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Spasmodic dysphonia

Spasmodic dysphonia (or laryngeal dystonia) is a voice disorder characterized by involuntary movements of one or more muscles of the larynx (vocal folds or voice box) during speech. Individuals who have spasmodic dysphonia may have occasional difficulty saying a word or two or they may experience sufficient difficulty to interfere with communication. Spasmodic dysphonia causes the voice to break or to have a tight, strained or strangled quality. more...

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Spasmodic dysphonia can affect anyone. The first signs of this disorder are found most often in individuals between 30 and 50 years of age. More women appear to be affected by spasmodic dysphonia than are men.

Types of spasmodic dysphonia

The three types of spasmodic dysphonia are adductor spasmodic dysphonia, abductor spasmodic dysphonia and mixed spasmodic dysphonia.

Adductor spasmodic dysphonia

In adductor spasmodic dysphonia, sudden involuntary muscle movements or spasms cause the vocal folds (or vocal cords) to slam together and stiffen. These spasms make it difficult for the vocal folds to vibrate and produce voice. Words are often cut off or difficult to start because of the muscle spasms. Therefore, speech may be choppy and sound similar to stuttering. The voice of an individual with adductor spasmodic dysphonia is commonly described as strained or strangled and full of effort. Surprisingly, the spasms are usually absent while whispering, laughing, singing, speaking at a high pitch or speaking while breathing in. Stress, however, often makes the muscle spasms more severe.

Abductor spasmodic dysphonia

In abductor spasmodic dysphonia, sudden involuntary muscle movements or spasms cause the vocal folds to open. The vocal folds can not vibrate when they are open. The open position of the vocal folds also allows air to escape from the lungs during speech. As a result, the voices of these individuals often sound weak, quiet and breathy or whispery. As with adductor spasmodic dysphonia, the spasms are often absent during activities such as laughing or singing.

Mixed spasmodic dysphonia

Mixed spasmodic dysphonia involves muscles that open the vocal folds as well as muscles that close the vocal folds and therefore has features of both adductor and abductor spasmodic dysphonia.

Origins

The cause of spasmodic dysphonia is unknown. Because the voice can sound normal or near normal at times, spasmodic dysphonia was once thought to be psychogenic, that is, originating in the affected personĀ¹s mind rather than from a physical cause. While psychogenic forms of spasmodic dysphonia exist, research has revealed increasing evidence that most cases of spasmodic dysphonia are in fact neurogenic or having to do with the nervous system (brain and nerves). Spasmodic dysphonia may co-occur with other movement disorders such as blepharospasm (excessive eye blinking and involuntary forced eye closure), tardive dyskinesia (involuntary and repetitious movement of muscles of the face, body, arms and legs), oromandibular dystonia (involuntary movements of the jaw muscles, lips and tongue), torticollis (involuntary movements of the neck muscles), or tremor (rhythmic, quivering muscle movements).

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Botulinum Toxin-A for Neuromuscular Pain
From American Family Physician, 4/15/02 by Monica Preboth

The Health Technology and Advisory Committee (HTAC) has published a report on the use of botulinum toxin-A for pain associated with neuromuscular disorders. HTAC was established in 1992 by the Minnesota state legislature. It is an independent, nonpartisan advisory body that evaluates new and emerging health care technologies based on existing scientific research and technology assessments.

According to the HTAC report, botulinum toxin-A is injected directly into affected muscles to produce chemical denervation of the abnormally functioning muscles by blocking synaptic transmission. The effects are dose dependent and last for two to six months. Most patients require repeated injections to maintain the beneficial effects.

HTAC examined the use of botulinum toxin-A in a number of neuromuscular conditions. Clinical applications that are not approved by the U.S. Food and Drug Administration (FDA) but where data exist to support the use of botulinum toxin-A include spasmodic torticollis, focal hand dystonia, spasmodic dysphonia, dynamic contracture in patients with cerebral palsy, post-stroke spasticity, myofascial pain syndrome, and chronic low-back pain. The FDA has already approved botulinum toxin-A for the treatment of patients with cervical dystonia, and strabismus and blepharospasm associated with dystonia.

Treatment with botulinum toxin-A can be painful. It should not be used in persons with an infection at the injection site or in persons known to be hypersensitive to any ingredient in the drug. Botulinum toxin-A should be used with caution in patients with peripheral motor neuropathic diseases or neuromuscular junctional disorders, or who are receiving aminoglycosides or other agents that interfere with neuromuscular transmission.

This report and others published by HTAC may be obtained by calling 651-282-6374 or by e-mail (htac@ health.state.mn.us). There is no charge for the reports. All reports are also available on the HTAC Web site at www.health.state.mn.us/htac/index./htm.

COPYRIGHT 2002 American Academy of Family Physicians
COPYRIGHT 2002 Gale Group

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