TREATMENT OF LARYNGEAL DYSTONIA WITH BOTULINUM TOXIN: A CASE REPORT
Abstract
Background. Laryngeal dystonia (LD) is a form of focal dystonia, involving laryngeal muscles and causing disturbed phonation. Adductor, abductor and mixed forms of LD are described.
Methods. Largely unsuccessful treatments include voice therapy, psychotherapy, biofeedback, section of the laryngeal recurrent nerve, laryngeal framework surgery and the use of centrally acting drugs. Botulinum toxin proved to be the most efficient treatment of LD; it acts by chemically denervating hyperactive laryngeal muscles.
Case report. Authors report on the first use of botulinum toxin in a patient with LD in Slovenia. A female patient with a degenerative disease of extrapyramidal, cerebellar and autonomous system (probable multiple system atrophy) and severe adductor form of LD is presented. By gradually increasing dose, the optimal dosage of botulinum has been established that greatly improves the patient’s speech for four months and causes transient mild adverse effects (dysphagia). Botulinum is injected percutaneously under endoscopic control, using the method, which has been described in literature for the first time.
Conclusions. Treatment of LD with botulinum toxin demonstrated good results. It improves patient’s communication with others and the quality of his/her life.
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References
Traube L. Spastisch Form der nervosen Heiserkeit. Gesammelte Beitr Pathol Physiol 1871; 2: 677–7.
Critchley M. Spastic dysphonia: inspiratory speech. Brain 1939; 62: 96–6.
Thomsen SC, Negus VE, Bateman GH. Diseases of the nose and throat. 6th ed. London: Cassell, 1955.
Robe E, Brumlik J, Moore P. A study of spastic dysphonia: Neurologic and electroencephalographic abnormalities. Laryngoscope 1960; 70: 219–45.
Luschinger R. Vocal disorders of emotional origin: psychogenic dysphonia. In: Luschinger R, Arnold E eds. Voice, speech and language. London: Constable, 1965.
Aronson AE, Brown JE, Litin EM, Pearson JS. Spastic dysphonia 1. Voice, neurologic and psychiatric aspects. J Speech Dis 1968; 33: 203–3.
Aronson AE, Brown JE, Litin EM, Pearson JS. Spastic dysphonia 2. Comparison with essential (voice) tremor and other neurological and psychogenic disorders. J Speech Dis 1968; 33: 219–9.
Aronson AE. Clinical voice disorders. An interdisciplinary approach. 3rd ed. New York: Thieme Inc., 1990.
Blitzer A, Brin MF, Fahn S, Lovelace RE. Clinical and laboratory characteristics of laryngeal dystonia: A study of 110 cases. Laryngoscope 1988; 98: 636–40.
Blitzer A, Brin MF. Laryngeal dystonia: A series with botulinum toxin therapy. Ann Otol Rhinol Laryngol 1991; 100: 85–90.
Miller RH, Woodson GE. Treatment options in spasmodic dysphonia. Otolaryngol Clin North Am 1991; 24: 1227–37.
Marsden CD, Obeso JA, Zarranz JJ et al. The anatomical basis of symptomatic hemidystonia. Brain 1985; 108: 463–83.
Zweig RM, Hedreen JC, Jankel WR et al. Pathology in brainstem regions of individuals with primary dystonia. Neurology 1988; 38: 702–6.
Hirano S, Kojima H, Naito Y et al. Cortical dysfunction of the supplementary motor area in a spasmodic dysphonia patient. Am J Otolaryngol 2001; 22: 219–22.
Hirano S, Kojima H, Naito Y et al. Cortical speech processing mechanism for vocalization with auditory verbal feedback. Neuro Report 1997; 8: 2379–82.
Blitzer A, Brin MF, Stewart CF. Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): A 12-year experience in more than 900 patients. Laryngoscope 1998; 108: 1435–41.
Brin MF, Fahn S, Blitzer A, Ramig LO, Stewart C. Movement disorders of the larynx. In: Blitzer A, Brin MF, Sasaki CT, Fahn S, Harris K eds. Neurological disorders of the larynx. New york: Thieme, 1992: 240–8.
Cannito MP, Johnson P. Spastic dysphonia: a continuum disorder. J Commun Disord 1981; 14: 215–23.
Grillone G, Blitzer A, Brin MF. Treatment of adductor breathing dystonia with botulinum toxin. Laryngoscope 1994; 104: 30–3.
Mehta RP, Goldman SN, Orloff LA. Long-term therapy for spasmodic dysphonia. Arch Otolaryngol Head Neck Surg 2001; 127: 393–9.
