Subthalamic Stimulation Reduces Vowel Space at the Initiation of Sustained Production: Implications for Articulatory Motor Control in Parkinson's Disease

John J Sidtis, Amy G Alken, Michele Tagliati, Ron Alterman, Diana Van Lancker Sidtis, John J Sidtis, Amy G Alken, Michele Tagliati, Ron Alterman, Diana Van Lancker Sidtis

Abstract

Background: Stimulation of the subthalamic nuclei (STN) is an effective treatment for Parkinson's disease, but complaints of speech difficulties after surgery have been difficult to quantify. Speech measures do not convincingly account for such reports.

Objective: This study examined STN stimulation effects on vowel production, in order to probe whether DBS affects articulatory posturing. The objective was to compare positioning during the initiation phase with the steady prolongation phase by measuring vowel spaces for three "corner" vowels at these two time frames.

Methods: Vowel space was measured over the initial 0.25 sec of sustained productions of high front (/i/), high back (/u/) and low vowels (/a/), and again during a 2 sec segment at the midpoint. Eight right-handed male subjects with bilateral STN stimulation and seven age-matched male controls were studied based on their participation in a larger study that included functional imaging. Mean values: age = 57±4.6 yrs; PD duration = 12.3±2.7 yrs; duration of DBS = 25.6±21.2 mos, and UPDRS III speech score = 1.6±0.7. STN subjects were studied off medication at their therapeutic DBS settings and again with their stimulators off, counter-balanced order.

Results: Vowel space was larger in the initiation phase compared to the midpoint for both the control and the STN subjects off stimulation. With stimulation on, however, the initial vowel space was significantly reduced to the area measured at the mid-point. For the three vowels, the acoustics were differentially affected, in accordance with expected effects of front versus back position in the vocal tract.

Conclusions: STN stimulation appears to constrain initial articulatory gestures for vowel production, raising the possibility that articulatory positions normally used in speech are similarly constrained.

Keywords: Deep brain stimulation; Parkinson’s disease; speech; subthalamic nucleus; vowels.

Figures

Fig.1
Fig.1
Vowel space for /a/, /i/, and /u/ representing the initial 250 msec of the production and a 2 sec portion at the production midpoint. The PD subjects were studied twice, once with STN-DBS on and once with the stimulation off. Parkinson’s medications were withheld for 12 hrs prior to testing in both conditions. The age-matched normal subjects were studied once.
Fig.2
Fig.2
Average F2 values across vowels for the three study conditions. Asterisks indicate significant differences between groups (p < 0.05).

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