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158 Reviews in the Archive. Showing 141 to 158

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European Neurology

Moretti, R., Torre, P., Antonello, R. M., Capus, L., Gioulis, M., Marsala, S. Zambito, Cazzato, G., & Bava, A. (2003). Speech initiation hesitation' following subthalamic nucleus stimulation in a patient with Parkinson's disease. European Neurology, 49(4), 251-25349(4), 251-253

This article examined speech initiation hesitation in a 68 year-old male with Parkinson's disease after subthalamic nucleus stimulation (DBS-STN). The researchers found that one-month after his surgery, he reported difficulty in initiating speech. Initial stuttering was very limiting for the patient who began a word 3 to 4 times, repeating the first phoneme or the initial syllable. It is hypothesized that frontal lobe structures of the brain may play a role in language control and that speech initiation hesitation may result from damage to the circuitry between structures that are toward the middle of the brain (in the basal ganglia) and the frontal part of the brain.

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Pell, M.D. & Leonard, C.L. (2003). Processing emotional tone from speech in Parkinson's disease: A role for the basal ganglia. , 3(4), 275-2883(4), 275-288

In this study, twenty-one individuals with Parkinson's disease were tested to infer how basal ganglia dysfunction (dysfunction to structures that are near the middle of the brain) contribute to the processing of emotional speech tone. Non-demented individuals with and without Parkinson's disease (twenty-one in each group) completed neuropsychological tests (tests that assess brain function) and tasks that required them to process the meaning of emotional speech tone in various ways (discrimination, identification, emotional feature rating). The individuals with PD in this study were unable to discriminate, verbally identify, and rate five "basic" attributes of emotionally expressed utterances. Difficulties in comprehending emotional speech tone emerged in the absence of cognitive impairment and were not influenced by the severity of depressive signs in individuals with PD who had depression.

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Clinical Linguistics & Phonetics

Wang, E., Metman, L.V., Bakay, R., Arzbaecher, J., & Bernard, B. (2003). The effect of unilateral electrostimulation of the subthalamic nucleus on respiratory/phonatory subsystems of speech production in Parkinson's disease-a preliminary report. Clinical Linguistics & Phonetics, 17(4-5), 283-28917(4-5), 283-289

This paper reports findings on the respiratory/phonatory subsystems (systems that influence speech sounds, which are made by the vibration of the vocal cords) from an on-going study investigating the effect of unilateral stimulation (stimulation on one side of the brain) of the subthalamic nucleus (STN) on different speech subsystems in people with Parkinson's disease (PD). Speech recordings were made in the medication-off state at baseline, three months post surgery with stimulation-on, and with stimulation-off, in six right-handed PD patients (aged 38-63 yrs). Subjects completed several speech tasks. Acoustic analyses of the maximally sustained vowel phonation (the vowel sounds made by the vibration of the vocal cords) were reported. The results were compared to the scores of the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS-III) obtained under the same conditions. Results showed that stimulation-on improved UPDRS-III scores in all six subjects. While mild improvement was observed for all subjects in the stimulation-on condition, three subjects who received left-STN stimulation showed a significant decline in vocal intensity and vowel duration from their baseline. The authors claim that the speech production was very susceptible to lesions caused by the surgical procedure itself when the surgical site was in the dominant hemisphere (the left side of the brain in the majority of individuals).

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Clinical Linguistics & Phonetics

Hoffman-Ruddy, B., Schulz, G., Vitek, J., & Evatt, M. (2001). A preliminary study of the effects of sub thalamic nucleus (STN) deep brain stimulation (DBS) on voice and speech characteristics in Parkinson's Disease (PD). Clinical Linguistics & Phonetics, 15(1-2), 97-101 15(1-2), 97-101

This study was a preliminary investigation that looked at the effects of DBS of the STN on voice and speech characteristics in one male PD patient, aged 57 years, with a history of 7 years of documented symptoms. It explained the brain chemicals and structures that are influential in changes of speech. The consequences of neurological disruption to voice and speech characteristics of PD are the following: imprecise articulation, rapid speech rate with progressive acceleration and short rushes of speech, reduced stress of syllables, reduced loudness, a hoarse, tremorous and monotone voice. One of the recent treatment techniques to remediate the motor symptoms associated with PD is chronic deep brain stimulation (DBS). Their study concluded that DBS-STN had positive effects in the voice and speech measures utilized, which was indicative of increased support and coordination of multiple speech and voice subsystems (respiration, phonation, articulation, resonance, and prosody). The researchers claimed that a decrease in rigidity and bradykinesia (slow movement) can positively impact respiratory and laryngeal preparation for speech production. Furthermore, they found that increased speech intensity levels, pitch range, and acoustic measures directly correlated to the amount of subglottal pressure generation (subglottal pressure is pressure in the space between the vocal cords) and laryngeal muscle coordination.

