Auditory-Perceptual Evaluation of Deep Brain Stimulation on Voice and Speech in Patients With Dystonia |
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| Institution: | 2. Departments of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina;2. Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York;3. Department of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, California;2. Immunology Department, Edgard Santos University Hospital of the Federal University of Bahia-UFBA, Salvador, Bahia, Brazil;3. Department of Speech-Language Pathology and Post-Graduation Program in Human Communication Disorders, Federal University of Santa Maria-UFSM, Santa Maria, Rio Grande do Sul, Brazil;4. Health Sciences, Federal University of Bahia-UFBA, Salvador, Bahia, Brazil;5. Immunology Service, Edgard Santos University Hospital of the Federal University of Bahia-UFBA, Salvador, Bahia, Brazil;2. University of Pittsburgh Voice Center, University of Pittsburgh School of Medicine, Department of Otolaryngology, Pittsburgh, Pennsylvania;3. Istanbul University Faculty of Medicine, Department of Otolaryngology, Istanbul, Turkey;4. Center for Research on Health Care Data Center, University of Pittsburgh School of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania;2. Neurosciences Institute, University of Louvain, Brussels, Belgium |
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| Abstract: | ObjectiveTo determine the effects of globus pallidus interna (GPi) deep brain stimulation (DBS) on speech and voice quality of patients with primary, medically refractory dystonia.MethodsVoices of 14 patients aged ≥18 years (males = 7 and females = 7) with primary dystonia (DYT1 gene mutation dystonia = 4, cervical dystonia = 6, and generalized dystonia = 4) with bilateral GPi DBS were assessed. Five blinded raters (two fellowship-trained laryngologists and three speech/language pathologists) evaluated audio recordings of each patient pre- and post-DBS. Perceptual voice quality was rated using the Grade, Roughness, Breathiness, Asthenia, and Strain scale and changes in speech intelligibility were assessed with the Clinical Global Impression scale of Severity instrument. Inter-rater and intrarater reliability rates for perceptual voice ratings were assessed using the kappa coefficient.ResultsVoice quality parameters showed mean improvements in Grade (P < 0.0001), Roughness (P = 0.0043), and Strain (P < 0.0001) 12 months post-DBS. Asthenia increased from baseline to 6 months (P = 0.0022) and declined significantly from 6 to 12 months (P = 0.0170). Breathiness did not change significantly over time. Speech intelligibility also improved from 6 to 12 months (P = 0.0202) and from pre-DBS to 12 months post-DBS (P = 0.0022). Grade and Strain ratings had nearly perfect and substantial inter-rater agreement (0.84 and 0.71, respectively).ConclusionsVoice and speech intelligibility improved after bilateral GPi DBS for dystonia. GPi DBS may emerge as a potential treatment option for patients with medically refractory laryngeal dystonia. |
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