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Adductor laryngeal dystonia (spastic dysphonia): Treatment with local injections of botulinum toxin (Botox)
Author(s) -
Brin Mitchell F.,
Blitzer Andrew,
Fahn Stanley,
Lovelace Robert E.,
Gould Wilbur
Publication year - 1989
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.870040401
Subject(s) - medicine , spasmodic dysphonia , botulinum toxin , dystonia , anesthesia , spastic , surgery , recurrent laryngeal nerve , larynx , adductor muscles , electromyography , anatomy , physical medicine and rehabilitation , cerebral palsy , thyroid , psychiatry
Adductor spastic dysphonia (SD) is a laryngeal dystonia characterized by a choked, constrained voice pattern with breaks in vocal flow. Treatment with a variety of therapies including speech and pharmacotherapy have minimal benefit; only one‐third of patients undergoing recurrent laryngeal nerve section have benefitted at 3 years. We have used local injections of botulinum toxin (Botox) bilaterally into vocalis muscles in 42 patients with SD. Injections were through a teflon‐coated hollow electromyography (EMG) recording needle. Unilateral small doses (2.53.75 U) were of no clinical benefit. Bilateral small doses resulted in sustained improvement lasting 84.4 ± 9.3 days. The degree of improvement was 61.1 ± 4.6%. Common side‐effects included a brief period of breathy hypophonia (8.5 ± 2.5 days) and a mild sensation of choking/aspiration of fluids (1.7 ± 0.6 days); there were no serious adverse effect. Vocal cord paralysis was not necessary for benefit. Follow‐up vocalis muscle EMGs revealed denervation. All patients responded to retreatment (longest follow‐up 3.5 years). Patients with prior recurrent laryngeal nerve surgery and residual uncomplicated dysphonia had similar results. Our results indicate that local injection of low‐dose Botox is the treatment of choice for SD.