視丘下核深部腦刺激對巴金森氏症個案言語表現初探

Preliminary Effect of Subthalamic Nucleus Stimulation on Parkinsonian Speech

10.6143/JSLHAT.2009.12.01

李慧欣(Huei-Shing Li)；李超群(Chao-Chun Li)；王南梅(Nan-Mai Wang)

深部腦刺激術 ； 視丘下核 ； 巴金森氏症 ； 運動不及吶語症 ； 言語分析 ； Subthalamic nucleus ； Deep brain stimulation ； Parkinson's disease ； Hypokinetic dysarthria ； Speech measures

台灣聽力語言學會雜誌

24期（2009 / 12 / 01）

1 - 17

繁體中文

巴金森氏症是一種神經退化性疾病，主要是中腦黑質分泌多巴胺的多巴胺神經細胞發生病變而使得其凋亡，導致多巴胺的分泌減少，造成動作問題等病狀，甚至言語或語言問題。深部腦刺激是目前巴金森氏症重要手術治療方法，將電極植入視丘下核並放出高頻率的電刺激，即可抑制視丘下核不當之電生理表現。本研究目的是比較五名巴金森氏症患者，接受雙側視丘下核深部腦刺激手術後，言語改變的型態，提供深部腦刺激對巴金森氏症患者在言語影響的初步數據。受試者為五名44至75歲巴金森氏症患者，接受雙側視丘下核深部腦刺激手術治療，言語機轉測量包括「口功能檢測」、「母音構音聲學評估」、「口語流暢度」、「嗓音聲學分析評估」。研究設計使用單一受試個案研究法，探討與比較視丘下核深部腦刺激治療前後言語表現。雖然患者之間有相當差異性，但三名患者(S1、S2、S3)在DBS-on加快說話動作功能、包括舌頭上下移動、唇舌輪替動作；而四名患者(S1、S2、S4、S5)增加舌頭的移動強度、S2改善聲帶閉合、發聲效率、以及四名患者(S2、S3、S4、S5)增加聲音持續性、三名患者(S1、S4、S5)增加口語流暢度。本研究提供國內視丘下核深部腦刺激手術對巴金森氏症患者言語成效初步數據，雖然五名患者在言語運動輪替、構音位置與強度、口語流暢度、嗓音功能呈現不同程度改善狀態，但是患者間表現差異大，未來研究需考量病患條件與分類，術後時間一致性、藥物使用、大樣本等因素。視丘下核深部腦刺激刺激於國內巴金森氏症患者，其言語的改變需接受長期追蹤與進一步關切。

Background: Parkinson's disease (PD) is a neurodegenerative disease. The cause of PD is the pathological change of dopaminergic neurons, and followed decreased dopamine secretion because of neurons apoptosis in midbrain substantia nigra. The lower dopamine level induces motor disorders, and even causes speech or language disorders. Subthalamic nucleus-deep brain stimulation (STN-DBS) is currently a standard therapy for PD patients. The effect of speech with (STN-DBS) remains controversial. Objectives: The purpose of this investigation was to present and compare the preliminary data of speech effect with (STN-DBS) performed on five Mandarin Chinese Parkinsonia patients. Methods: Five PD patients with bilateral STN-DBS, aged from 43 to 75 were included as subjects. Speech measures included diadochokinetic syllable rate test, articulation-acoustic analysis, verbal fluency rate, and voice evaluation and acoustic analysis. Design: Within subject design and Wilcoxon signed ranks test was used to compare result. Results: Speech effect of five patients with DBS-on and off indicated no significant level of difference on four measures; however, three to four subjects improved diado rate and the movement range of tongue, four subjects increased the maximum phonation time, three subjects increased verbal fluency, although the variability of subjects performance noticed. Conclusion: Preliminary data on speech effect of STN-DBS on five Chinese Parkinsonia patients were demonstrated. Inconsistent outcome of the performance suggests that future study should include subject selection criteria such as with/ without medication, longterm effects, as well as larger sample size. In addition to Parkinson hypokinetic dysarthria, language dimension should also be included in the future investigation.

