Direct subthalamic nucleus stimulation influences speech and voice quality in Parkinson's disease patients.

BACKGROUND: DBS of the subthalamic nucleus (STN) considerably ameliorates cardinal motor symptoms in PD. Reported STN-DBS effects on secondary dysarthric (speech) and dysphonic symptoms (voice), as originating from vocal tract motor dysfunctions, are however inconsistent with rather deleterious outcomes based on post-surgical assessments. OBJECTIVE: To parametrically and intra-operatively investigate the effects of deep brain stimulation (DBS) on perceptual and acoustic speech and voice quality in Parkinson's disease (PD) patients. METHODS: We performed an assessment of instantaneous intra-operative speech and voice quality changes in PD patients (n = 38) elicited by direct STN stimulations with variations of central stimulation features (depth, laterality, and intensity), separately for each hemisphere. RESULTS: First, perceptual assessments across several raters revealed that certain speech and voice symptoms could be improved with STN-DBS, but this seems largely restricted to right STN-DBS. Second, computer-based acoustic analyses of speech and voice features revealed that both left and right STN-DBS could improve dysarthric speech symptoms, but only right STN-DBS can considerably improve dysphonic symptoms, with left STN-DBS being restricted to only affect voice intensity features. Third, several subareas according to stimulation depth and laterality could be identified in the motoric STN proper and close to the associative STN with optimal (and partly suboptimal) stimulation outcomes. Fourth, low-to-medium stimulation intensities showed the most optimal and balanced effects compared to high intensities. CONCLUSIONS: STN-DBS can considerably improve both speech and voice quality based on a carefully arranged stimulation regimen along central stimulation features.

Auditory cortical micro-networks show differential connectivity during voice and speech processing in humans.

The temporal voice areas (TVAs) in bilateral auditory cortex (AC) appear specialized for voice processing. Previous research assumed a uniform functional profile for the TVAs which are broadly spread along the bilateral AC. Alternatively, the TVAs might comprise separate AC nodes controlling differential neural functions for voice and speech decoding, organized as local micro-circuits. To investigate micro-circuits, we modeled the directional connectivity between TVA nodes during voice processing in humans while acquiring brain activity using neuroimaging. Results show several bilateral AC nodes for general voice decoding (speech and non-speech voices) and for speech decoding in particular. Furthermore, non-hierarchical and differential bilateral AC networks manifest distinct excitatory and inhibitory pathways for voice and speech processing. Finally, while voice and speech processing seem to have distinctive but integrated neural circuits in the left AC, the right AC reveals disintegrated neural circuits for both sounds. Altogether, we demonstrate a functional heterogeneity in the TVAs for voice decoding based on local micro-circuits.