Category: Surgical Therapy: Parkinson's Disease
Objective: To explore structural network correlates of stimulation-induced dysarthria (SID) in patients with Parkinson’s Disease (PD) chronically treated with deep brain stimulation (DBS) of the subthalamic nucleus (STN).
Background: Stimulation-induced dysarthria is a common and disabling side-effect of STN-DBS in PD patients [1,2]. It has been shown that especially stimulation at higher amplitudes can lead to reduced speech intelligibility postoperatively, even when motor status is improved [3]. Therefore, a deeper insight in structural networks associated with SID is warranted to improve the pathophysiological understanding of this disabling side-effect.
Method: We examined 25 PD patients with bilateral STN-DBS (4 female). A hemisphere-wise monopolar review was conducted contact-wise in a randomized manner. The amplitude was increased in steps of 0.5 mA until i) occurrence of SID, ii) occurrence of other intolerable side-effects or iii) reaching a maximum of 10 mA. Stimulation volumes were calculated for each investigated amplitude. A modified fiber filtering approach was applied to identify structural network correlates in the PPMI connectome [4] by calculating fiber-wise odds ratios for the occurrence of SID. The results were validated in a leave-one-out-design employing receiver operating curve analysis.
Results: SID was provoked at 128 out of the 191 contacts tested. Fibers associated with SID were located medially and laterally to the STN on both hemispheres. Leave-one-out ROC analysis resulted in AUC values of 84 % (right hemisphere) and 81 % (left hemisphere), respectively.
Conclusion: This study elucidates potential structural network correlates of SID in STN-DBS. The approach applied might be helpful for imaging-guided programming or electrode placement to improve the outcome of STN-DBS in PD patients.
References: 1 Tripoliti E, Zrinzo L, Martinez-Torres I, et al. Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease. Neurology 2011;76:80–6. doi:10.1212/WNL.0b013e318203e7d0
2 Tsuboi T, Watanabe H, Tanaka Y, et al. Distinct phenotypes of speech and voice disorders in Parkinson’s disease after subthalamic nucleus deep brain stimulation. J Neurol Neurosurg Psychiatry 2015;86:856–64. doi:10.1136/jnnp-2014-308043
3 Tripoliti E, Zrinzo L, Martinez‐Torres I, et al. Effects of contact location and voltage amplitude on speech and movement in bilateral subthalamic nucleus deep brain stimulation. Movement Disorders 2008;23:2377–83. doi:https://doi.org/10.1002/mds.22296
4 Horn A, Reich M, Vorwerk J, et al. Connectivity Predicts deep brain stimulation outcome in Parkinson disease. Annals of Neurology 2017;82:67–78. doi:https://doi.org/10.1002/ana.24974
To cite this abstract in AMA style:
H. Jergas, JN. Petry-Schmelzer, JG. Hannemann, T. Thies, JC. Baldermann, JN. Strelow, HS. Dafsari, D. Muecke, V. Visser-Vandewalle, TA. Dembek, MT. Barbe. Network Fingerprint of Stimulation-Induced Speech Impairment in Parkinson’s Disease [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/network-fingerprint-of-stimulation-induced-speech-impairment-in-parkinsons-disease/. Accessed September 7, 2024.« Back to 2022 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/network-fingerprint-of-stimulation-induced-speech-impairment-in-parkinsons-disease/