1. Speech Impairment in Parkinson’s Disease is Improved by Transcranial Application of Electromagnetic Fields By: Reuven Sandyk

2. Parkinson’s Disease Frequently associated with speech disturbance Affects 50-70% of patients An even greater percentage in advanced stages of disease

3. Parkinsonian Speech Impairment Monotonous pitch Slow rate Decrease in volume (hypophonia) Symptoms generally worse when patient is tired or anxious

4. In mid to advanced stages –Phonemes are less articulated Produces a hypokinetic dysarthria (stuttering) –Festinating speech Dysfluency may become worse as disease progresses

5. Hypothesis Treatment with weak electromagnetic fields (EMFs) applied transcranially

6. Case Report 52 year old radiologist Freezing of gate, increased difficulties with hypophonia and with articulation Mental depression, chronic insomnia Anxiety and autonomic symptoms Hyperkinetic dysarthria-particulaly severe during periods of mental stress Started on serotonergic medication one month before treatment started

7. Treatment Four years, one treatment session each week Treatment session Patient continued to take serotonergic and antiParkinsonian medications

8. Results 80-90% improvement in speech Impact of treatment is best the day after Effect of treatment lasts 5-6 days Continues to experience “on-off” fluctuations Dramatic improvement in cognitive functions Speech impairment was one of first symptoms to reappear

9. Discussion Stuttering observed in young children Acquired stuttering is rarely observed in adults Transient stuttering-left hemispheric lesions Acquired stuttering-bilateral cerebral lesions Prefrontal lobe, caudate-putamen, limbic system

10. Many symptoms associated with decreased levels of serotonin SSRIs may improve speech impairment Mechanisms by which EMFs improved speech impairment –Synaptic level –Synergistic interaction

11. Conclusion Transcranial applications of EMFs may provide a novel, nonpharmacologic approach to the management of speech impairment associated with Parkinsonism