Optimising speech outcomes in Deep Brain Stimulation for essential tremor
-
1
The University of Melbourne, Speech Neuroscience Unit, Australia
-
2
The University of Melbourne, Audiology and Speech Pathology, Australia
-
3
Bionics Institute, Australia
-
4
The University of Melbourne, Medical Bionics, Australia
-
5
St Vincent's, Neurology, Australia
-
6
The University of Manchester, School of Psychological Sciences, United Kingdom
Deep Brain Stimulation (DBS) is rapidly emerging as a safe and effective treatment option for mitigating the effects of tremor. Despite the relative success of DBS for treating tremor, a common and typically unquantified adverse effect of treatment is dysarthria (slurred speech). Current assessment protocols are driven by the qualitative judgements of treating clinicians and lack the sensitivity and objectivity required to make reliable decisions about treatment optimisation. Therefore we aimed to pilot a speech evaluation procedure that would form the basis of an objective clinical DBS optimisation tool for use in patients with tremor.
Six patients diagnosed with essential tremor receiving treatment via deep brain stimulation of the posterior sub-thalamic nucleus were recruited. Electrical stimulation parameters (i.e., pulse rate, pulse duration, and current amplitude) were systematically adjusted and speech samples recorded to identify the patient-specific settings required for optimal therapeutic benefit (reduced tremor) with minimal adverse effects (dysarthria). Altered speech production between stimulation parameters was quantified via acoustic analysis. Measures of timing (e.g., speech rate), intonation (e.g., pitch variation) and quality (e.g., noise-to-harmonics ratio) reflected increasing/decreasing levels of dysarthria (see associated figure).
Via this protocol we aim to understand the inter-relationship between the effects of the parameters as well as to develop a real-time objective system for surgeons to optimise these parameters for each patient. A secondary outcome is to increase our understanding of how electrical parameter settings are related to movement and speech, and how the optimal parameters are related to the nature of the individual’s pathology.
Acknowledgements
Supported by the Helen McPherson Smith Trust and the Colonial Foundation. The Bionics Institute acknowledges the support it receives from the Victorian Government through its Operational Infrastructure Support Program. APV is supported by an NHMRC Early Career Fellowship. We thank Mary Jones and Sarah Katthagen for their assistance in data collection.
References
Blomstedt P, Sandvik U, Tisch S. Deep brain stimulation in the posterior subthalamic area in the treatment of essential tremor. Movement Disorders 2010;25(10):1350-1356.
Rodriguez-Oroz MC, Obeso JA, Lang AE, et al. Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up. Brain 2005;128(10):2240-2249.
Keywords:
Speech,
Dysarthria,
Deep Brain Stimulation,
Essential Tremor,
assessment,
Electric Stimulation,
optimization
Conference:
ACNS-2012 Australasian Cognitive Neuroscience Conference, Brisbane, Australia, 29 Nov - 2 Dec, 2012.
Presentation Type:
Oral Presentation
Topic:
Language
Citation:
Vogel
AP,
McDermott
HJ,
Peppard
R and
McKay
CM
(2012). Optimising speech outcomes in Deep Brain Stimulation for essential tremor.
Conference Abstract:
ACNS-2012 Australasian Cognitive Neuroscience Conference.
doi: 10.3389/conf.fnhum.2012.208.00108
Copyright:
The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers.
They are made available through the Frontiers publishing platform as a service to conference organizers and presenters.
The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated.
Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed.
For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions.
Received:
25 Oct 2012;
Published Online:
07 Nov 2012.
*
Correspondence:
Dr. Adam P Vogel, The University of Melbourne, Speech Neuroscience Unit, Melbourne, Australia, vogela@unimelb.edu.au