Deep Brain Stimulation in Laryngeal Dystonia and Voice Tremor

项目概要/摘要 语音控制的丧失对于进行有效的口头交流至关重要，这通常是一个严重的问题 患有运动障碍（例如肌张力障碍和特发性震颤）的患者的特征。声音功能障碍， 然而，临床上对肢体运动症状的关注却掩盖了这一点。例如，大脑深处 刺激（DBS）有效减少这些患者的肢体肌张力障碍和震颤，但声音的调制 DBS 的症状尚未得到充分研究。假设语音的产生和调制是 由基底神经节-丘脑-皮质网络以所有运动共有的循环结构调节 行为。然而，几乎没有经验数据可以帮助我们具体了解语音功能如何发挥作用。 编码于基底神经节-丘脑-皮质相互作用。该项目的总体目标是使用 侵入性和非侵入性人类神经科学的结合，以提高我们对 神经性声音障碍（喉肌张力障碍和声音震颤）的发病率和神经相关性 接受 DBS 手术的孤立性肌张力障碍和特发性震颤患者。我们将使用 肌张力障碍和震颤患者的同步皮质电图 (ECoG) 和皮质下活动记录 在 DBS 植入手术期间保持清醒并说话的人。我们将用非 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，以增强我们的 了解 DBS 诱导的与肌张力障碍发声运动症状相关的神经网络调制 震颤患者。所有参与中心站点都已使用相同的系统，这一事实将促进这项工作 DBS 植入的设备和技术，并将遵循标准化实验方案。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制定提供信息，专门用于治疗神经性声音 可以在随后的临床试验中测试功能障碍。

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.