Blitzer A, Brin M F, Fahn S, Lovelace R E
Department of Otolaryngology, Dystonia Clinical Research Center, Columbia-Presbyterian Medical Center, New York, NY.
Laryngoscope. 1988 Jun;98(6 Pt 1):636-40. doi: 10.1288/00005537-198806000-00012.
Spastic dysphonia is a syndrome often producing a strain-strangle voice. We have previously classified most of these patients as having focal laryngeal dystonia, a disorder of central motor processing. In a study of 1,280 cases of dystonia registered at the Dystonia Clinical Research Center at the Columbia-Presbyterian Medical Center, we found 110 patients who had vocal cord involvement. These patients had historical information evaluated for age of onset (mean 34.6 years), duration of symptoms (mean 13.8 years), sex (1.4:1 female to male) family history (positive in 23%), and primary (66%) and secondary (34%) etiology; neurological evaluation for other dystonic involvement (25% with segmental cranial involvement, 23% with generalized dystonia) or tremor (irregular 23%, regular 6% on EMG). Treatment options were evaluated and included speech therapy, psychotherapy, biofeedback (with limited success), systemic medication (limited success except in abductor cases), nerve section (with late failure rate), and the use of botulinum toxin (improvement in all 34 injected patients).
痉挛性发音障碍是一种常导致紧张性发声困难的综合征。我们之前将大多数这类患者归类为患有局灶性喉肌张力障碍，这是一种中枢运动处理障碍。在对哥伦比亚长老会医学中心肌张力障碍临床研究中心登记的1280例肌张力障碍病例进行的一项研究中，我们发现110例患者存在声带受累。这些患者的病史信息评估了发病年龄（平均34.6岁）、症状持续时间（平均13.8年）、性别（女性与男性比例为1.4:1）、家族史（23%呈阳性）以及原发性（66%）和继发性（34%）病因；还进行了神经系统评估，以确定是否存在其他肌张力障碍受累情况（25%有节段性颅部受累，23%有全身性肌张力障碍）或震颤（肌电图显示不规则震颤占23%，规则震颤占6%）。对治疗方案进行了评估，包括言语治疗、心理治疗、生物反馈（效果有限）、全身用药（除外展型病例外效果有限）、神经切断术（后期失败率较高）以及肉毒杆菌毒素的使用（所有34例接受注射的患者均有改善）。
