CoDAS
https://codas.org.br/article/doi/10.1590/2317-1782/20232023055en
CoDAS
Original Article

Did the speech of patients with Myasthenia Gravis decline over 4 years?

Annelise Ayres; Marina Martins Pereira Padovani; Maira Rozenfeld Olchik; Maiara Laís Mallmann Kieling; Vanessa Brzoskowski dos Santos; Rui Rothe-Neves; Mara Behlau

Downloads: 0
Views: 314

Abstract

ABSTRACT: Purpose: To compare the speech and voice patterns of myasthenia gravis (MG) patients over four years, and correlate the results with clinical aspects of the disease.

Methods: Data was collected for 4 years. The clinical assessment tools included the Quantitative Myasthenia Gravis (QMG) score, the Myasthenia Gravis Foundation of America (MGFA) clinical classification, and the Myasthenia Gravis Quality of Life 15-item Scale (MG-QoL). To assess speech, the recorded speaking tasks were analyzed acoustically and given auditory-perceptual ratings. Sex (equal distribution) and age (p=0.949) were used as matching criteria in the final sample, which consisted of 10 individuals in the MG group (MGG) and 10 individuals in the control group (CG).

Results: After 4 years, the MG participants presented stable health status, increased mild and moderate dysarthria (from 40% to 90% of the subjects), and a significant deterioration in the respiration, phonation, and articulation subsystems. The acoustic analysis showed a decline in articulatory patterns (speech rate p=0.047, articulation rate p=0.007, mean syllable duration p=0.007) and vocal quality (increased jitter p=0.022). In the follow-up comparison, there was a significant difference between the phonation variables (shimmer and harmonic-to-noise ratio) of the MGG and CG.

Conclusion: The MG patients presented a decline in speech over four years and an increase in mild and moderate dysarthria. Despite presenting stable health status, their respiratory, phonatory, and articulatory subsystems worsened. There was no correlation between speech patterns and clinical characteristics of the disease (severity and motor scale).

Keywords

Speech, Voice, Dysarthria, Speech Acoustics, Myasthenia Gravis

Referencias

1 Juel VC, Massey JM. Myasthenia gravis. Orphanet J Rare Dis. 2007;2(1):44. PMid:17986328.

2 Meriggioli MN, Sanders DB. Autoimmune myasthenia gravis: emerging clinical and biological heterogeneity. Lancet Neurol. 2009;8(5):475-90. PMid:19375665.

3 Jayam Trouth A, Dabi A, Solieman N, Kurukumbi M, Kalyanam J. Myasthenia Gravis: a review. Autoimmune Dis. 2012;2012:874680. http://dx.doi.org/10.1155/2012/874680 PMid:23193443.

4 Deenen JCW, Horlings CGC, Verschuuren JJGM, Verbeek ALM, van Engelen BGM. The epidemiology of neuromuscular disorders: a comprehensive overview of the literature. J Neuromuscul Dis. 2015;2(1):73-85. http://dx.doi.org/10.3233/JND-140045 PMid:28198707.

5 Montero-Odasso M. Dysphonia as first symptom of late-onset myasthenia gravis. J Gen Intern Med. 2006;21(6):C4-6. PMid:16808732.

6 Mao VH, Abaza M, Spiegel JR, Mandel S, Hawkshaw M, Heuer RJ, et al. Laryngeal Myasthenia Gravis: report of 40 cases. J Voice. 2001;15(1):122-30. PMid:12269627.

7 David Neal G, Clarke LR. Neuromuscular disorders. Otolaryngol Clin North Am. 1987;20(1):195-201. PMid:3550594.

8 Ayres A, Winckler PB, Jacinto-Scudeiro LA, Rech RS, Padovani MMP, Jotz GP, et al. Speech characteristics in individuals with myasthenia gravis: a case control study. Logoped Phoniatr Vocol. 2022;47(1):35-42. PMid:33106062.

9 Duffy J. Motor speech disorders: substrates, differential diagnosis, and management. 4. ed. Cidade: Elsevier; 2013.

10 Ortiz KZ, Carrillo L. Comparação entre as análises auditiva e acústica nas disartrias. Rev Soc Bras Fonoaudiol. 2008;13(4):325-31. http://dx.doi.org/10.1590/S1516-80342008000400005

11 Liu WB, Xia Q, Men LN, Wu ZK, Huang RX. Dysphonia as a primary manifestation in myasthenia gravis (MG): a retrospective review of 7 cases among 1520 MG patients. J Neurol Sci. 2007;260(1–2):16-22. PMid:17466337.

12 Konstantopoulos K, Christou YP, Vogazianos P, Zamba-Papanicolaou E, Kleopa KA. A quantitative method for the assessment of dysarthrophonia in myasthenia gravis. J Neurol Sci. 2017;377:42-6. PMid:28477705.