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Santens, P., De Letter, M., Van Borsel, J., De Reuck, J., Caemaert, J. (2003). Lateralized effects of subthalamic nucleus stimulation on different aspects of speech in Parkinson's disease. , 87(2), 253-25887(2), 253-258

This article analyzed the effects of left and right subthalamic nuclei (STN) stimulation separately on different aspects of speech. Seven patients were included, and two tasks were used to evaluate speech in different STN stimulation conditions. First, the seven patients were asked to read a 200-word standard passage, then they were asked to perform sustained vowel "ah" phonation (the sound made by the vibration of the vocal cords). The two tasks were performed in four different conditions of STN stimulation: (1) left on, right off; (2) right on, left off; (3) bilateral stimulation off; and (4) bilateral stimulation on. Significant differences were found between left and right stimulation. It appears that selective left-sided stimulation has a profoundly negative effect on prosody (e.g., intonation, rhythm, or inflection in one's voice), articulation and hence intelligibility. Right-sided stimulation does not display this side-effect. There is no significant difference in speech characteristics between bilateral stimulation on and off. Thus, the authors suggest that a balanced tuning of bilateral basal ganglia networks (anatomical structures towards the middle of the brain that are effected by deep brain stimulation in PD patients) is necessary for good speech production.

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Gentil, M., Pinto, S., Pollack, P., & Benabid, A. (2003). Effect of bilateral stimulation of the subthalamic nucleus on parkinsonian dysarthria. , Vol 85(2), 190-196Vol 85(2), 190-196

This study examined speech production in 16 PD patients on and off bilateral DBS-STN stimulation.  The patients' speech was moderately impaired when assessed without medication and without stimulation.  Speech production was quantitatively assessed by measuring the force of the lips and tongue and the acoustic features (i.e., duration, vocal vibration, intensity) of vocal expression.  The results showed that on stimulation, patients showed a large increase in maximal force of the lips and tongue.  In addition, a reduction in speech pauses and an increase in phonemic length was observed during stimulation.  These results suggest some improvement in the motoric (related to the muscles influential in speech) and acoustic components of speech during stimulation, but the authors note that the results are not applicable to patients with more severe speech disorders.

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Gentil, M., Chauvin, P., Pinto, S., Pollak, P., & Benabid, A.L . (2001). Effect of bilateral stimulation of the subthalamic nucleus in parkinsonian voice. , 78, 233-24078, 233-240

This study examined the acoustic parameters of speech (including phonemic duration, fundamental frequency, and relative intensity) in various speech tasks in 26 PD patients while on or off stimulation.  The patients' speech was moderately impaired when assessed without medication and without stimulation.  The results showed that while on stimulation, patients were able to lengthen their maximal phonation time (the elapsed time of the speech sounds made by the vibration of the vocal cords) of sustained vowels and reduced their pauses in phrase repetitions during a 30 second speech sample.  Post surgery in an "on state", patients varied the pitch of their voice, and their speech sounded more normal and natural.

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Poewe, W., & Luginger, E, (1999). Depression in Parkinson's disease: Impediments to recognition and treatment options. , 52 (7 Suppl 3): S2-S652 (7 Suppl 3): S2-S6

These investigators provide a good review of the prevalence, recognition, and treatment options for depression in PD. They indicated that an independent abnormality rather than a maladaptive response to disease likely causes parkinsonian depression, in that the degree of depression is not correlated with PD severity. Prognostically, depressive features may represent a subtle premorbid state heralding the onset o PD or an accelerated cognitive decline thereafter. Therapeutic mainstays for parkinsonian depression are discussed.

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Berney, A., Vingerhoets, F., Perrin, A., Guex, P., Villemure, J-G, Burkard, P.R., Benkelfat, C., & Ghika, J. (2002. Effect on mood of subthalamic DBS for Parkinson's disease: A consecutive series of 24 patients. , 59, 1427-142959, 1427-1429

A series of 24 consecutive PD patients were prospectively studied prior to and within 6 months postoperatively for mood, motor, and cognitive status to investigate the effects on mood of DBS-STN in PD. In six patients (25%), mood state worsened significantly, and three were transiently suicidal despite clear motor improvement.

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Doshi, P.K., Chhaya, N., & Bhatt, M.H. (2002). Depression leading to attempted suicide after bilateral subthalamic nucleus stimulation for Parkinson's disease. , 17, 1084-108517, 1084-1085

Doshi and colleagues examined 31 patients after DBS-STN. Case reports were provided for three of their patients, as they became depressed after a successful STN stimulation, and one of them attempted suicide, despite clinical improvement.

