Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): A 12‐year experience in more than 900 patients

Abstract

Botulinum toxin A injection of the laryngeal hyperfunctional muscles has been found over the past 12 years to be the treatment of choice to control the dystonic symptoms in most patients with spasmodic dysphonia.

Spasmodic Dysphonia

“…The dosage may vary from 1 MU to 30 MU depending on the patient's response to the treatment, the level of side effects, and the technique used. Blitzer et al (36) recommend initiating the treatment with an average of 1 MU and then adjusting the dose according to the patient's response. According to Blitzer et al (36), 90% of patients with adductor SD benefit from the botulinum toxin treatment and have a symptom-free period of 15 weeks on average.…”

“…Abductor SD: In these patients, botulinum toxin injections have been administered into the PCA muscle since 1989 (36). As a treatment protocol, Blitzer et al (36) recommend that, first of all, a more active PCA should be determined through EMG and a 3.75 MU Botulinum toxin should be injected into the muscle; then, botulinum toxin at lower doses should be injected into the contralateral PCA muscle of patients with ongoing symptoms during the follow-ups.…”

“…As a treatment protocol, Blitzer et al (36) recommend that, first of all, a more active PCA should be determined through EMG and a 3.75 MU Botulinum toxin should be injected into the muscle; then, botulinum toxin at lower doses should be injected into the contralateral PCA muscle of patients with ongoing symptoms during the follow-ups. They found that botulinum toxin effects started within a minimum of 4 days, reached the maximum level on the 10 th day, and that the patients benefited from it for an average of 10 weeks (36). After botulinum toxin injection, mild side effects such as breathy phonation in 35% of patients, breath obstruction following fluid intake in 15% of patients, and pain and sensitivity at the injection site in 1% of patients can be seen (36).…”

“…They found that botulinum toxin effects started within a minimum of 4 days, reached the maximum level on the 10 th day, and that the patients benefited from it for an average of 10 weeks (36). After botulinum toxin injection, mild side effects such as breathy phonation in 35% of patients, breath obstruction following fluid intake in 15% of patients, and pain and sensitivity at the injection site in 1% of patients can be seen (36).…”

Dystonia of the Oromandibular, Lingual and Laryngeal Areas

“…In addition to medications, lingual dystonia has been reported to occur secondary to head injury, electrical injury, varicella infection or part of a neurodegenerative disease. [39][40][41][42] Action induced lingual dystonia can be a striking and early finding in chorea-acanthocytosis. It is also a characteristic of pantothenate kinase associated neurodegeneration (PKAN), Lesch-Nyhan syndrome and Wilsons disease.…”