1. 劉康渡（2005）。腦深層電刺激術─巴金森氏病最有效的外科治療方式。台北榮民總醫院演講摘要。檢自：http://www1.vghtpe.gov.tw/msg/80940701.htm
2. Breit, S.,Schulz, J. B.,Benabid, A. L.(2004).Deep brain stimulation.Cell Tissue Res,318(1),275-288.
3. Castner, J. E.,Chenery, H. J.,Silburn, P. A.,Coyne, T. J.,Sinclair, F.,Smith, E. R.(2008).Effects of subthalamic deep brain stimulation on noun/verb generation and selection from competing alternatives in Parkinson's disease.J Neurol Neurosurg Psychiatry,79(6),700-705.
4. Castner, J. E.,Copland, D. A.,Silburn, P. A.,Coyne, T. J.,Sinclair, F.,Chenery, H. J.(2008).Subthalamic stimulation affects homophone meaning generation in Parkinson's disease.J Int Neuropsychol Soc,14(5),890-894.
5. Chinta, S. J.,Andersen, J. K.(2005).Dopaminergic neurons.Int J Biochem Cell Biol,37(5),942-946.
6. Ciucci, M. R.,Barkmeier-Kraemer, J. M.,Sherman, S. J.(2008).Subthalamic nucleus deep brain stimulation improves deglutition in Parkinson's disease.Mov Disord,23(5),676-683.
7. Contarino, M. F.,Daniele, A.,Sibilia, A. H.,Romito, L. M.,Bentivoglio, A. R.,Gainotti, G.(2007).Cognitive outcome 5 years after bilateral chronic stimulation of subthalamic nucleus in patients with Parkinson's disease.J Neurol Neurosurg Psychiatry,78(3),248-252.
8. Darley, F. L.,Aronson, A. E.,Brown, J. R.(1969).Differential diagnostic patterns of dysarthria.J Speech Hear Res,12(2),246-269.
9. Derost, P. P.,Ouchchane, L.,Morand, D.,Ulla, M.,Llorca, P. M.,Barget, M.(2007).Is DBS-STN appropriate to treat severe Parkinson disease in an elderly population?.Neurology,68(17),1345-1355.
10. Dromey, C.,Kumar, R.,Lang, A. E.,Lozano, A. M.(2000).An investigation of the effects of subthalamic nucleus stimulation on acoustic measures of voice.Mov Disord,15(6),1132-1138.
11. Duffy, J. R.(1995).Motor speech disorders: Substrates, differential diagnosis, and management.St. Louis:Mosby.
12. Farrell, A.,Theodoros, D.,Ward, E.,Hall, B.,Silburn, P.(2005).Effects of neurosurgical management of Parkinson's disease on speech characteristics and oromotor function.J Speech Lang Hear Res,48(1),5-20.
13. Freed, D. B.(2000).Motor speech disorders: Diagnosis and treatment.San Diego, CA:Singular Thomson Learning.
14. Gentil, M.,Chauvin, P.,Pinto, S.,Pollak, P.,Benabid, A. L.(2001).Effect of bilateral stimulation of the subthalamic nucleus on parkinsonian voice.Brain Lang,78(2),233-240.
15. Gentil, M.,Garcia-Ruiz, P.,Pollak, P.,Benabid, A. L.(1999).Effect of stimulation of the subthalamic nucleus on oral control of patients with parkinsonism.J Neurol Neurosurg Psychiatry,67(3),329-333.
16. Gentil, M.,Pinto, S.,Pollak, P.,Benabid, A. L.(2003).Effect of bilateral stimulation of the subthalamic nucleus on parkinsonian dysarthria.Brain Lang,85(2),190-196.
17. Hassler, R.,Riechert, T.,Mundinger, F.,Umbach, W.,Ganglberger, J. A.(1960).Physiological observations in stereotaxic operations in extrapyramidal motor disturbances.Brain,83,337-350.
18. Hilker, R.,Voges, J.,Weisenbach, S.,Kalbe, E.,Burghaus, L.,Ghaemi, M.(2004).Subthalamic nucleus stimulation restores glucose metabolism in associative and limbic cortices and in cerebellum: evidence from a FDG-PET study in advanced Parkinson,s disease.J Cereb Blood Flow Metab,24(1),7-16.
