Ludlow Christy L
Laryngeal and Speech Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive MSC 1416, Bethesda, MD 20892-1416, USA.
Curr Opin Otolaryngol Head Neck Surg. 2009 Jun;17(3):160-5. doi: 10.1097/MOO.0b013e32832aef6f.
Although botulinum toxin injection is the gold standard for treatment of spasmodic dysphonia, surgical approaches aimed at providing long-term symptom control have been advancing over recent years.
When surgical approaches provide greater long-term benefits to symptom control, they also increase the initial period of side effects of breathiness and swallowing difficulties. Recent analyses of quality-of-life questionnaires in patients undergoing regular injections of botulinum toxin demonstrate that a large proportion of patients have limited relief for relatively short periods due to early breathiness and loss-of-benefit before reinjection.
Most medical and surgical approaches to the treatment of spasmodic dysphonia have been aimed at denervation of the laryngeal muscles to block symptom expression in the voice, and have both adverse effects as well as treatment benefits. Research is needed to identify the central neuropathophysiology responsible for the laryngeal muscle spasms in order target treatment towards the central neurological abnormality responsible for producing symptoms.
尽管肉毒杆菌毒素注射是治疗痉挛性发音障碍的金标准，但近年来旨在提供长期症状控制的手术方法不断发展。
当手术方法能为症状控制带来更大的长期益处时，它们也会增加呼吸急促和吞咽困难等副作用的初始阶段。近期对定期注射肉毒杆菌毒素患者的生活质量问卷分析表明，由于早期呼吸急促和再次注射前益处丧失，很大一部分患者在相对较短的时间内缓解有限。
大多数治疗痉挛性发音障碍的医学和手术方法旨在使喉肌去神经化以阻止声音中的症状表现，且既有不良反应也有治疗益处。需要开展研究以确定导致喉肌痉挛的中枢神经病理生理学，从而针对产生症状的中枢神经异常进行治疗。