Izdebski K, Dedo HH, Boles L. Spastic dysphonia: A patient profile of 200 cases. Am J Otolaryngol 1984; 5: 7–14.
Greene MCL, Mathieson L. The voice and its disorders. London, New Jersey: Whurr Publishers, 1989.
Aronson AE, DeSanto LW. Adductor spastic dysphonia: three years after recurrent laryngeal nerve resection. Laryngoscope 1983; 93: 1183–204.
Wilson DK. Voice problems of children. 3rd ed. Baltimore: Williams & Wilkins, 1987.
Miller RH, Woodson GE. Treatment options in spasmodic dysphonia. Otolaryngol Clin North Am 1991; 24:
Dedo HH, Shipp T. Spastic dysphonia – a surgical and voice therapy program. Houston, Texas: College-Hill Press, 1980.
Blitzer A, Lovelace RE, Brin MF, Fahn S. Electromyographic findings in focal laryngeal dystonia (dysphonia). Ann Otol Rhinol Laryngol 1985; 94: 591–4.
Gibbs SR, Blitzer A. Botulinum toxin for the treatment of spasmodic dysphonia. Otolaryngol Clin North Am 2001; 33: 879–94.
Dedo HH. Recurrent nerve section for spastic dysphonia. Ann Otol Rhinol Laryngol 1976; 85: 451–9.
Brin MF, Blitzer A, Fahn S, Gould W, Lovelace RE. Adductor laryngeal dystonia (spastic dysphonia): treatment with local injections of botulinum toxin. Mov Disord 1989; 4: 287–96.
Levine H, Wood BG, Batza E, Rusnov M, Tucker H. Recurrent laryngeal nerve section for spasmodic dysphonia. Ann Otol Rhinol Laryngol 1979; 88: 527–30.
Dedo HH, Izdebski K. Problems with surgical treatment of spastic dysphonia. Laryngoscope 1983; 93: 268–71.
Aronson AE, DeSanto LW. Adductor spastic dysphonia: three years after recurrent nerve section. Laryngoscope 1983; 93: 1–8.
Tucker H. Laryngeal framework surgery in the management of spasmodic dysphonia: preliminary report. Ann Otol Rhinol Laryngol 1989; 98: 52–4.
Friedman M, Toriumi DM, Grybauskas VT, Applebaum EL. Implantation of a recurrent laryngeal nerve stimulator for the treatment of spastic dysphonia. Ann Otol Rhinol Laryngol 1989; 98: 130–4.
Pirtošek Z. Limb dystonia, including writer’s cramp. In: Moore P ed. Botulinum toxin treatment. Oxford: Blackwell Science, 1995: 131–50.
Pirtošek Z. Zdravljenje z botulinom. In: Neubauer D, Kopač Š eds. Zbornik predavanj iz otroške nevrologije. Ljubljana: Medicinski razgledi, 1998: 326– 31.
George EF, Zimbler M, Wu BL, Biller HF, Sanders I. Quantitative mapping of the effect of botulinum toxin injections in the thyroarytenoid muscle. Ann Otol Rhinol Laryngol 1992; 101: 888–92.
Castellanos PF, Gates GA, Esselman G, Song F, Vannier MW, Kuo M. Anatomic considerations in botulinum toxin type A therapy for spasmodic dysphonia. Laryngoscope 1994; 104: 656–62.
Ludlow C, Naunton RF, Sedory SE, Schulz MA, Hallet M. Effects of botulinum toxin injections on speech in adductor spasmodic dysphonia. Neurology 1988; 38: 1220–5.
Miller RH, Woodson GE, Jancovic J. Botulinum toxin injection of the vocal fold for spasmodic dysphonia. A preliminary report. Arch Otolaryngol Head Neck Surg 1989; 113: 603–5.
Ford CN, Bless DM, Lowery JD et al. Treatment of spasmodic dysphonia with visually directed minimal injections of botulinum toxin. Otolaryngol Head Neck Surg 1989; 101: 151–1.
Rhew F, Fiedler DA, Ludlow JD. Technique for injection of botulinum toxin through a flexible nasolaryngoscope. Otolaryngol Head Neck Surg 1994; 111: 787–94.
Pirtošek Z, Denišlič M, Zidar J, Vodušek DB. Treatment of idiopathic torticollis with Botulinum toxin. 2nd Yugoslav Symposium on Diseases of the Extrapyramidal System, Ljubljana, May 24–26, 1990. Book of Abstracts. Ljubljana: 1990 : 43–3.
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