RESUMEN
OBJECTIVES: Vocal tremors, which cause social difficulties for patients, may be classified as resting or action tremors. Of the vocal action tremors, essential and dystonic tremors are the most common. Botulinum toxin and oral medications have been used to treat vocal tremors, but no comparative clinical trials have been performed. The aim of this study was to compare the effects of botulinum toxin injection and the oral administration of propranolol in the treatment of essential and dystonic vocal tremors. METHODS: This clinical trial recruited 15 patients, divided into essential and dystonic vocal tremor groups. Patients in both groups received successive treatment with botulinum toxin and propranolol. The treatments were administered at different times; the order of treatment was randomly selected. Patients were assessed with flexible nasofibrolaryngoscopy and with perceptual and acoustic voice evaluations. A statistical significance level of 0.05 (5%) was used. RESULTS: Botulinum toxin produced statistically significant improvements in perceptual measures of vocal instability in patients with dystonic vocal tremors compared with baseline values and treatment with propranolol. The acoustic measure of variability in the fundamental frequency was significantly lower in patients with dystonic vocal tremors after treatment with botulinum toxin. CONCLUSION: Essential and dystonic vocal tremors responded differently to treatment. Dystonic vocal tremors responded significantly to treatment with botulinum toxin but not oral propranolol. Essential vocal tremors did not respond significantly to either treatment, perhaps due to the small number of patients, which is a limitation of this research.
Asunto(s)
Antagonistas Adrenérgicos beta/administración & dosificación , Toxinas Botulínicas Tipo A/uso terapéutico , Trastornos Distónicos/tratamiento farmacológico , Músculos Laríngeos/efectos de los fármacos , Fármacos Neuromusculares/administración & dosificación , Propranolol/administración & dosificación , Trastornos de la Voz/tratamiento farmacológico , Electromiografía , Humanos , Inyecciones Intramusculares , Propranolol/uso terapéutico , Reproducibilidad de los Resultados , Estadísticas no Paramétricas , Resultado del Tratamiento , Temblor/tratamiento farmacológicoRESUMEN
OBJECTIVES: Vocal tremors, which cause social difficulties for patients, may be classified as resting or action tremors. Of the vocal action tremors, essential and dystonic tremors are the most common. Botulinum toxin and oral medications have been used to treat vocal tremors, but no comparative clinical trials have been performed. The aim of this study was to compare the effects of botulinum toxin injection and the oral administration of propranolol in the treatment of essential and dystonic vocal tremors. METHODS: This clinical trial recruited 15 patients, divided into essential and dystonic vocal tremor groups. Patients in both groups received successive treatment with botulinum toxin and propranolol. The treatments were administered at different times; the order of treatment was randomly selected. Patients were assessed with flexible nasofibrolaryngoscopy and with perceptual and acoustic voice evaluations. A statistical significance level of 0.05 (5%) was used. RESULTS: Botulinum toxin produced statistically significant improvements in perceptual measures of vocal instability in patients with dystonic vocal tremors compared with baseline values and treatment with propranolol. The acoustic measure of variability in the fundamental frequency was significantly lower in patients with dystonic vocal tremors after treatment with botulinum toxin. CONCLUSION: Essential and dystonic vocal tremors responded differently to treatment. Dystonic vocal tremors responded significantly to treatment with botulinum toxin but not oral propranolol. Essential vocal tremors did not respond significantly to either treatment, perhaps due to the small number of patients, which is a limitation of this research.
