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Comprehensive Evaluation of Voice-Specific Outcomes in Patients With Essential Tremor Before and After Deep Brain Stimulation

Published:October 16, 2020DOI:https://doi.org/10.1016/j.jvoice.2020.09.013

      Summary

      Objective

      Deep brain stimulation (DBS) is a treatment for medically refractory essential tremor (ET), but there is a paucity of literature examining the effects of DBS on voice in patients with ET pre-DBS and post-DBS. This study aimed to report a comprehensive evaluation of voice in patients with ET pre-DBS and 6-months post-DBS.

      Study Design

      Case series.

      Methods

      Five patients receiving DBS for ET underwent voice evaluations pre-DBS and 6-months post-DBS. One patient had concurrent ET of the vocal tract (ETVT). The evaluation included patient-reported, perceptual, acoustic, and phonatory aerodynamic analyses of voice. Voice Handicap Index-10, Grade, Roughness, Breathiness, Asthenia, Strain Scale, perturbation measures, cepstral spectral index of dysphonia, cepstral peak prominence, and mean phonatory airflow measures were also among the data collected.

      Results

      Patients with ET presented with minimal changes in perceptual, acoustic, and phonatory aerodynamic parameters. Perceived vocal roughness significantly increased 6-months post-DBS (P = 0.047). The patient with ETVT presented with clinically significant improvement in almost all collected voice parameters 6-months post-DBS.

      Conclusion

      This is the first study to provide data encompassing auditory perceptual voice analysis, voice-specific patient-reported quality of life measures, acoustic, and phonatory aerodynamic outcomes in patients pre-DBS and 6-months post-DBS for ET. The results of our preliminary study have implications for the use of a comprehensive voice assessment to identify and measure change in voice outcomes in patients with ET and ETVT pre- and postsurgery.

