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Journal of Neural Transmission

, Volume 122, Issue 12, pp 1663–1672 | Cite as

Characteristic laryngoscopic findings in Parkinson’s disease patients after subthalamic nucleus deep brain stimulation and its correlation with voice disorder

  • Takashi Tsuboi
  • Hirohisa Watanabe
  • Yasuhiro Tanaka
  • Reiko Ohdake
  • Noritaka Yoneyama
  • Kazuhiro Hara
  • Mizuki Ito
  • Masaaki Hirayama
  • Masahiko Yamamoto
  • Yasushi Fujimoto
  • Yasukazu Kajita
  • Toshihiko Wakabayashi
  • Gen SobueEmail author
Neurology and Preclinical Neurological Studies - Original Article

Abstract

Speech and voice disorders are one of the most common adverse effects in Parkinson’s disease (PD) patients treated with subthalamic nucleus deep brain stimulation (STN-DBS). However, the pathophysiology of voice and laryngeal dysfunction after STN-DBS remains unclear. We assessed 47 PD patients (22 treated with bilateral STN-DBS (PD-DBS) and 25 treated medically (PD-Med); all patients in both groups matched by age, sex, disease duration, and motor and cognitive function) using the objective and subjective voice assessment batteries (GRBAS scale and Voice Handicap Index), and laryngoscopy. Laryngoscopic examinations revealed that PD-DBS patients showed a significantly higher incidence of incomplete glottal closure (77 vs 48 %; p = 0.039), hyperadduction of the false vocal folds (73 vs 44 %; p = 0.047), anteroposterior hypercompression (50 vs 20 %; p = 0.030) and asymmetrical glottal movement (50 vs 16 %; p = 0.002) than PD-Med patients. On- and off-stimulation assessment revealed that STN-DBS could induce or aggravate incomplete glottal closure, hyperadduction of the false vocal folds, anteroposterior hypercompression, and asymmetrical glottal movement. Incomplete glottal closure and hyperadduction of the false vocal folds significantly correlated with breathiness and strained voice, respectively (r = 0.590 and 0.539). We should adjust patients’ DBS settings in consideration of voice and laryngeal functions as well as motor function.

Keywords

Parkinson’s disease Subthalamic nucleus deep brain stimulation Laryngoscope Voice disorder Dysarthria 

Notes

Acknowledgments

This study was supported by Health and Labor Sciences Research grants for research on measures for intractable diseases and comprehensive research on aging and health from the Ministry of Health, Labor and Welfare, Japan. The authors would like to thank Enago (www.enago.jp) for the English language review.

Compliance with ethical standards

Conflict of interest

None.

Supplementary material

Segment 1. Patient 1 had moderate incomplete glottal closure, mild hyperadduction of the false vocal folds, and asymmetrical glottal movement in the on-stimulation condition. Thirty minutes after stopping stimulation, incomplete glottal closure was marginally ameliorated and asymmetrical glottal movement disappeared. (MP4 16520 kb)

Segment 2. Patient 2 had moderate incomplete glottal closure, severe hyperadduction of the false vocal folds, anteroposterior hypercompression, and asymmetrical glottal movement in the on-stimulation condition. Thirty minutes after stopping stimulation, incomplete glottal closure and anteroposterior hypercompression disappeared and hyperadduction of the false vocal folds slightly improved. (MP4 18507 kb)

Segment 3. Patient 6 had severe incomplete glottal closure, severe hyperadduction of the false vocal folds, anteroposterior hypercompression, and asymmetrical glottal movement in the on-stimulation condition. Incomplete glottal closure, hyperadduction of the false vocal folds, and anteroposterior hypercompression disappeared with off-stimulation of the left-side DBS. (MP4 18005 kb)

702_2015_1436_MOESM4_ESM.xlsx (26 kb)
Supplementary material 4 (XLSX 26 kb)

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Copyright information

© Springer-Verlag Wien 2015

Authors and Affiliations

  • Takashi Tsuboi
    • 1
  • Hirohisa Watanabe
    • 1
  • Yasuhiro Tanaka
    • 1
  • Reiko Ohdake
    • 1
  • Noritaka Yoneyama
    • 1
  • Kazuhiro Hara
    • 1
  • Mizuki Ito
    • 1
  • Masaaki Hirayama
    • 1
  • Masahiko Yamamoto
    • 2
  • Yasushi Fujimoto
    • 3
  • Yasukazu Kajita
    • 4
  • Toshihiko Wakabayashi
    • 4
  • Gen Sobue
    • 1
    Email author
  1. 1.Department of NeurologyNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Faculty of Psychological and Physical ScienceAichi-Gakuin UniversityAichiJapan
  3. 3.Department of OtorhinolaryngologyNagoya University Graduate School of MedicineNagoyaJapan
  4. 4.Department of NeurosurgeryNagoya University Graduate School of MedicineNagoyaJapan

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