Brin M F, Blitzer A, Fahn S, Gould W, Lovelace R E
Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York.
Mov Disord. 1989;4(4):287-96. doi: 10.1002/mds.870040401.
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 (2.5-3.75 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 effects. 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.
内收肌痉挛性发音障碍（SD）是一种喉部肌张力障碍，其特征为声音哽咽、受限，发声过程中有中断。包括言语治疗和药物治疗在内的多种治疗方法效果甚微；接受喉返神经切断术的患者中，只有三分之一在3年后有所获益。我们对42例SD患者双侧声带肌局部注射肉毒杆菌毒素（保妥适）。注射通过涂有特氟龙的空心肌电图（EMG）记录针进行。单侧小剂量（2.5 - 3.75单位）无临床益处。双侧小剂量注射导致持续改善，持续时间为84.4±9.3天。改善程度为61.1±4.6%。常见副作用包括短暂的气息性发声减弱期（8.5±2.5天）和轻微的呛噎/液体误吸感（1.7±0.6天）；无严重不良反应。获益并不需要声带麻痹。随访时声带肌肌电图显示失神经支配。所有患者再次治疗均有反应（最长随访3.5年）。既往接受过喉返神经手术且残留无并发症的发音障碍患者结果相似。我们的结果表明，局部注射低剂量保妥适是SD的首选治疗方法。
