4.2 Article

Effects of low-frequency repetitive transcranial magnetic stimulation in adductor laryngeal dystonia: a safety, feasibility, and pilot study

Journal

EXPERIMENTAL BRAIN RESEARCH
Volume 240, Issue 2, Pages 561-574

Publisher

SPRINGER
DOI: 10.1007/s00221-021-06277-4

Keywords

Adductor laryngeal dystonia; Spasmodic dysphonia; Repetitive transcranial magnetic stimulation; Cortical silent period; Acoustics

Categories

Funding

  1. National Institute on Deafness and Other Communication, National Institutes of Health (NIDCD) [R21DC012344, R01DC015216, P50DC015446]
  2. Research Grant, National Spasmodic Dysphonia Association (NSDA)
  3. Minnesota Discovery, Research and Innovation Economy (MnDRIVE) initiative

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The study aimed to investigate the safety, feasibility, and effects of a single session 1 Hz rTMS in individuals with adductor laryngeal dystonia. Results showed potential benefits on voice quality and phonatory function in the treatment group.
Purpose The effects of neuromodulation are virtually unexplored in adductor laryngeal dystonia (AdLD), a disorder characterized by involuntary contraction of intrinsic laryngeal muscles. Recent findings indicated that intracortical inhibition is reduced in people with AdLD. Low-frequency repetitive transcranial magnetic stimulation (rTMS) induces prolonged intracortical inhibition, but the effects in AdLD are unexplored. This pilot and feasibility study aimed to examine the safety, feasibility, and effects of a single session 1 Hz rTMS over the laryngeal motor cortex (LMC) in people with AdLD and healthy individuals. Methods The stimulation location was individualized and determined through TMS-evoked responses in the thyroarytenoid muscles using fine-wire electrodes. 1200 pulses of 1 Hz rTMS were delivered to the left LMC in two groups: Control (n = 6) and AdLD (n = 7). Tolerance, adverse effects, intracortical inhibition, and voice recordings were collected immediately before and after rTMS. Voice quality was assessed with acoustic-based and auditory-perceptual measures. Results All participants tolerated the procedures, with no unexpected adverse events or worsening of symptoms. No significant effects on intracortical inhibition were observed. In the AdLD group, there was a large-effect size after rTMS in vocal perturbation measures and a small-effect size in decreased phonatory breaks. Conclusions One rTMS session over the LMC is safe and feasible, and demonstrated trends of beneficial effects on voice quality and phonatory function in AdLD. These preliminary findings support further investigation to assess clinical benefits in a future randomized sham-controlled trial. ClinicalTrials.gov NCT02957942, registered on November 8, 2016.

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