Deep Brain Stimulation in Laryngeal Dystonia and Voice Tremor

项目总结/摘要 丧失对传达有效的口头沟通至关重要的语音控制通常是一个重要的障碍。 运动障碍患者的特征，如肌张力障碍和原发性震颤。声音功能障碍， 然而，临床上对肢体运动症状的关注使其黯然失色。比如说， 刺激（DBS）有效地减少肢体肌张力障碍和震颤在这些患者中，但声音的调制 DBS引起的症状还没有被充分研究。假设语音的产生和调制是 由基底神经节-丘脑-皮质网络以循环结构调节，这是所有运动神经元共同的。 行为。然而，几乎没有经验数据来告诉我们语音功能是如何具体理解的。 在基底神经节-丘脑-皮质相互作用中编码。本项目的总体目标是使用 结合侵入性和非侵入性人类神经科学，以提高我们对 神经性嗓音障碍（喉肌张力障碍和嗓音震颤）的发病率和神经相关性 孤立性肌张力障碍和原发性震颤患者行DBS手术。我们将使用 肌张力障碍和震颤患者皮层电图和皮层下活动同步记录 在DBS植入手术中醒着说话的人。我们将补充这些数据与非- 侵入性、多模式头皮磁/脑电图（M/EEG）和功能性MRI（fMRI）记录 DBS手术前和手术后一年内的纵向M/EEG记录， 理解DBS诱导的神经网络调制与肌张力障碍中的声音运动症状相关， 震颤患者所有参与中心的研究中心都已使用相同的 DBS植入的设备和技术，并将遵循标准化的实验方案。的 疾病特异性颅内神经生理学特征将与非侵入性成像相关 结果、刺激位置定义的连接图和语音结果。该项目的成果将 为闭环脑刺激策略的开发提供信息，专门用于治疗神经性语音 可以在随后的临床试验中测试的功能障碍。

PROJECT SUMMARY / ABSTRACT Loss of voice control, which is critical for conveying effective spoken communication, is often a significant feature in patients with movement disorders, such as dystonia and essential tremor. Voice dysfunction, however, has been overshadowed clinically by a focus on limb motor symptoms. For example, deep brain stimulation (DBS) effectively reduces limb dystonia and tremor in these patients, but the modulation of voice symptoms by DBS has been vastly understudied. It is assumed that the production and modulation of voice are regulated by the basal ganglia-thalamo-cortical network in a loop architecture that is common to all motor behaviors. There is, however, little empirical data to inform our specific understanding of how voice function is encoded in basal ganglia-thalamo-cortical interactions. The overall goal of this Project is to use a combination of invasive and non-invasive human neuroscience to improve our understanding of the incidence and neural correlates of neurological voice disorders (laryngeal dystonia and voice tremor) in patients with isolated dystonia and essential tremor undergoing DBS surgery. We will use simultaneous electrocorticography (ECoG) and subcortical activity recording in dystonia and tremor patients who are awake and speaking during DBS implantation surgery. We will supplement these data with non- invasive, multimodal scalp magneto/electroencephalography (M/EEG) and functional MRI (fMRI) recordings before DBS surgery and longitudinal M/EEG recordings within one year after surgery to enhance our understanding of DBS-induced neural network modulation relevant to voice motor symptoms in dystonia and tremor patients. This work will be facilitated by the fact that all participating Center sites already use the same equipment and techniques for DBS implantation and will follow standardized experimental protocols. The disorder-specific intracranial neurophysiological signatures will be correlated with non-invasive imaging findings, stimulation location defined connectivity maps, and voice outcomes. The results of this Project will inform the development of strategies for closed-loop brain stimulation specifically to treat neurological voice dysfunction that can be tested in a subsequent clinical trial.