19. Hutchison, W. D.,Allan, R. J.,Opitz, H.,Levy, R.,Dostrovsky, J. O.,Lang, A. E.(1998).Neurophysiological identification of the subthalamic nucleus in surgery for Parkinson's disease.Ann Neurol,44(4),622-628.
20. Iansek, R.,Rosenfeld, J. V.,Huxham, F. E.(2002).Deep brain stimulation of the subthalamic nucleus in Parkinson's disease.Med J Aust,177(3),142-146.
21. Kent, R. D.,Duffy, J. R.,Slama, A.,Kent, J. F.,Clift, A.(2001).Clinicoanatomic studies in dysarthria: Review, critique, and directions for research.J Speech Lang Hear Res,44(3),535-551.
22. Kolchinsky, A.(2001).Neurosurgical intervention for Parkinson's disease: An update.Surg Neurol,56(4),277-281.
23. Kopell, B. H.,Rezai, A. R.,Chang, J. W.,Vitek, J. L.(2006).Anatomy and physiology of the basal ganglia: implications for deep brain stimulation for Parkinson's disease.Mov Disord,21(14),S238-246.
24. Krack, P.,Pollak, P.,Limousin, P.,Hoffmann, D.,Xie, J.,Benazzouz, A.(1998).Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson's disease.Brain,121(Pt 3),451-457.
25. Lee, V. S.,Zhou, X. P.,Rahn, D. A.,Wang, E. Q.,Jiang, J. J.(2008).Perturbation and nonlinear dynamic analysis of acoustic phonatory signal in Parkinsonian patients receiving deep brain stimulation.J Commun Disord,41(6),485-500.
26. Levy, R.,Ashby, P.,Hutchison, W. D.,Lang, A. E.,Lozano, A. M.,Dostrovsky, J. O.(2002).Dependence of subthalamic nucleus oscillations on movement and dopamine in Parkinson's disease.Brain,125(Pt6),1196-1209.
27. Olanow, C. W.,Stern, M. B.,Sethi, K.(2009).The scientific and clinical basis for the treatment of Parkinson disease.Neurology,72(21_Supplement_4),S1-136.
28. Ondo, W.,Jankovic, J.,Schwartz, K.,Almaguer, M.,Simpson, R. K.(1998).Unilateral thalamic deep brain stimulation for refractory essential tremor and Parkinson's disease tremor.Neurology,51(4),1063-1069.
29. Pinto, S.,Gentil, M.,Krack, P.,Sauleau, P.,Fraix, V.,Benabid, A. L.(2005).Changes induced by levodopa and subthalamic nucleus stimulation on parkinsonian speech.Mov Disord,20(11),1507-1515.
30. Pinto, S.,Thobois, S.,Costes, N.,Le Bars, D.,Benabid, A.-L.,Broussolle, E.(2004).Subthalamic nucleus stimulation and dysarthria in Parkinson's disease: A PET study.Brain,127(3),602-615.
31. Putzer, M.,Barry, W. J.,Moringlane, J. R.(2008).Effect of bilateral stimulation of the subthalamic nucleus on different speech subsystems in patients with Parkinson's disease.Clin Linguist Phon,22(12),957-973.
32. Rezai, A. R.,Lozano, A. M.,Crawley, A. P.,Joy, M. L.,Davis, K. D.,Kwan, C. L.(1999).Thalamic stimulation and functional magnetic resonance imaging: Localization of cortical and subcortical activation with implanted electrodes. Technical note..J Neurosurg,90(3),583-590.
33. Rodriguez, R. L.,Fernandez, H. H.,Haq, I.,Okun, M. S.(2007).Pearls in patient selection for deep brain stimulation.Neurologist,13(5),253-260.
