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We conducted a PROSPERO\u2010registered systematic review and meta\u2010analysis of publications through August 2024 (CRD42024527738). Among 2726 screened records, we included 184 studies: 131 in Parkinson's disease (PD), 32 in essential tremor (ET), and 21 in dystonia, assessing perceptual, acoustic, and patient\u2010reported speech outcomes. Meta\u2010analyses showed that subthalamic nucleus DBS in PD resulted in poorer speech intelligibility compared with best medical treatment (effect size \u22120.24; 95% confidence interval: \u22120.46 to \u22120.03;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.027), with state\u2010dependent decline under active stimulation on longitudinal analysis (Unified Parkinson's Disease Rating Scale Part III item 18 monthly change: medication\n                    <jats:italic>on<\/jats:italic>\n                    +0.016,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001; medication\n                    <jats:italic>off<\/jats:italic>\n                    +0.002,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.50). In ET, DBS consistently suppressed vocal tremor but increased the risk of dysarthria, particularly with bilateral stimulation. Dystonia outcomes showed greater heterogeneity. Across disorders, sustained phonation measures improved, whereas connected speech performance worsened, indicating selective vulnerability of complex motor tasks. Neuroanatomical mapping identified two nonexclusive mechanisms: current spread to corticobulbar fibers producing spastic speech features and to the cerebellothalamocortical pathway producing ataxic features. Hypokinetic and stuttering\u2010like phenotypes also occurred but likely reflect network\u2010level interactions rather than tract\u2010specific spread. These tract\u2010mediated and network\u2010level alterations appear to interact with hemispheric lateralization, medication state, and longer\u2010term plasticity to produce complex clinical phenotypes. We outline a clinical framework integrating systematic screening, phenotype identification, and targeted programming adjustments. Enhanced speech assessment, precise field mapping, and adaptive DBS paradigms may promote individualized care that optimizes speech and motor function in precision DBS therapy. \u00a9 2026 The Author(s).\n                    <jats:italic>Movement Disorders<\/jats:italic>\n                    published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.\n                  <\/jats:p>","DOI":"10.1002\/mds.70322","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T09:14:51Z","timestamp":1777540491000},"page":"1928-1978","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Speech and Deep Brain Stimulation in Parkinson's Disease, Essential Tremor, and Dystonia: A Systematic Review and Meta\u2010analysis"],"prefix":"10.1002","volume":"41","author":[{"given":"Elina","family":"Tripoliti","sequence":"first","affiliation":[{"name":"Department of Clinical and Movement Neurosciences UCL, Institute of Neurology and National Hospital for Neurology and Neurosurgery, UCLH NHS Trust  London United Kingdom"},{"name":"1st Neurology Department National and Kapodistrian University of Athens, Medical School  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Tsuboi","sequence":"additional","affiliation":[{"name":"Department of Neurology Nagoya University Graduate School of Medicine  Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Barbe","sequence":"additional","affiliation":[{"name":"Department of Neurology Faculty of Medicine and University Hospital Cologne, University of Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Sousa","sequence":"additional","affiliation":[{"name":"Department of Neurology Inselspital University Hospital Bern  Bern Switzerland"},{"name":"Graduate School for Health Sciences University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Barkmeier\u2010Kraemer","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Utah  Salt Lake City Utah USA"},{"name":"Department of Communication Sciences &amp; Disorders University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Jergas","sequence":"additional","affiliation":[{"name":"Department of Neurology Faculty of Medicine and University Hospital Cologne, University of Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaia","family":"Arno","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head &amp; Neck Surgery Massachusetts Eye and Ear, Harvard Medical School  Boston Massachusetts 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