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Laryngoscope. 2018 Jan;128 Suppl 1:S1-S9. doi: 10.1002/lary.27003. Epub 2017 Dec 8.

Phenomenology, genetics, and CNS network abnormalities in laryngeal dystonia: A 30-year experience.

Author information

1
Department of Otolaryngology-Head and Neck Surgery, Columbia University, College of Physicians and Surgeons, New York, New York.
2
Department of Neurology, Icahn School of Medicine at Mt. Sinai, New York, New York.
3
New York Center for Voice and Swallowing Disorders, New York, New York.
4
Department of Neurology, the University of California, Irvine, Irvine, California.
5
Allergan, PLC, Dublin, Republic of Ireland.
6
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
7
Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.

Abstract

OBJECTIVE:

Laryngeal dystonia (LD) is a functionally specific disorder of the afferent-efferent motor coordination system producing action-induced muscle contraction with a varied phenomenology. This report of long-term studies aims to review and better define the phenomenology and central nervous system abnormalities of this disorder and improve diagnosis and treatment.

METHODS:

Our studies categorized over 1,400 patients diagnosed with LD over the past 33 years, including demographic and medical history records and their phenomenological presentations. Patients were grouped on clinical phenotype (adductor or abductor) and genotype (sporadic and familial) and with DNA analysis and functional magnetic resonance imaging (fMRI) to investigate brain organization differences and characterize neural markers for genotype/phenotype categorization. A number of patients with alcohol-sensitive dystonia were also studied.

RESULTS:

A spectrum of LD phenomena evolved: adductor, abductor, mixed, singer's, dystonic tremor, and adductor respiratory dystonia. Patients were genetically screened for DYT (dystonia) 1, DYT4, DYT6, and DYT25 (GNAL)-and several were positive. The functional MRI studies showed distinct alterations within the sensorimotor network, and the LD patients with a family history had distinct cortical and cerebellar abnormalities. A linear discriminant analysis of fMRI findings showed a 71% accuracy in characterizing LD from normal and in characterizing adductor from abductor forms.

CONCLUSION:

Continuous studies of LD patients over 30 years has led to an improved understanding of the phenomenological characteristics of this neurological disorder. Genetic and fMRI studies have better characterized the disorder and raise the possibility of making objective rather than subjective diagnoses, potentially leading to new therapeutic approaches. Laryngoscope, 128:S1-S9, 2018.

KEYWORDS:

Laryngeal dystonia; botulinum toxin; dysphonia

PMID:
29219190
PMCID:
PMC5757628
DOI:
10.1002/lary.27003
[Indexed for MEDLINE]
Free PMC Article

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