title: Characteristic laryngoscopic findings in Parkinson's disease patients after subthalamic nucleus deep brain stimulation and its correlation with voice disorder.
abstract: Speech and voice disorders are one of the most common adverse effects in Parkinson's disease (PD) patients treated with subthalamic nucleus deep brain stimulation (STN-DBS). However, the pathophysiology of voice and laryngeal dysfunction after STN-DBS remains unclear. We assessed 47 PD patients (22 treated with bilateral STN-DBS (PD-DBS) and 25 treated medically (PD-Med); all patients in both groups matched by age, sex, disease duration, and motor and cognitive function) using the objective and subjective voice assessment batteries (GRBAS scale and Voice Handicap Index), and laryngoscopy. Laryngoscopic examinations revealed that PD-DBS patients showed a significantly higher incidence of incomplete glottal closure (77 vs 48 %; p = 0.039), hyperadduction of the false vocal folds (73 vs 44 %; p = 0.047), anteroposterior hypercompression (50 vs 20 %; p = 0.030) and asymmetrical glottal movement (50 vs 16 %; p = 0.002) than PD-Med patients. On- and off-stimulation assessment revealed that STN-DBS could induce or aggravate incomplete glottal closure, hyperadduction of the false vocal folds, anteroposterior hypercompression, and asymmetrical glottal movement. Incomplete glottal closure and hyperadduction of the false vocal folds significantly correlated with breathiness and strained voice, respectively (r = 0.590 and 0.539). We should adjust patients' DBS settings in consideration of voice and laryngeal functions as well as motor function.
authors.affiliation: Department of Neurology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tsuboi
authors.affiliation: Department of Neurology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Watanabe
authors.affiliation: Department of Neurology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Neurology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Reiko
authors.initials: R
authors.lastname: Ohdake
authors.affiliation: Department of Neurology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Noritaka
authors.initials: N
authors.lastname: Yoneyama
authors.affiliation: Department of Neurology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hara
authors.affiliation: Department of Neurology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Mizuki
authors.initials: M
authors.lastname: Ito
authors.affiliation: Department of Neurology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hirayama
authors.affiliation: Faculty of Psychological and Physical Science, Aichi-Gakuin University, Aichi, 470-0195, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Fujimoto
authors.affiliation: Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
authors.forename: Yasukazu
authors.initials: Y
authors.lastname: Kajita
authors.affiliation: Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Wakabayashi
authors.affiliation: Department of Neurology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, 466-8550, Japan. sobueg@med.nagoya-u.ac.jp.
authors.forename: Gen
authors.initials: G
authors.lastname: Sobue
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007828:Laryngoscopy; D007830:Larynx / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D010300:Parkinson Disease / Q000150:complications / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D014831:Voice / Q000502:physiology; D014832:Voice Disorders / Q000150:complications / Q000473:pathology / Q000503:physiopathology*
keywords: Dysarthria; Laryngoscope; Parkinson’s disease; Subthalamic nucleus deep brain stimulation; Voice disorder