Deep Brain Stimulation in Laryngeal Dystonia and Voice Tremor

项目摘要/摘要 语音控制的丧失对于传达有效的口语交流至关重要，通常是一个重要的问题 运动障碍患者的特点，如肌张力障碍和特发性震颤。发声功能障碍， 然而，临床上对肢体运动症状的关注使其黯然失色。例如，深脑 刺激(DBS)有效地减少了这些患者的肢体肌张力障碍和震颤，但声音的调制 星展银行的症状一直没有得到充分的研究。假设声音的产生和调制是 由基底节-丘脑-皮质网络在环状结构中调节，这是所有运动共同的 行为。然而，几乎没有经验数据来帮助我们具体了解语音功能是如何发挥作用的 编码于基底节-丘脑-皮质的相互作用。此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来提高我们对 神经性发声障碍(喉部肌张力障碍和发声震颤)的发生率和神经相关性 接受DBS手术的单纯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层脑电和皮层下活动记录 在DBS植入手术中醒着说话的人。我们将补充这些数据的非 有创性、多模式头皮磁图/脑电(M/EEG)和功能磁共振(FMRI)记录 DBS手术前和术后一年内的纵向M/EEG记录以增强我们的 DBS诱导的神经网络调制与肌张力障碍患者发声运动症状相关的认识 震颤患者。所有参与中心的站点都已使用相同的 植入DBS的设备和技术，并将遵循标准化的实验方案。这个 疾病特有的颅内神经生理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 介绍专门治疗神经性发音的闭环式脑刺激策略的发展 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.