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158 Reviews in the Archive. Showing 121 to 140

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Movement Disorders

Stefurak T, Mikulis D, Mayberg H, Lang AE, Hevenor S, Pahapill P, Saint-Cyr J, & Lozano A. Deep brain stimulation for Parkinson's disease dissociates mood and motor circuits: a functional MRI case study. Movement Disorders, 2003 Dec;18(12):1508-16.2003 Dec;18(12):1508-16.

This is a case study of a 36-year old woman who underwent bilateral DBS-STN 10 years after motor symptoms began. She had a pre-existing history of recurrent depression (starting at age 12) treated with drug therapy as well as ECT. At the time of her surgery her depression had been in remission for two years. After her surgery, when her left STN was stimulated she experienced decreased tremor and improved motor functioning. When her right STN was stimulated she experienced various emotional disturbances within 30 seconds, which ceased immediately after cessation of the stimulation. The right-sided STN effect was not reproducible after 4 weeks (no stimulation to that side during that time) or after surgical repositioning/revision. This case provides evidence of possible physiological mechanisms to explain depressive symptoms as well as resolution of symptoms in patients undergoing DBS-STN surgery.

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Nyholm D, Nilsson Remahl AI, Dizdar N, Constantinescu R, Holmberg B, Jansson R, Aquilonius SM, & Askmark H. Duodenal levodopa infusion monotherapy vs oral polypharmacy in advanced Parkinson's disease. , 2005 Jan 25;64(2):216-232005 Jan 25;64(2):216-23

Duodenal levodopa infusion monotherapy vs oral polypharmacy in advanced Parkinson disease. Neurology. 2005 Jan 25;64(2):216-23. This study looked at a new method of administering levodopa/carbidopa (gel infused through the nose to the intestine**) versus standard oral tablets for continuous dopaminergic stimulation (continuous stimulation of a chemical in the brain that affects the control of movement)). Each of 24 advanced PD patients tried the new method (3 weeks) and the standard method (3 weeks). The patients judged their motor performance and quality of life during this time as well as prior to and after the study. Neurologists also rated each patient's motor symptoms during each method of administration. The patients generally preferred the infusion therapy and had decreased motor difficulties and improved quality of life. It is notable that 16 of the 24 patients chose the permanent tube system over conventional treatment after this study. The authors suggest that this method may be a good alternative for PD patients before DBS needs to be considered or for those that are unsuitable for DBS. They suggest that the infusion method is well tolerated, there are fewer complications than DBS, and it is practical in the home.    **It should be noted that for long-term use of the gel an abdominal tube must be surgically placed.

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Walsh, K. & Bennett, G. (2001). Parkinson's Disease and Anxiety. , 77, 88-9377, 88-93

These investigators provide a general overview of the prevalence, pathophysiology, laterality, medication effects, comorbidity, and management of anxiety in patients with PD. They discuss that all types of anxiety have been found with PD, but the most common diagnoses are panic disorder, phobic disorder, and generalized anxiety disorder areas. There is also a higher prevalence of comorbid anxiety and depression in PD patients than compared to healthy controls. It is unclear if anxiety in PD is related to a neurochemical change or a maladaptive response to the disease. The article suggests there are still quite a few uncertainties between anxiety and PD and that more research needs to be conducted.

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NeuroReport

Pollo, A., Torre, E., Lopiano, L., Rizzone, M., Lanotte, M., Cavanna, A., Bergamasco, B., & Benedetti, F. (2002). Expectation modulates the response to subthalamic nucleus stimulation in Parkinsonian patients. NeuroReport, 13, 1383-138613, 1383-1386

These investigators suggest that patient expectations can play a significant role in treatment outcome. They analyzed right hand movement, during various intensity levels of STN stimulation, of 7 patients with PD that had previously undergone DBS-STN. There were two conditions, either the patient was told exactly what would happen (e.g. expect worsening) or they were told good expectations of what would happen (e.g. they should expect no change or big improvement in motor performance when really they may not) during various levels of STN stimulation. These investigators found that when patients were given instructions regarding good expectations about their performance that they had less motor slowing than those patients given instructions for poor expectations, although the stimulation was the same. These authors suggest that there may be a placebo-activated process in the brain that will affect the motor system, as has been shown in pain patients. This study suggests that positive instructions and attitudes should be taken into account during the treatment of all patients.

