ESSA - TF - Artigos em revistas científicas
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Browsing ESSA - TF - Artigos em revistas científicas by Author "Accornero, Anna"
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- Deep brain stimulation fine-tuning in Parkinson’s disease: short pulse width effect on speechPublication . Fabbri, Margherita; Natale, Federico; Artusi, Carlo Alberto; Romagnolo, Alberto; Bozzali, Marco; Giulietti, Giovanni; Guimarães, Isabel; Rizonni, Mario Georgio; Accornero, Anna; Lopiano, Leonardo; Zibetti, MaurizioBackground: subthalamic nucleus deep brain stimulation (STN-DBS) may have a detrimental effect on speech in Parkinson’s disease (PD) patients and new stimulation technologies may help in addressing this issue. Objective: to evaluate the STN-DBS acute effect of 30 μs pulse width (30PW) versus conventional 60 μs PW (60PW) on speech and identify the core features of voice modified by 30PW. Methods: seven STN-DBS treated PD patients participated into a pilot cross-sectional study. Motor and speech performances were tested by means of both automatic analysis and blinded clinical evaluations in four stimulation conditions: 30PW and 60PW both at the usual amplitude and at an amplitude just below the threshold for stimulation-related side effects. Results: at the threshold amplitude, 30PW stimulation improved speech intelligibility for both words (p = 0.02) and sentences (p = 0.04), without worsening motor performance. A lower but not statistically significant voice variability and instability and percentage of stuttering disfluencies was also observed. The beneficial effect of 30PW detected by automatic analysis, was confirmed by patients’ perception. Conclusions: STN-DBS treated patients experiencing low speech intelligibility may benefit from a 30PW stimulation trial at a higher amplitude. Deep characterization of PD speech profiles may help in a better application of recent DBS hardware advances.
- Is lowering stimulation frequency a feasible option for subthalamic deep brain stimulation in Parkinson's disease patients with dysarthria?Publication . Fabbri, Margherita; Zibetti, Maurizio; Ferrero, Giulia; Accornero, Anna; Guimarães, Isabel; Rizzone, Mario Giorgio; Romagnolo, Alberto; Ferreira, Joaquim J; Lopiano, LeonardoBackground: The long-term effect of subthalamic nucleus deep brain stimulation (STN-DBS) on dysarthria can be detrimental. A transient beneficial effect of low-frequency stimulation (LFS) has been reported. Objective: to investigate if the magnitude of dysarthria could predict the effect of LFS on speech in STN-DBS PD patients and to verify whether the benefit is maintained over time. Methods: a cohort study, comparing 10 PD patients with severe speech impairment (MDS-UPDRS item 3.1≥3) with 10 PD patients with mild speech impairment (MDS-UPDRS item 3.1≤2), all submitted to STN-DBS. Patients were tested in: MED OFF/STIM OFF, MED OFF/STIM ON (130 Hz, high frequency stimulation [HFS]), MED OFF/STIM ON (60 Hz - LFS) and MED ON with both HFS and LFS. The following was assessed in all conditions: voice (fundamental frequency and jitter), speech (articulatory diadochokinesis [DDK], pitch variability, rate and intelligibility) and motor performance (MDS-UPDRS-III). Results: LFS compared to no stimulation and HFS, in the absence of L-dopa effect, significantly improved DDK and speech intelligibility for sentence, among patients with severe speech impairment. During the L-dopa effect, comparing LFS vs. HFS, there was a significant improvement of speech intelligibility in both groups. Five patients with severe speech impairment opted to maintain LFS. After six months, speech benefit was maintained but treatment adjustments were required. Conclusions: LFS may offer both an immediate and long-lasting improvement of speech in a subgroup of STNDBS patients with severe speech impairment during HFS. Nevertheless, its effect on motor symptoms may not be preserved over time.