Asunto(s)
Humanos , Propranolol/administración & dosificación , Trastornos de la Voz/tratamiento farmacológico , Agonistas Adrenérgicos beta/administración & dosificación , Toxinas Botulínicas Tipo A/uso terapéutico , Trastornos Distónicos/tratamiento farmacológico , Músculos Laríngeos/efectos de los fármacos , Fármacos Neuromusculares/administración & dosificación , Propranolol/uso terapéutico , Temblor/tratamiento farmacológico , Reproducibilidad de los Resultados , Resultado del Tratamiento , Estadísticas no Paramétricas , Electromiografía , Inyecciones IntramuscularesRESUMEN
OBJECTIVE: The study aimed to compare and correlate perceptual-auditory analysis of vocal parameters and self-perception in individuals with adductor spasmodic dysphonia before and after the application of botulinum toxin. STUDY DESIGN: This is a prospective cohort study. METHODS: Sixteen individuals with a diagnosis of adductor spasmodic dysphonia were submitted to the application of botulinum toxin in the thyroarytenoid muscle, to the recording of a voice signal, and to the Voice Handicap Index (VHI) questionnaire before the application and at two time points after application. Two judges performed a perceptual-auditory analysis of eight vocal parameters with the aid of the Praat software for the visualization of narrow band spectrography, pitch, and intensity contour. RESULTS: Comparison of the vocal parameters before toxin application and on the first return revealed a reduction of oscillation intensity (P = 0.002), voice breaks (P = 0.002), and vocal tremor (P = 0.002). The same parameters increased on the second return. The degree of severity, strained-strangled voice, roughness, breathiness, and asthenia was unchanged. The total score and the emotional domain score of the VHI were reduced on the first return. There was a moderate correlation between the degree of voice severity and the total VHI score before application and on the second return, and a weak correlation on the first return. CONCLUSIONS: Perceptual-auditory analysis and self-perception proved to be efficient in the recognition of vocal changes and of the vocal impact on individuals with adductor spasmodic dysphonia under treatment with botulinum toxin, permitting the quantitation of changes along time.
Asunto(s)
Acústica , Percepción Auditiva , Disfonía/fisiopatología , Disfonía/psicología , Músculos Laríngeos/fisiopatología , Fonación , Autoimagen , Calidad de la Voz , Inhibidores de la Liberación de Acetilcolina/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Toxinas Botulínicas/administración & dosificación , Evaluación de la Discapacidad , Disfonía/diagnóstico , Disfonía/tratamiento farmacológico , Emociones , Femenino , Humanos , Juicio , Músculos Laríngeos/efectos de los fármacos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Fonación/efectos de los fármacos , Valor Predictivo de las Pruebas , Estudios Prospectivos , Procesamiento de Señales Asistido por Computador , Programas Informáticos , Espectrografía del Sonido , Encuestas y Cuestionarios , Resultado del Tratamiento , Calidad de la Voz/efectos de los fármacosRESUMEN
BACKGROUND: Vocal impairment is one of the main debilitating symptoms of Parkinson disease (PD). The effect of levodopa on vocal function remains unclear. OBJECTIVE: This study aimed to determine the effect of levodopa on electromyographic patterns of the laryngeal muscle in patients with PD. STUDY DESIGN: This is a prospective interventional trial. METHODS: Nineteen patients with PD-diagnosed by laryngeal electromyography-were enrolled. Cricothyroid and thyroarytenoid (TA) muscle activities were measured at rest and during muscle contraction (phonation), when participants were on and off medication (12 hours after the last levodopa dose). RESULTS: Prevalence of resting hypertonia in the cricothyroid muscle was similar in the off and on states (7 of 19, P = 1.00). Eight patients off medication and four patients on medication had hypertonic TA muscle at rest (P = 0.289). No electromyographic alterations were observed during phonation for either medication states. CONCLUSION: Despite a tendency for increased rest tracings in the TA muscle when participants were on medication, no association was found between laryngeal electromyography findings and levodopa + carbidopa administration.
Asunto(s)
Antiparkinsonianos/administración & dosificación , Carbidopa/administración & dosificación , Electromiografía , Músculos Laríngeos/efectos de los fármacos , Levodopa/administración & dosificación , Enfermedad de Parkinson/tratamiento farmacológico , Fonación/efectos de los fármacos , Calidad de la Voz/efectos de los fármacos , Anciano , Antiparkinsonianos/efectos adversos , Brasil , Carbidopa/efectos adversos , Esquema de Medicación , Combinación de Medicamentos , Femenino , Humanos , Músculos Laríngeos/fisiopatología , Levodopa/efectos adversos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson/fisiopatología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Laryngeal dystonia or spasmodic dysphonia is characterized by involuntary and inappropriate spasms of vocal muscles, having the adductor type as the most common one. It is characterized by strain-strangled voice with pitch breaks. Diagnosis is made by means of videolaryngostroboscopic exam. The treatment of choice is done with botulinum toxin directly injected in the muscles responsible for the mismatched movement. The aim of this study is to report on an adductor- type dysphonia patient and to discuss the advantages and observations about this treatment reported in the literature.