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Journal of Neurology, Neurosurgery, and Psychiatry

Dujardin, K., Blairy, S., Defebvre, L., Krystkowiak, P., Hess, U., Blond, S., & Destee, A. (2004). Subthalamic nucleus stimulation induces deficits in decoding emotional facial expressions in Parkinson's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 75(2), 202-20875(2), 202-208

The aim of this study was to empirically evaluate the effects of bilateral STN stimulation on emotion processing (decoding facial expression) in patients with PD. These investigators looked at a consecutive series of 12 PD patients one month prior to DBS-STN surgery and three months post surgery compared to 12 matched controls. Presurgery the PD patients did not differ from the controls, however after surgery 9 of the 12 patients showed impairments in accuracy in decoding others facial expression of sadness and anger. There was also a similar trend for disgust. It is notable that as a group the patients had a significant reduction in their Unified Parkinson's Disease Rating Scale value, motor symptoms, and levodopa dosage. However, this study suggests that after successful surgery there may be behavioral adverse events such as a decline in processing facial emotions due to a change in STN function, which could contribute to a change in social and affective interactions of patients with PD.

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Brain

Saint-Cyr JA., Trepanier LL., Kumar R., Lozano AM., & Lang AE. (2000). Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease. Brain, 123(Pt 10):2091-2108 123(Pt 10):2091-2108

This study examined possible neuropsychological changes (changes in brain function) in patients with advanced Parkinson's disease treated with bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN). Eleven patients were evaluated (in their best “on state”) prior to the procedure (n = 11), at 3-6 months (n = 11) and at 9-12 months (n =10) post-operatively. Six of these patients were older than 69 years. Despite motor benefits at 3-6 months post-operative, significant declines were noted in certain cognitive functions (e.g., speed of mental processing, motor speed and coordination, mental set switching, generation of words, and memory). Declines were more consistently observed in patients who were older than 69 years.

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Koller WC., Pahwa R., Lyons KE., & Albanese A. (1999). Surgical treatment of Parkinson's disease. , 167(1),1-10167(1),1-10

This article explains stereotaxtic surgery (a precise method of identifying non-visualized anatomic structures by use of three-dimensional coordinates) as an effective therapeutic maneuver in the management of advanced Parkinson's disease (PD). The article reviews the differences between a pallidotomy (a permanent lesion to the globas pallidus - brain structure towards the middle of the brain), thalamotomy (a permanent lesion to the thalamus - brain structure towards the middle of the brain), and deep brain stimulation (DBS; a reversible procedure), which includes deep brain stimulation to the globas pallidus, thalamus, or subthalamic nucleus (all are structures towards the middle of the brain). Furthermore, it highlights the benefits of deep brain stimulation over the other procedures.

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Obeso J.A., Rodriguez M.C., Gorospe A., Guridi J., Alvarez L., & Macias R. (1997). Surgical treatment of Parkinson's disease. , 6(1):125-456(1):125-45

This article provides a sound overview of the surgical procedures that have been used to treat Parkinson's disease. At present, there are three major surgical approaches to Parkinson's disease (PD): (1) Ablative surgery (surgery that permanently damages part of the brain to alleviate symptoms); (2) deep brain stimulation (DBS) of structures deep within the brain; and (3) transplanting fetal cells into the brain. As a result of increasing understanding of the function of the basal ganglia (brain structures influential in Parkinson's disease) and the demonstration of surgical alleviation of the symptoms of Parkinson's disease, surgery has regained a paramount importance in the management of PD.  Consideration of surgery in any given patient should be weighed against the risks (about 1% mortality and 2-6% having cognitive deficit, speech problems, severe paralysis on one side of the body, etc.) associated with these techniques. The development of better x-ray methods and the growing expertise of multidisciplinary teams will undoubtedly make surgery for PD safer and more effective in the future.

