Pathophysiology of Spasmodic Dysphonia: a TMS study

痉挛性发声障碍的病理生理学：一项 TMS 研究

• 批准号: 8281729
• 负责人: Teresa Jacobson Kimberley
• 金额: $ 21.85万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8281729
• 关键词: Affect; Communication; Communication Methods; Communication impairment; Corticobulbar Tracts; Data; Development; Diagnosis; Diagnostic; Diagnostic Procedure; Differential Diagnosis; Disease; Dorsal; Dysphonia; Dystonia; Electrodes; Electromyography; Evidence based intervention; Focal Dystonias; Functional disorder; Future; Goals; Hand; Health; Healthcare; Human; Impairment; Individual; Intervention; Investigation; Knowledge; Larynx; Lateral; Lead; Learning; Left; Life; Measurement; Measures; Methods; Mission; Motor Cortex; Motor Evoked Potentials; Motor Neurons; Movement Disorders; Muscle; Muscle Tension; National Institute on Deafness and Other Communication Disorders; Neuraxis; Neurologic; Outcome; Pattern; Physiologic pulse; Population; Procedures; Protocols documentation; Research Priority; Response to stimulus physiology; Societies; Spastic Dysphonias; Speech; Techniques; Technology; Thyroarytenoid Muscle; Transcranial magnetic stimulation; Voice; Voice Disorders; Work; base; clinical Diagnosis; comparison group; cricoarytenoideus; design; experience; improved; innovation; motor control; neuromechanism; novel; relating to nervous system; repetitive transcranial magnetic stimulation; response; tool; vocal cord; voice therapy

DESCRIPTION (provided by applicant): One of the most meaningful aspects to human life is communication. The primary method of communication in humans is voice, thus impairment of the voice can have a devastating consequences in one's ability to fully participate in society. Adductor spasmodic Dysphonia (AdSD) is a type of focal dystonia that affects the muscles of the vocal cords and can severely impair the ability to speak. There is no diagnostic marker for this neurologic-based movement disorder and it is frequently confused with other voice disorders. Often people go years before being correctly diagnosed, only to learn that there are no long-term efficacious treatments available. Misdiagnosis of AdSD leads to provision of ineffective treatment such as voice therapy prolonging this debilitating communication disorder and resulting in unnecessary health care expenses. There is growing evidence that people with other types of focal dystonia have reduced cortical inhibition, leading to excessive excitation, which may contribute to the resultant abnormal motor control. Transcranial magnetic stimulation (TMS) is a safe, non-invasive tool that can provide extensive information about the neurophysiologic underpinnings in a disorder. This has been used extensively to investigate focal hand dystonia, greatly enhancing the understanding of that disorder, but has not been used in spasmodic dysphonia. This R21 proposal in response to PA 10-156 will use fine wire EMG electrodes in the muscle primarily affected by SD, the thyroarytenoid, and TMS to measure the central conduction latency and intracortical excitation and inhibition associated with the corticobulbar control of the larynx in healthy people and people with SD. It will also use well established techniques to collect the same data in the unaffected corticospinal control of the hand. Design: Two group comparison (healthy vs. AdSD) of the cortical excitability of the thyroarytenoid muscle and first dorsal interosseous muscle will be performed. Expected outcomes: It will refine techniques described in the preliminary data section to optimize procedures for TMS measurement in the larynx; begin to establish norms for the excitability measures in healthy people; determine the relationship of measures in the hand to the larynex; and compare data in subjects with SD to healthy. Impact: The results of this study will: (1) advance the knowledge regarding the central nervous system pathophysiology in AdDS, (2) elucidate potential neurophysiologic underpinnings of the disorder such as which intracortical mechanism differs from healthy and if it is localized to the affected musculature or pervasive. (3) It will refine techniques for other investigations of excitability in the larynx. Long term objecties: Future work may lead to a more definitive differential diagnosis between AdSD and other disorders and the development of innovative evidence-based interventions directly advancing the mission of NIDCD. PUBLIC HEALTH RELEVANCE: This proposal will establish techniques to safely measure the cortical latency and excitability of the muscles of the vocal cords in the larynx. It will use thos techniques to determine which neural mechanisms are faulty in a neurologic movement disorder that affects the vocal cords, spasmodic dysphonia, by comparing responses in the affected muscles to unaffected muscles in healthy people and those with the disorder.

描述（申请人提供）：交流是人类生活中最有意义的方面之一。人类沟通的主要方式是声音，因此声音的损伤会对一个人充分参与社会的能力造成毁灭性的后果。内收肌痉挛性发声障碍（AdSD）是局灶性肌张力障碍的一种，它会影响声带肌肉，严重损害说话能力。这种基于神经系统的运动障碍没有诊断标记，它经常与其他声音障碍混淆。通常，人们在得到正确诊断之前要过很多年，才知道没有长期有效的治疗方法。对注意力缺陷障碍的误诊导致提供无效的治疗，如语音治疗，延长了这种使人衰弱的交流障碍，并导致不必要的医疗费用。越来越多的证据表明，患有其他类型局灶性肌张力障碍的人皮质抑制减少，导致过度兴奋，这可能导致运动控制异常。经颅磁刺激（TMS）是一种安全、无创的工具，可以提供有关疾病神经生理基础的广泛信息。这已被广泛用于研究局灶性手肌张力障碍，大大提高了对该疾病的理解，但尚未用于痉挛性发声障碍。针对PA 10-156的R21提案将在主要受SD、类甲状腺素和TMS影响的肌肉中使用细丝肌电图电极来测量健康人群和SD患者中与喉皮质球控制相关的中枢传导潜伏期和皮质内兴奋和抑制。它也会很好用