Treatment of Adductor Spasmodic Dysphonia with Botulinum Toxin

以肉毒桿菌治療內收型痙攣性發音障礙

游家銘(Chia-Ming Yu) ； 李學禹(Hsueh-Yu Li) ； 王南梅(Nan-Mei Wang) ； 陳柔賢(Rou-Shayn Chen) ； 蔡崇豪(Chon-Haw Tsai) ； 陸清松(Chin-Song Lu)

《北市醫學雜誌》 2卷5期 (2005/05) Pp. 438-444

https://doi.org/10.6200/TCMJ.2005.2.5.04

摘要

目的：以肉毒桿茵毒素治療單純內收痙攣性發音障礙及合併有聲音顫抖的病人，評估其結果。方法：研究對象為10位內收型痙攣性發音障礙的患者，其中6位為單純發音障礙的病患，另4位為合併有明顯聲音顫抖的病患。在注射前及注射後，皆由神經內科醫師、耳鼻喉科醫師、語言分析師，分別評估其發音的品質及由軟式鼻咽喉內視鏡觀察聲帶運動的情況。病患藉由肌電圖導引確定注射位置後，於左側的杓狀甲狀軟骨肌肉注入15-20單位的肉毒桿茵毒素。結果：6位單純內收痙攣性發音障礙的病患，有5位有明顯的改善。起始效果平均在5天後出現（4-6天），有效期限平均4週（3-6週），另一位病患僅有些許改善。另4位合併有聲音顫抖的病患，則沒有明顯的進步。結論：對於單純內收型痙攣性發音障礙的病患，肉毒桿茵毒素注射是有效的治療，但對於合併有明顯聲音顫抖的病患則不然。因此治療前軟式鼻咽喉內視鏡的評估是非常有價值的。

關鍵字

內收型痙攣性發音障礙 ； 聲音顫抖 ； 肉毒桿茵毒素

並列摘要

Background and Purpose: The aim of our study is to evaluate the effect of botulinum toxin in patients of adductor spasmodic dysphonia (SD) with and without voice tremor. Methods: We used botulinum toxin A (BTX-A, Botox®) in treating 10 patients with adductor SD. Among them, 6 patients were presenting simple adductor SD, 4 patients were presenting adductor SD and prominent voice tremor. The features of their voices were evaluated blindly by another neurologist, by a speech pathologist, and by an otolarygologist with direct videoendoscopic observation before and after treatment. Guided with EMG, a dose of 15 to 20 units of BTX-A was injected into the unilateral thyroarytenoid muscle. Results: We obtained a significant improvement of voice quality in 5 out of 6 simple adductor SD patients. The benefits commenced at a mean of 5 days (range; 4-6 days). The median duration of peak effects was 4 weeks (range: 3-6 weeks). The remaining 1 patient had only mild effects. The videoendoscopic parameters also showed a significant improvement in correlation with the clinical effect. Four adductor SD patients associated with dominant voice tremor did not improve, especially in the tremor component. Conclusion: We have proved that BTX-A is an effective treatment for simple adductor SD, but not for adductor SD with prominent voice tremor. We suggest that a videoendoscopic evaluation is valuable for selecting the patients with adductor SD, particularly complicated with voice tremor.

並列關鍵字

adductor spasmodic dysphonia ； voice tremor ； botulinum toxin