13 Harris L, Graham S, MacLachlan S, Exuzides A, Jacob S. A retrospective longitudinal cohort study of the clinical burden in myasthenia gravis. BMC Neurol. 2022;22(1):172. PMid:35534810.

14 Burns TM, Grouse CK, Conaway MR, Sanders DB. Construct and concurrent validation of the MG-QOL15 in the practice setting. Muscle Nerve. 2010;41(2):219-26. PMid:19941339.

15 Mourão AM, Barbosa LSM, Comini-Frota ER, Freitas DS, Gomez RS, Burns TM, et al. Clinical profile of patients with myasthenia gravis followed at the University Hospital, Federal University of Minas Gerais. Rev Assoc Med Bras. 2015;61(2):156-60. PMid:26107366.

16 Kalf JG, Borm GF, de Swart BJ, Bloem BR, Zwarts MJ, Munneke M. Reproducibility and validity of patient-rated assessment of speech, swallowing, and saliva control in Parkinson’s disease. Arch Phys Med Rehabil. 2011;92(7):1152-8. PMid:21704797.

17 Presotto M, Olchik MR, Kalf JG, Rieder CRM. Translation, linguistic and cultural adaptation, reliability and validity of the Radboud Oral Motor Inventory for Parkinson’s Disease - ROMP questionnaire. Arq Neuropsiquiatr. 2018;76(5):316-23. PMid:29898078.

18 Benatar M, Sanders DB, Burns TM, Cutter GR, Guptill JT, Baggi F, et al. Recommendations for myasthenia gravis clinical trials. Muscle Nerve. 2012;45(6):909-17. PMid:22581550.

19 Oliveira EF, Valério BCO, Cavalcante V, Urbano JJ, Silva AS, Polaro MN, et al. Quantitative Myasthenia Gravis Score: a Brazilian multicenter study for translation, cultural adaptation and validation. Arq Neuropsiquiatr. 2017;75(7):457-63. PMid:28746433.

20 Jaretzki A 3rd, Barohn RJ, Ernstoff RM, Kaminski HJ, Keesey JC, Penn AS, et al. Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology. 2000;55(1):16-23. PMid:10891897.

21 Rusz J, Tykalova T, Ramig LO, Tripoliti E. Guidelines for speech recording and acoustic analyses in dysarthrias of movement disorders. Mov Disord Off J Mov Disord Soc. 2021;36(4):803-14. PMid:33373483.

22 Boersma PWD. Praat: doing phonetics by computer [Internet]. 2022 [cited 2023 March 27]. Available from: https://www.praat.org.

23 Rusz J, Cmejla R, Ruzickova H, Ruzicka E. Quantitative acoustic measurements for characterization of speech and voice disorders in early untreated Parkinson’s disease. J Acoust Soc Am. 2011;129(1):350-67. PMid:21303016.

24 Vogel AP, Maruff P. Comparison of voice acquisition methodologies in speech research. Behav Res Methods. 2008;40(4):982-7. PMid:19001389.

25 Jong NH, Wempe T. Praat script to detect syllable nuclei and measure speech rate automatically. Behav Res Methods. 2009;41(2):385-90. PMid:19363178.

26 Padovani MMP. Vocal and speech acoustic measures, perceptual-auditory analysis and communication self-evaluation in dysarthrias. Rev Soc Bras Fonoaudiol. 2011;16:375-375. http://dx.doi.org/10.1590/S1516-80342011000300023.

27 Staiger A, Schölderle T, Brendel B, Bötzel K, Ziegler W. Oral motor abilities are task dependent: a factor analytic approach to performance rate. J Mot Behav. 2017;49(5):482-93. PMid:27935471.

28 Staiger A, Schölderle T, Brendel B, Ziegler W. Dissociating oral motor capabilities: evidence from patients with movement disorders. Neuropsychologia. 2017;95:40-53. PMid:27939368.

29 Bozovic I, Ilic Zivojinovic J, Peric S, Kostic M, Ivanovic V, Lavrnic D, et al. Long-term outcome in patients with myasthenia gravis: one decade longitudinal study. J Neurol. 2022;269(4):2039-45. PMid:34480608.

30 Devlin I, Williams KL, Shrubsole K. Fragmented care and missed opportunities: the experiences of adults with myasthenia gravis in accessing and receiving allied health care in Australia. Disabil Rehabil. 2023;45(15):2488-96. http://dx.doi.org/10.1080/09638288.2022.2094481. PMid:35786287.
 


Submitted date:
27/03/2023

Accepted date:
31/05/2023

665785b6a9539566b827bba6 codas Articles

CoDAS

Share this page
Page Sections