ON condition. On the single-case level, effects of GPi-DBS on speech were heterogenous. In one patient we observed a deterioration of speech (dysarthria), in a second patient with a history of childhood stuttering we found an aggravation of dysfluency. Impressive benefits could be documented in another patient who also suffered from spasmodic dysphonia.
  
  
  CONCLUSIONS
  The study provides evidence that speech impairment is not a necessary side-effect of GPi-DBS in primary dystonia. Both, recurring of stuttering and a worsening of dysarthria may be seen in individual patients. The positive effects of GPi-DBS on the symptoms of spasmodic dysphonia merits further research as DBS is not commonly applied in this population.
authors.affiliation: Clinical Neuropsychology Research Group (EKN), Städtisches Klinikum München GmbH, Klinikum Schwabing (Haus 19, 2. Stock), Kölner Platz 1, 80804 München, Germany(1).
authors.forename: Verena
authors.initials: V
authors.lastname: Risch
authors.affiliation: Clinical Neuropsychology Research Group (EKN), Städtisches Klinikum München GmbH, Klinikum Schwabing (Haus 19, 2. Stock), Kölner Platz 1, 80804 München, Germany(1).
authors.forename: Anja
authors.initials: A
authors.lastname: Staiger
authors.affiliation: Clinical Neuropsychology Research Group (EKN), Städtisches Klinikum München GmbH, Klinikum Schwabing (Haus 19, 2. Stock), Kölner Platz 1, 80804 München, Germany(1).
authors.forename: Wolfram
authors.initials: W
authors.lastname: Ziegler
authors.affiliation: Department of Neurology, Ludwig-Maximilians-University Munich, Klinikum Großhadern, Marchioninistrasse 15, 81366 Munich, Germany(2).
authors.forename: Katharina
authors.initials: K
authors.lastname: Ott
authors.affiliation: Clinical Neuropsychology Research Group (EKN), Städtisches Klinikum München GmbH, Klinikum Schwabing (Haus 19, 2. Stock), Kölner Platz 1, 80804 München, Germany(1).
authors.forename: Theresa
authors.initials: T
authors.lastname: Schölderle
authors.affiliation: Department of Orthopedics, Ludwig-Maximilians-University Munich, Klinikum Großhadern, Marchioninistrasse 15, 81366 Munich, Germany(3).
authors.forename: Olena
authors.initials: O
authors.lastname: Pelykh
authors.affiliation: Department of Neurology, Ludwig-Maximilians-University Munich, Klinikum Großhadern, Marchioninistrasse 15, 81366 Munich, Germany(2). Electronic address: kboetzel@med.uni-muenchen.de.
authors.forename: Kai
authors.initials: K
authors.lastname: Bötzel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D020821:Dystonic Disorders / Q000628:therapy*; D005260:Female; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013064:Speech Disorders / Q000209:etiology*
keywords: Basal ganglia; Deep brain stimulation; Dystonia; Spasmodic dysphonia; Speech; Stuttering