Hayashi Koji, Izumi Rina, Saito Namie, Suzuki Asuka, Nakaya Yuka, Sato Mamiko, Kobayashi Yasutaka
Department of Rehabilitation Medicine, Fukui General Hospital, Fukui, JPN.
Graduate School of Health Science, Fukui Health Science University, Fukui, JPN.
Cureus. 2024 Nov 6;16(11):e73106. doi: 10.7759/cureus.73106. eCollection 2024 Nov.
We describe a case of Parkinsonian-type multiple system atrophy (MSA-P) treated with Lee Silverman Voice Treatment (LSVT-LOUD; LSVT Global, Inc., Phoenix, AZ, USA). At age 73, the patient developed motor symptoms, including gait disturbances with a tendency to fall, as well as swallowing difficulties and impaired dexterity in his right hand, prompting a visit to our hospital. Brain magnetic resonance imaging (MRI) revealed atrophy in the cerebellum and brainstem, particularly in the pons, along with enlargement of the fourth ventricle; however, the "cross sign" on the pons was not clearly visible. Dopamine transporter single-photon emission computed tomography (DAT-SPECT) showed decreased nuclide accumulation in the striatum. Additionally, I-MIBG cardiac scintigraphy demonstrated preserved nuclide accumulation in the heart. L-dopa challenge tests were conducted, but no significant improvement in motor symptoms was observed. Based on these findings, he was diagnosed with MSA-P. Over the following years, his condition progressively worsened, with increasing orthostatic hypotension, dysphagia, and falls. Various treatments, including anti-Parkinson's medications and vasopressors, provided little relief. At age 75, due to severe dysphagia and hoarseness, he was admitted for LSVT-LOUD therapy. After LSVT-LOUD treatment, the patient improved voice volume, tongue pressures, alternating motion rates of "pa," "ta," and "ka," and the Frontal Assessment Battery (FAB) score. These results suggest that LSVT-LOUD may positively impact both speech and swallowing functions, as well as frontal lobe function. Larger studies are needed to validate these results.
我们描述了一例帕金森型多系统萎缩（MSA-P）患者接受李·西尔弗曼嗓音治疗（LSVT-LOUD；LSVT Global公司，美国亚利桑那州凤凰城）的病例。患者73岁时出现运动症状，包括步态障碍且有跌倒倾向，以及吞咽困难和右手灵活性受损，遂前来我院就诊。脑磁共振成像（MRI）显示小脑和脑干萎缩，特别是脑桥萎缩，同时第四脑室扩大；然而，脑桥上的“十字征”并不清晰可见。多巴胺转运体单光子发射计算机断层扫描（DAT-SPECT）显示纹状体中核素蓄积减少。此外，I-MIBG心脏闪烁显像显示心脏中核素蓄积保留。进行了左旋多巴激发试验，但未观察到运动症状有明显改善。基于这些发现，他被诊断为MSA-P。在接下来的几年里，他的病情逐渐恶化，直立性低血压、吞咽困难和跌倒情况日益加重。包括抗帕金森药物和血管加压药在内的各种治疗方法效果甚微。75岁时，由于严重的吞咽困难和声嘶，他入院接受LSVT-LOUD治疗。经过LSVT-LOUD治疗后，患者的音量、舌压力、“啪”“嗒”“咔”的交替运动速率以及额叶评估量表（FAB）评分均有所改善。这些结果表明，LSVT-LOUD可能对言语和吞咽功能以及额叶功能产生积极影响。需要更大规模的研究来验证这些结果。