Asunto(s)
Toxinas Botulínicas Tipo A/uso terapéutico , Distonía/complicaciones , Músculos Laríngeos/efectos de los fármacos , Fármacos Neuromusculares/uso terapéutico , Trastornos de la Voz/etiología , Distonía/diagnóstico , Distonía/tratamiento farmacológico , Femenino , Humanos , Persona de Mediana Edad , Resultado del Tratamiento , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/tratamiento farmacológicoRESUMEN
Distonia laríngea, ou disfonia espasmódica, é caracterizada por contrações involuntárias e inapropriadas da musculatura responsável pela fonação, sendo a do tipo adutora a mais comum. Caracteriza-se por quebras fonatórias, sendo seu diagnóstico confirmado por videolaringoestroboscopia. O tratamento de escolha é feito com a aplicação direta de toxina botulínica nos músculos responsáveis pelo movimento incoordenado. O objetivo desse trabalho é relatar o caso de uma paciente com diagnóstico de distonia laríngea do tipo adutora, tratada com toxina botulínica e discutir as vantagens e observações descritas na literatura a respeito desse tratamento.
Laryngeal dystonia or spasmodic dysphonia is characterized by involuntary and innapropiate spasms of vocal muscles, having the adductor type as the most common one. It is chacterized by strain-strangled voice with pitch breaks. Diagnosis is made by means of videolaryngostroboscopic exam. The treatment of choice is done with botulinum toxin directly injected in the muscles responsible for the mismatched movement. The aim of this study is to report on an adductor- type dysphonia patient and to discuss the advantages and observations about this treatment reported in the literature.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Fármacos Neuromusculares/uso terapéutico , Distonía/complicaciones , Trastornos de la Voz/etiología , Músculos Laríngeos/efectos de los fármacos , Toxinas Botulínicas Tipo A/uso terapéutico , Distonía/diagnóstico , Distonía/tratamiento farmacológico , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/tratamiento farmacológico , Resultado del TratamientoRESUMEN
Este estudo descreve dados preliminares de eletromiografia laríngea (LEMG) e tratamento com toxina botulínica em pacientes com disfonia associada a distúrbios do movimento. Foram estudados 25 pacientes, 19 com distonia laríngea ou disfonia espasmódica, 5 com tremor vocal e 1 com síndrome de Gilles de la Tourette. LEMG realizada com eletrodos monopolares, antes da administração de toxina botulínica, foi compatível com distonia em 14 pacientes (normal em 5), sugeriu tremor essencial em 3 e Parkinson em 2. Os diferentes padrões de LEMG e melhora considerável obtida com administração de toxina botulínica instituíram LEMG como rotina no ambulatório de distúrbios do movimento da UNICAMP.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Toxinas Botulínicas/uso terapéutico , Electromiografía , Trastornos del Movimiento/diagnóstico , Trastornos del Movimiento/tratamiento farmacológico , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/tratamiento farmacológico , Distribución por Edad , Toxinas Botulínicas/farmacología , Abuso de Ancianos , Laringe , Músculos Laríngeos/efectos de los fármacos , Trastornos del Movimiento/complicaciones , Distribución por Sexo , Trastornos de la Voz/complicacionesRESUMEN
This study describes preliminary laryngeal electromyography (LEMG) data and botulinum toxin treatment in patients with dysphonia due to movement disorders. Twenty-five patients who had been clinically selected for botulinum toxin administration were examined, 19 with suspected laryngeal dystonia or spasmodic dysphonia (SD), 5 with vocal tremor, and 1 with Gilles de la Tourette syndrome (GTS). LEMG evaluations were performed before botulinum toxin administration using monopolar electrodes. Electromyography was consistent with dystonia in 14 patients and normal in 5, and differences in frequency suggesting essential tremor in 3 and Parkinson tremors in 2. The different LEMG patterns and significant improvement in our patients from botulinum toxin therapy has led us to perform laryngeal electromyography as a routine in UNICAMP movement disorders ambulatory.