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Krack, P., Batir, A., Van Blercom, N., Chabardes, S., Fraix, V., Ardouin, C., Koudsie, A., Limousin, P., Benazzouz, A., LeBas, J., Benabid, A., & Pollak, P. (2003). Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. , 349 (20), 1925-1934349 (20), 1925-1934

This study examined the long-term outcome of bilateral DBS-STN (stimulation in both sides of the brain) in 49 PD patients.  Patients were assessed on and off medication.  The Unified Parkinson's Disease Rating Scale (UPDRS), as well and neuropsychological tests, were administered at one, three, and five years after surgery.  The results at five-years showed 54% improvement in UPDRS motor scores when off medication.  Overall, speech functioning declined in these patients after five-years.  This decline was interpreted as a reflection of the expected decline in speech that one would see in non-surgery treated PD patients.  DBS-STN does not appear to confer any protection against declines in speech functioning in PD.

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Liotti, M., Ramig, L. O., Vogel, D., New, P., Cook, C. I., Ingham, R. J., Ingham, J. C., & Fox, P. T. (2003). Hypophonia in Parkinson's disease: Neural correlates of voice treatment revealed by PET. , Vol 60(3), 432-440Vol 60(3), 432-440

This study examined brain activation changes using positron emission tomography (PET; a procedure that allows a physician to examine the brain) in five individuals with idiopathic Parkinson's disease after treatment with the Lee Silverman Voice Treatment method.  This voice treatment method involves intensive voice and loudness training, including 16 sessions, four times a week, over a 1-month period.  The results found that successful voice treatment is accompanied by increases in activity in certain parts of the brain during the production of sound, and decreases in other parts of the brain during the production of sound and reading. These findings, though preliminary, provide the first evidence linking voice treatment of hypophonia (decrease in volume of speech) in PD to specific neural correlates (specific parts of the brain) during speech tasks.

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Neurology

de Swart, Bert J. M; Willemse, S. C; Maassen, B. A. M; Horstink, M. W. I. M. (2003). Improvement of voicing in patients with Parkinson's disease by speech therapy. Neurology, 60(3), 498-500.60(3), 498-500.

Speech therapy in Parkinson's disease (PD) patients focusing on an increase of phonatory-respiratory effort (the sound made by the combination of breathing and the vibration of the vocal cords) has adverse effects because it raises vocal pitch and laryngeal muscle tension. The authors' approach, the Pitch Limiting Voice Treatment (PLVT), increases loudness but at the same time sets vocal pitch at a better level. In this study, the Lee Silverman Voice Treatment ("think loud, think shout") and PLVT ("speak loud and low") are compared. Both treatments produce the same increase in loudness, but PLVT limits an increase in vocal pitch and prevents a strained or pressed voicing.

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Dromey, C., Kumar, R., Lang, A., & Lozano, A. (2000). An investigation of the effects of subthalamic nucleus stimulation on acoustic measures of voice. , 15 (6), 1132-113815 (6), 1132-1138

This study examined the effects of DBS-STN on acoustic measures of voice.  Seven patients were assessed before and six-months after bilateral DBS-STN.  Patient's speech was assessed both on and off medication during the pre and post-surgery evaluations.  Two primary speech variables were assessed: fundamental frequency and speech intensity.  Fundamental frequency corresponds to the listener's perception of pitch.  Speech intensity corresponds to the perception of how weak or strong a person's voice is.  The results found only modest improvements in speech functioning and, according to the authors, "the overall impact is not substantial and would not represent a functionally useful change in speech performance." The authors note that the patient's speech was only mildly impaired before surgery and therefore improvement may have been difficult to detect.