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Houeto, J. L., Mesnage, V., Mallett, L., (2002). Behavioral disorders, Parkinson's disease and subthalamic stimulation. , 72, 701-70772, 701-707

Houeto and colleagues analyzed 24 parkinsonian patients who were successfully treated by bilateral STN stimulation for the presence of behavioral disorders. Improvement in parkinsonian motor disability is not necessarily accompanied by improvement in mood function and quality of life. Social adjustments were impaired in 15 patients. Behavioral and psychiatric changes that were seen in some of these patients included increased mood swings, aggressiveness, irritability, depressed mood, thoughts of suicide, social withdraw, and abnormal sexual behavior.

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Daniele, A., Albanese, A., Contarino, M.F., Zinzi, P., Barbier, A., Gasparini, F., Romito, L.M.A., Bentivoglio, A.R., & Scerrati, M. (2003). Cognitive and behavioural effects of chronic stimulation of the subthalamic nucleus in patients with Parkinson's disease. , 74, 175-18274, 175-182

Motor, cognitive, behavioral, and functional assessments were undertaken in 20 patients with PD before implantation and then at 3, 6, and 12 months afterwards. Nine patients were also examined at 18 months after surgery. On all postoperative assessments, there was an improvement in parkinsonian motor symptoms, quality of life, and activities of daily living while off antiparkinsonian drugs. A significant postoperative decrease in depressive and anxiety symptoms was observed across all assessments for most of the patients. Following implantation, three patients developed transient manic symptoms with hypersexuality.

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Thobois, S., Mertens, P., Guenot, M., Hermier, M., Mollion, H., Bouvard, M., Chazot, G., Broussolle, E., Sindou, M. (2002). Subthalamic nucleus stimulation in Parkinson's disease: Clinical evaluation of 18 patients. , 249, 529-524249, 529-524

Eighteen consecutive severely affected PD patients were evaluated clinically before and 6 months after the DBS-STN. Additionally, a 12 months follow-up was available in 14 patients. This study confirms the great value of subthalamic nucleus stimulation in the treatment of intractable PD. However, some individuals experienced episodes of depression following surgical procedures. Consequently, some adverse events, including depression, may be taken into account in the inclusion criteria and also in the post-operative outcome.

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Rao, S.M., Huber, S.J., & Bornstein, R.A. (1992). Emotional changes in multiple sclerosis and Parkinson's disease. , 60 (3), 369-37860 (3), 369-378

Patients with MS or PD exhibit a higher prevalence of emotional disorders relative to other patient groups with comparable degrees of physical disability. This article examines specific methodological issues associated with research in this area, describes the range and severity of emotional disorders in MS and PD, and examines both endogenous and reactive explanations to account for the increased prevalence of emotional dysfunction in these two disorders.

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Edwards, E., Kitt, C., Oliver, E., Finkelstein, J., Wagster, M., & McDonald, W. (2002). Depression and Parkinson's disease: A new look at an old problem. , 16, 39-4816, 39-48

These investigators provide a comprehensive overview of depression and PD. Topics include the impact of depression in PD, history and cause of depression in PD, neuroanatomical and neuropathological findings in PD and depression, somatic therapy in PD and depression, differential diagnosis of emotional disturbances in PD, relationship of dementia and depression, and recommendations for future studies.

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Brooks, D. & Doder, M. (2001). Depression in Parkinson's disease. , 14 (4), 465-47014 (4), 465-470

Brooks and Doder provide an overview of depression in Parkinson's disease.

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Morrison, C.E., Borod, J.C., Perrine, K., Beric, A., Brin, M.F., Rezai, A., Kelly, P., Sterio, D., Germano, I., Weisz, D., & Olanow, C.W. (2003). Neuropsychological functioning following bilateral subthalamic nucleus stimulation in Parkinson's disease. , 1-171-17

Seventeen PD patients were tested before and after bilateral DBS-STN, both on and off stimulation. Eleven matched PD controls were used for comparison. Relative to changes seen in the controls, the surgery for electrode placement mildly adversely affected attention and language functions. STN stimulation, per se, had little effect on cognition. The DBS-STN procedure as a whole resulted in a mild decline in delayed verbal recall and language functions. There were no surgery, stimulation, or procedure effects on depression scale scores.

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Ardouin, C., Pillon, B., Peiffer, E., et al. (1999). Bilateral subthalamic or pallidal stimulation for Parkinson's disease affects neither memory nor executive functions: a consecutive series of 62 patients. , 46, 217-223.46, 217-223.

The aim of this study was to assess the influence of bilateral stimulation of the STN or internal globus pallidus on cognition and mood in Parkinson's disease. Sixty-two patients were assessed before and after 3 to 6 months of chronic bilateral stimulation of the subthalamic nucleus (n = 49) or internal globus pallidus (n = 13). There were limited changes in cognition following the surgery. There was a deterioration on a word-generation task. There was also a mild but significant improvement in mood. This article concluded that stimulation of the subthalamic nucleus or internal globus pallidus does not change the overall cognitive performance in Parkinson's disease.

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