Surgical treatments and communication

♦ Surgical treatments for PD do not appear to have consistent significant benefit for the communication impairments associated with the disease. O Unilateral pallidotomy is usually not found to improve speech function and can cause cognitive and behavioural changes. O Bilateral pallidotomy is associated with an increase in the severity of pre-existing speech problems and a higher incidence of dysarthria and hypophonia. O Thalamotomy, especially when completed bilaterally, may cause dysarthria or increase its severity.

O Deep brain stimulation (DBS) applied to the globus pallidus interna may have a range of effects on speech function. These effects are variable, and responses could range from having improvement in speech function, to having no effect, to having a negative impact. O The effect of DBS on the subthalamic nucleus (STN) appears to be variable. There is some indication that speech may be differentially affected by left versus right stimulation, with selective left-sided-only stimulation interfering with speech production. In contrast, bilateral STN stimulation may have some limited beneficial impact on speech.

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