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Pinto, S., Gentil, M., Fraix, V., Benabid, A.L., & Pollak, P. (2003). Bilateral subthalamic stimulation effects on oral force control in Parkinson's disease. , 250, 179-187250, 179-187

This study examined the effects of DBS-STN on articulatory forces of the lips and tongue.  The authors note that although clinician-assessed speech may decline following DBS-STN, a detailed electrophysiological examination of oral control may be more sensitive to the impact DBS-STN has on oral motor control.  In a sample of 26 DBS-STN patients, this study found that while on stimulation, improvement in the initiation, speed, and strength of throat movements was found.  These findings help clear up the nature of akinetic (no voluntary motions) symptoms as they relate to speech functioning and suggest that subtle improvements in oral motor control can occur during STN stimulation.

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Krause, M., Fogel, W., Mayer, P., Kloss, M., & Tronnier, V. (2004). Chronic inhibition of the subthalamic nucleus in Parkinson's disease. , 219, 119-124219, 119-124

This study examined the effects of DBS-STN in 27 patients.  Patients were assessed with the UPDRS before and yearly after surgery.  The average follow-up time was 29.8 months (about 2 years).  Data were reported for changes in UPDRS scores in four conditions: off-meds/off-stimulation, on-meds/off stimulation, off-meds on stimulation, on-meds/on stimulation.  Consistent with other studies, significant improvements in motor functioning was seen in most patients.  The UPDRS has one item that assesses speech.  In this sample, after surgery when on-medication, speech was improved. However, when off-meds and on stimulation, speech actually worsened.

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Journal of Neurology, Neurosurgery, and Psychiatry

Ramig L.O., Sapir S., Countryman S., Pawlas A.A., O'Brien C., Hoehn M., & Thompson L.L. (2001). Intensive voice treatment (LSVT) for patients with Parkinson's disease: a 2 year follow up. Journal of Neurology, Neurosurgery, and Psychiatry, 71(4), 493-871(4), 493-8

This study examined 33 patients with idiopathic Parkinson’s disease (IPD) to assess long term (24 months) effects of the Lee Silverman voice treatment (LSVT), a method designed to improve vocal function in patients with Parkinson's disease. The 33 patients with IPD were stratified and randomly assigned to two treatment groups. One group received the LSVT, which emphasizes high phonatory-respiratory effort (the sound made by the combination of breathing and the vibration of the vocal cords), and the other group received respiratory therapy (RET), which emphasizes high respiratory effort alone. The LSVT was significantly more effective than the RET in improving (increasing) sound pressure level and semitone standard deviation immediately post-treatment and maintaining those improvements at 2 year follow up. The findings provide evidence for the efficacy of the LSVT as well as the long-term maintenance of these effects in the treatment of voice and speech disorders in patients with idiopathic Parkinson's disease.

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Journal of Neurology, Neurosurgery, and Psychiatry

Gentil, M., Garcia-Ruiz, P., Pollak, P., & Benabid, A. (1999). Effect of stimulation of the subthalamic nucleus on oral control of patients with parkinsonism. Journal of Neurology, Neurosurgery, and Psychiatry, 67, 329-33367, 329-333

This study examined oral control in 10 patients with DBS-STN compared to 14 normal control subjects.  Patients were assessed with the UPDRS and a device that measures compression forces of the lips and tongue.  Compared to the off-stimulation condition, the speech item from the UPDRS improved when stimulation was on, although for only one patient was their speech described as normal.  Stimulation resulted in a near-normalization of other motoric-speech variables, such as the force of lip and tongue movements and of oral-reaction time. 

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Journal of Neurology, Neurosurgery, and Psychiatry

Bejjani, B.P., Gervais, D., Arnulf, I., Papadopoulos, S., Demeret, S., Bonnet, A.M., Cornu, P., Damier, P., Agid, Y. (2000). Axial parkinsonian symptoms can be improved: the role of levodopa and bilateral subthalamic stimulation. Journal of Neurology, Neurosurgery, and Psychiatry, 68, 595-60068, 595-600

This study examined the synergistic effects of levodopa and DBS-STN in 10 PD patients.  Patients were assessed with the UPDRS before and six months after DBS-STN surgery.  The findings showed that speech was significantly improved by levodopa before surgery.  However, additional improvement in speech beyond the improvement seen using levodopa alone before surgery was not seen following DBS-STN.  These findings are consistent with other research that shows either no improvement or some decline in speech following DBS-STN.

