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

基本信息

批准号：
8443814
负责人：
Teresa Jacobson Kimberley
金额：
$ 17.56万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-04-01 至 2016-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8443814
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

项目摘要

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.

描述（由申请人提供）：人类生活最有意义的方面之一是沟通。人类交流的主要方式是声音，因此声音受损会对一个人充分参与社会的能力产生毁灭性的后果。内收肌痉挛性发声障碍 (AdSD) 是一种局灶性肌张力障碍，会影响声带肌肉并严重损害说话能力。这种基于神经系统的运动障碍没有诊断标记，并且经常与其他声音障碍混淆。通常，人们要经过数年时间才能得到正确诊断，却发现没有长期有效的治疗方法。 AdSD 的误诊会导致提供无效的治疗，例如声音治疗，从而延长这种使人衰弱的沟通障碍，并导致不必要的医疗费用。越来越多的证据表明，患有其他类型的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、非侵入性的工具，可以提供有关疾病神经生理学基础的广泛信息。这已被广泛用于研究局灶性手肌张力障碍，极大地增强了对该疾病的理解，但尚未用于痉挛性发声障碍。响应 PA 10-156 的 R21 提案将在主要受 SD、甲状杓状肌和 TMS 影响的肌肉中使用细线 EMG 电极，以测量健康人喉部皮质延髓控制相关的中枢传导潜伏期以及皮质内兴奋和抑制。人和患有 SD 的人。也会用得好建立了在手部未受影响的皮质脊髓控制中收集相同数据的技术。设计：将对甲杓肌和第一背侧骨间肌的皮质兴奋性进行两组比较（健康与 AdSD）。预期成果：它将完善初步数据部分中描述的技术，以优化喉部 TMS 测量程序；开始制定健康人兴奋性测量标准；确定手部与喉部的测量关系；并将 SD 受试者与健康受试者的数据进行比较。影响：这项研究的结果将：(1) 增进有关 AdDS 中枢神经系统病理生理学的知识，(2) 阐明该疾病的潜在神经生理学基础，例如哪种皮质内机制不同于健康以及是否局限于受影响的患者肌肉组织或普遍。 (3) 它将完善其他喉部兴奋性研究的技术。长期目标：未来的工作可能会导致 AdSD 和其他疾病之间更明确的鉴别诊断，并开发创新的循证干预措施，直接推进 NIDCD 的使命。