      Key Words

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      References

        • Louis ED
        • Ferreira JJ.
        How common is the most common adult movement disorder? Update on the worldwide prevalence of essential tremor throughout the world.
        Mov Disord. 2010; 25: 534-541
        • Deuschl G
        • Bain P
        • Brin M
        • et al.
        Consensus statement of the movement disorder society on tremor.
        Mov Disord. 1998; 13: 2-23
        • Bhatia KP
        • Bain P
        • Bajaj N
        • et al.
        Consensus statement on the classification of tremors. From the task force on tremor of the International Parkinson and Movement Disorder Society.
        Mov Disord. 2018; 33: 75-87
        • Sulica L
        • Louis ED.
        Clinical characteristics of essential voice tremor: a study of 34 cases.
        Laryngoscope. 2010; 120: 516-528
        • Wolraich D
        • Vasile Marchis-Crisan C
        • Redding N
        • et al.
        Laryngeal tremor: co-occurrence with other movement disorders.
        Otorhinolaryngol Relat Spec. 2010; 72: 291-294
        • Koller WC
        • Hristova A
        • Brin MF
        Pharmacologic treatment of essential tremor.
        Neurology. 2000; 54: S30-S38
        • Blitzer A
        • Crumley RL
        • Dailey SH
        • et al.
        Recommendations of the Neurolaryngology Study Group on laryngeal electromyography.
        Otolaryngol Head and Neck Surg. 2009; 140 (782-703)
        • Benabid AL
        • Pollak P
        • Dongming G
        • et al.
        Chronic electrical stimulation of the ventralis intermediate nucleus of the thalamus as a treatment of movement disorders.
        J Neurosurg. 1996; 84: 203-214
        • Hubble JP
        • Busenbark KL
        • Wilkinson S
        • et al.
        Deep brain stimulation for essential tremor.
        Neurology. 1996; 46: 1150-1153https://doi.org/10.1212/WNL.46.4.1150
        • Koller W
        • Pahwa R
        • Busenbark K
        • et al.
        High-frequency unilateral thalamic stimulation in the treatment of essential and parkinsonian tremor.
        Ann Neurol. 1997; 42: 292-299
        • Ondo W
        • Jankovic J
        • Schwartz K
        • et al.
        Unilateral thalamic deep brain stimulation for refractory essential tremor and Parkinson's disease tremor.
        Neurology. 1998; 51: 1063-1069
        • Pahwa R
        • Lyons KL
        • Wilkinson SB
        • et al.
        Bilateral thalamic stimulation for the treatment of essential tremor.
        Neurology. 1999; 53: 1447-1450
        • Rehncrona S
        • Johnels B
        • Widner H
        • et al.
        Long-term efficacy of thalamic deep brain stimulation for tremor: double blind assessments.
        Mov Disord. 2003; 18: 163-170
        • Zesiewicz TA
        • Elble R
        • Louis ED
        Practice parameter: therapies for essential tremor: report of the quality standards subcommittee of the American academy of neurology.
        Neurology. 2005; 64: 2008-2020
        • Hawkshaw MJ
        • Sataloff RT.
        Deep brain stimulation for treatment of voice disorders.
        J Voice. 2012; 26: 769-771
        • Taha JM
        • Janszen MA
        • Favre J
        Thalamic deep brain stimulation for the treatment of head, voice, and bilateral limb tremor.
        J Neurosurg. 1999; 91: 68-72
        • Kundu B
        • Schrock L
        • Davis T
        • et al.
        Thalamic deep brain stimulation for essential tremor also reduces voice tremor.
        Neuromodulation Technol Neural Interface. 2018; 21: 748-754
        • Sataloff RT
        • Heuer RJ
        • Munz M
        Vocal tremor reduction with deep brain stimulation: a preliminary report.
        J Voice. 2002; 16: 132-135
        • Ho AL
        • Erickson-DiRenzo E
        • Pendharkar AV
        • et al.
        Deep brain stimulation for vocal tremor: a comprehensive, multidisciplinary methodology.
        Neurosurg Focus. 2015; 38: E6
        • Fahn S
        • Tolosa E
        • Concepcion M
        Clinical rating scale for tremor.
        (editors)in: Jankovic J Tolosa E Parkinson's Disease and Movement Disorders. 2nd ed. Williams and Wilkins, Baltimore1993
        • Webb AL
        • Carding PN
        • Deary IJ
        • et al.
        The reliability of three perceptual evaluation scales for dysphonia.
        Eur Arch Otorhinolaryngol. 2004; 261: 429-434
        • Patel R
        • Connaghan K
        • Franco D
        • et al.
        "The caterpillar": a novel reading passage for assessment of motor speech disorders.
        Am J Speech Lang Pathol. 2013; 22: 1-9
        • Rosen CA
        • Lee AS
        • Osborne J
        • et al.
        Development and validation of the voice handicap index-10.
        Laryngoscope. 2004; 114: 1549-1556
        • Arffa RE
        • Krishna P
        • Gartner-Schmidt J
        • et al.
        Normative values for the voice handicap index-10.
        J Voice. 2012; 26: 462-465
        • Goodglass H
        • Kaplan E.
        The Assessment of Aphasia and Related Disorders.
        Lea & Febiger, Philadelphia, PA1983
        • Heman-Ackah YD
        • Heuer RJ
        • Michael DD
        • et al.
        Cepstral peak prominence: a more reliable measure of dysphonia.
        Ann Otol Rhinol Laryngol. 2003; 112: 324-333
        • Awan SN
        • Roy N
        • Jette ME
        • et al.
        Quantifying dysphonia severity using a spectral/cepstral-based acoustic index: comparisons with auditory-perceptual judgments from the Cape-V.
        Clin Linguist Phon. 2010; 24: 742-758
        • Awan SN
        • Roy N
        • Zhang D
        Validation of the cepstral spectral index of dysphonia (CSID) as a screening tool for voice disorders: development of clinical cutoff scores.
        J Voice. 2016; 30: 130-144
        • Peterson EA
        • Roy N
        • Awan SN
        • et al.
        Toward validation of the cepstral spectral index of dysphonia (CSID) as an objective treatment outcomes measure.
        J Voice. 2013; 27: 401-410
        • Kempster GB
        • Gerratt BR
        • Verdolini Abbott KB
        • et al.
        Consensus auditory‐perceptual evaluation of voice: development of a standardized clinical protocol.
        Am J Speech Lang Pathol. 2009; 18: 124-132
        • Lewandowski A
        • Gillespie A
        • Kridgen S
        • et al.
        Adult normative data for phonatory aerodynamics in connected speech.
        Laryngoscope. 2017; 128: 904-915
        • Gartner-Schmidt J
        • Hirai R
        • Dastolfo C
        • et al.
        Phonatory aerodynamics in connected speech.
        Laryngoscope. 2015; 125: 2764-2771
        • KayPENTAX
        Software Instruction Manual: Real-Time Pitch Model 5151.
        KayPENTAX, Lincoln Park, NJ2009: 71-72
        • KayPENTAX
        Software Instruction Manual: Multi-dimensional Voice Program Model 5105.
        KayPENTAX, Lincoln Park, NJ2008: 133-188
        • KayPENTAX
        Software Instruction Manual: Analysis of Dysphonia in Speech and Voice Model 5109.
        KayPENTAX, Montvale, NJ2011: 46-48
        • KayPENTAX
        Instruction Manual: Phonatory Aerodynamic System (PAS) Model 6600.
        KayPENTAX, Montvale, NJ2010
        • Louis ED
        • Gerbin M.
        Voice handicap in essential tremor: a comparison with normal controls and Parkinson's disease.
        Tremor Other Hyperkinet Mov (N Y). 2013; 3 (tre-03-114-970-1)https://doi.org/10.7916/D8KD1WN3
        • Jacobson GA
        • Johnson A
        • Grywalski C
        • et al.
        The voice handicap index: development and validation.
        Am J Speech Lang Pathol. 1997; 6: 66-70
        • Finger ME
        • Madden LL
        • Haq IU
        • et al.
        Analysis of the prevalence and onset of dysphonia and dysphagia symptoms in movement disorders at an academic medical center.
        J Clin Neurosci. 2019; 64: 111-115
        • Dastolfo C
        • Gartner‐Schmidt J
        • Yu L
        • et al.
        Aerodynamic outcomes of four common voice disorders: moving toward disorder‐specific assessment.
        J Voice. 2016; 30: 301-307
        • Titze IR
        • Liang H.
        Comparison of Fo extraction methods for high precision voice perturbation measurements.
        J Speech Hearing Res. 1993; 36: 1120-1133
        • Bové M
        • Daamen N
        • Rosen C
        • et al.
        Development and validation of the vocal tremor scoring system.
        Laryngoscope. 2006; 116: 1662-1667
        • Della Flora E
        • Perera C
        • Cameron A
        • et al.
        Deep brain stimulation for essential tremor: a systematic review.
        Mov Disord. 2010; 25: 1550-1559
        • Louis E
        • Gillman A.
        Factors associated with receptivity to deep brain stimulation surgery among essential tremor cases.
        Parkinsonism Relat Disord. 2011; 17: 482-485