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Journal of Medical Speech-Language Pathology

Sapir, S., Pawlas, A.A., Ramig, L.O., Countryman, S., O'Brien, C., Hoehn, M.M., & Thompson, L.A. (2001). Voice and speech abnormalities in Parkinson disease: Relation to severity of motor impairment, duration of disease, medication, depression, gender, and age. Journal of Medical Speech-Language Pathology, 9(4), 213-2269(4), 213-226

This study utilized two experienced speech pathologists to judge recordings of the "Rainbow Passage" for the presence or absence of voice, articulation, prosody, and fluency abnormalities in 42 individuals with idiopathic Parkinson disease (IPD). The prevalence of these abnormalities was then examined with respect to (1) severity of motor impairment, measured by the Unified Parkinson's Disease Rating Scale (UPDRS), section III; (2) disease duration; (3) depression, measured by the Montgomery Asberg Depression Rating Scale; (4) age; and (5) gender. Six participants were judged free of voice and speech abnormalities. All others (85.7%) had an abnormal voice, either alone (28%) or in combination with abnormal articulation (58%), fluency (39%), or rhythm/intonation (39%). Abnormal voice was prevalent even in participants with short duration of IPD and low UPDRS scores. Individuals with high UPDRS scores and/or long duration of IPD tended to have significantly more voice and speech abnormalities than individuals with lower UPDRS scores and/or shorter duration of IPD. This difference was related primarily to abnormalities in articulation and fluency. Voice and speech abnormalities did not correlate with depression, age, or gender. These findings are discussed with respect to the source of dysarthria (disturbance in speech) in IPD.

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Journal of Fluency Disorders

Goberman, A.M. & Blomgren, M. (2003). Parkinsonian speech disfluencies: Effects of L-dopa-related fluctuations. Journal of Fluency Disorders, 28(1), 55-7028(1), 55-70

As Parkinson's disease (PD) patients commonly exhibit changes in the dopamine levels (a neurotransmitter [a chemical] in the brain that affects the control of movement) accompanied by changes in motor performance, the present study examined disfluency (not having fluent speech) in PD patients to gain information on the role of dopamine in speech abnormalities. Nine PD patients with no history of developmental stuttering were recorded once before and twice after taking their morning medication (on separate days). They read a passage and produced a monologue. Within-word and overall speech disfluencies were calculated at each recording. Through motor testing, it was inferred that participants had relatively low dopamine levels before taking medication and relatively high dopamine levels after taking medication. There were no group changes in disfluency levels when the low-dopamine and high-dopamine states were compared. There were, however, significant differences in disfluencies between the PD participants and age-matched controls. The results of this study do not strongly support that excess dopamine influences stuttering.

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Journal of Communication Disorders

Schulz, G.M. & Grant, M.K. (2000). Effects of speech therapy and pharmacologic and surgical treatments on voice and speech in Parkinson's disease: A review of the literature. Journal of Communication Disorders, 33(1), 59-8833(1), 59-88

This article examined the different treatment approaches for persons with Parkinson's disease (PD) and examined the effects of these treatments on speech. Treatment methods reviewed include speech therapy, pharmacological, and surgical. Recent research has shown that speech therapy (when persons with PD are optimally medicated) has proven to be the most efficacious therapeutic method for improving voice and speech function. Therapeutic devices have included the voice amplifier, delayed auditory feedback (DAF), the wearable intensity biofeedback device, and a masking device. Pharmacological methods of treatment in isolation do not appear to significantly improve voice and speech function in PD across research studies. Surgical treatment methods including pallidotomy and deep brain stimulation may be significant treatment options that improve voice and speech function in some persons with PD. Furthermore, future research should examine the combination of these three treatment approaches to examine their effects on speech.

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