A noninvasive imaging approach to understanding speech changes following deep brain stimulation in Parkinson's disease

Shalini Narayana, Adam Jacks, Donald A. Robin, Howard Poizner, Wei Zhang, Crystal Franklin, Mario Liotti, Deanie Vogel, Peter T. Fox

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Purpose: To explore the use of noninvasive functional imaging and "virtual" lesion techniques to study the neural mechanisms underlying motor speech disorders in Parkinson's disease. Here, we report the use of positron emission tomography (PET) and transcranial magnetic stimulation (TMS) to explain exacerbated speech impairment following subthalamic nucleus deep brain stimulation (STN-DBS) in a patient with Parkinson's disease. Method: Perceptual and acoustic speech measures, as well as cerebral blood flow during speech as measured by PET, were obtained with STN-DBS on and off. TMS was applied to a region in the speech motor network found to be abnormally active during DBS. Speech disruption by TMS was compared both perceptually and acoustically with speech produced with DBS on. Results: Speech production was perceptually inferior and acoustically less contrastive during left STN stimulation compared to no stimulation. Increased neural activity in left dorsal premotor cortex (PMd) was observed during DBS on. "Virtual" lesioning of this region resulted in speech characterized by decreased speech segment duration, increased pause duration, and decreased intelligibility. Conclusions: This case report provides evidence that impaired speech production accompanying STN-DBSmay result fromunintended activation of PMd. Clinical application of functional imaging and TMS may lead to optimizing the delivery of STNDBS to improve outcomes for speech production as well as general motor abilities.

Original languageEnglish (US)
Pages (from-to)146-161
Number of pages16
JournalAmerican Journal of Speech-Language Pathology
Issue number2
StatePublished - May 2009


  • Deep brain stimulation
  • Neuroimaging
  • Parkinson's disease
  • Transcranial magnetic stimulation

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Speech and Hearing
  • Otorhinolaryngology
  • Linguistics and Language


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