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Voice tremor in patients with Essential tremor: Effects of deep brain stimulation of caudal zona incerta
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
2015 (English)Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
Abstract [en]

Background. Essential tremor (ET) is one of the most common adult-onset motor disorders and can be treated with deep brain stimulation (DBS) of the caudal Zona incerta (cZi). Stimulation of the cZi has been found to reduce overall tremor in patients with ET. However, few studies have reported specifically on voice tremor outcome in patients with ET receiving cZi-DBS.

Aim. The present study aimed at evaluating the effect of cZi-DBS on voice tremor in patients with ET.

Method. Twenty-six patients operated with cZi-DBS were evaluated under two conditions: without stimulation (Stim OFF) and with stimulation (Stim ON). Voice tremor was assessed based on recordings of sustained vowel productions using a 4-point rating scale in a blinded and randomised procedure. Averaged values of multiple assessments for each stimulus were used in statistical testing. The group of patients with voice tremor in Stim OFF was analysed separately from the group of patients without voice tremor in Stim OFF.

Results. Severity of voice tremor was significant lower in the Stim ON condition compared to the Stim OFF condition for the subgroup with initial voice tremor. Individual differences in voice tremor outcome were noticeable. Voice tremor prevalence was found to be 50% (13 patients).

Conclusions. On the group level, voice tremor in patients with ET was found to reduce when stimulating the cZi. However, individual differences in voice tremor outcomes suggest that not all patients benefit from cZi-DBS. Patients should be consulted and informed before surgery regarding individual differences in response to DBS treatment. 

Abstract [sv]

Bakgrund. Essentiell tremor (ET) är en av de vanligaste motoriska störningarna. ET kan behandlas med djup hjärnstimulering (DBS) i caudala Zona incerta (cZi). Stimulering av cZi har visat sig minska tremor generellt för patienter med ET. I dagsläget finns dock få studier gjorda där man rapporterat specifikt kring effekter av cZi-DBS med avseende på rösttremor hos patienter med ET.

Syfte. Denna studie syftade till att utvärdera effekten av cZi-DBS med avseende på rösttremor hos patienter med ET.

Metod. Tjugosex patienter, opererade med cZi-DBS, utvärderades under två olika tillstånd: utan stimulering (Stim OFF) och med stimulering (Stim ON). Rösttremor bedömdes utifrån inspelningar av uthållna vokalproduktioner med hjälp av en 4-gradig skala i en blindad och randomiserad bedömningsprocedur. Varje stimulus bedömdes flertalet gånger och medelvärdet av dessa bedömningar användes i efterföljande statistiska prövningar. Separata analyser gjordes för gruppen patienter med rösttremor i Stim OFF respektive för gruppen patienter utan rösttremor i Stim OFF.

Resultat. Grad av rösttremor var signifikant lägre med stimulering jämfört med utan stimulering för undergruppen med initial rösttremor. Individuella skillnader i rösttremorutfall var märkbara. Prevalens av rösttremor befanns vara 50 % (13 patienter). 

Slutsatser. Resultat på gruppnivå visade att svårighetsgrad av rösttremor minskade vid stimulering av cZi för patienter med ET. Individuella skillnader med avseende på rösttremor reflekterar dock att inte alla patienter tycks vara hjälpta av cZi-DBS. Patienter bör konsulteras och informeras före operation avseende individuella skillnader vid DBS-behandling.

Place, publisher, year, edition, pages
2015. , p. 16
Keywords [en]
Essential tremor, DBS, cZi, voice tremor, perceptual evaluation
Keywords [sv]
Essentiell tremor, DBS, cZi, rösttremor, perceptuell bedömning
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:umu:diva-98516OAI: oai:DiVA.org:umu-98516DiVA, id: diva2:783016
Educational program
Speech-Language Pathology
Supervisors
Examiners
Available from: 2015-01-26 Created: 2015-01-23 Last updated: 2015-01-28Bibliographically approved

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