34. Rodriguez-Oroz, M. C.,Obeso, J. A.,Lang, A. E.,Houeto, J. L.,Pollak, P.,Rehncrona, S.(2005).Bilateral deep brain stimulation in Parkinson's disease: A multicentre study with 4 years follow-up.Brain,128(Pt 10),2240-2249.
35. Romito, L. M.,Contarino, M. F.,Ghezzi, D.,Franzini, A.,Garavaglia, B.,Albanese, A.(2005).High frequency stimulation of the subthalamic nucleus is efficacious in Parkin disease.J Neurol,252(2),208-211.
36. Romito, L. M.,Contarino, M. F.,Vanacore, N.,Bentivoglio, A. R.,Scerrati, M.,Albanese, A.(2009).Replacement of dopaminergic medication with subthalamic nucleus stimulation in Parkinson's disease: Long-term observation.Mov Disord,24(4),557-563.
37. 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.Brain and Language,87(2),253-258.
38. Shipley, K. G. M.,J.G.(1998).Assessment In Speech-Language Pathology: A Resource Manual (2nd ed.).San Diego:Singular Publising Group.
39. Siderowf, A.,Jaggi, J. L.,Xie, S. X.,Loveland-Jones, C.,Leng, L.,Hurtig, H.(2006).Long-term effects of bilateral subthalamic nucleus stimulation on health-related quality of life in advanced Parkinson's disease.Mov Disord,21(6),746-753.
40. Tripoliti, E.,Zrinzo, L.,Martinez-Torres, I.,Tisch, S.,Frost, E.,Borrell, E.(2008).Effects of contact location and voltage amplitude on speech and movement in bilateral subthalamic nucleus deep brain stimulation.Mov Disord,23(16),2377-2383.
41. Volkmann, J.,Albanese, A.,Kulisevsky, J.,Tornqvist, A. L.,Houeto, J. L.,Pidoux, B.(2009).Long-term effects of pallidal or subthalamic deep brain stimulation on quality of life in Parkinson's disease.Mov Disord,24(8),1154-1161.
42. Wang, E.,Verhagen Metman, L.,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.Clin Linguist Phon,17(4-5),283-289.
43. Watson, P.,Montgomery, E. B. ,Jr.(2006).The relationship of neuronal activity within the sensorimotor region of the subthalamic nucleus to speech.Brain Lang,97(2),233-240.
44. Whelan, B. M.,Murdoch, B. E.,Theodoros, D. G.,Hall, B.,Silburn, P.(2003).Defining a role for the subthalamic nucleus within operative theoretical models of subcortical participation in language.J Neurol Neurosurg Psychiatry,74(11),1543-1550.
45. Whelan, B. M.,Murdoch, B. E.,Theodoros, D. G.,Silburn, P.,Hall, B.(2005).Beyond verbal fluency:Investigating the long-term effects of bilateral subthalamic (STN) deep brain stimulation (DBS) on language function in two cases.Neurocase,11(2),93-102.
46. Yunusova, Y.,Weismer, G.,Westbury, J. R.,Lindstrom, M. J.(2008).Articulatory Movements During Vowels in Speakers With Dysarthria and Healthy Controls.J Speech Hear Res,51(3),596-611.
47. Zahodne, L. B.,Okun, M. S.,Foote, K. D.,Fernandez, H. H.,Rodriguez, R. L.,Kirsch-Darrow, L.(2009).Cognitive declines one year after unilateral deep brain stimulation surgery in Parkinson's disease: A controlled study using reliable change.Clin Neuropsychol,23(3),385-405.
48. 林欣榮(1997)。腦組織移植治療巴金森氏症。臺灣醫學，1(3)，6。
49. 戴春暉、郭鐘金(2006)。正常與巴金森氏症狀熊下之視丘下核電生理表現。Acta Neurologica Taiwanica，15(3)，11。

1. Hwang, Wen-Juh,Fang, Tsen,Chen, Li-Mei(2014).Speech Disorders of Voice Quality, Maximum Sound Prolongation, and S/Z Ratio in Patients with Parkinson's Disease.intergrams,15(1),1-22.