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Thalamic Deep Brain Stimulation for Spasmodic Dysphonia: A Phase I Prospective Randomized Double-Blind Crossover Trial

Authors
  • Honey, Christopher R1
  • Krüger, Marie T2, 3
  • Almeida, Timóteo1
  • Rammage, Linda A4
  • Tamber, Mandeep S1
  • Morrison, Murray D5
  • Poologaindran, Anujan6, 7
  • Hu, Amanda5
  • 1 Division of Neurosurgery, University of British Columbia, Canada , (Canada)
  • 2 Department of Neurosurgery, Cantonal Hospital St. Gallen, Switzerland , (Switzerland)
  • 3 Department of Stereotactic and Functional Neurosurgery, University Medical Clinic Freiburg, Germany , (Germany)
  • 4 Division of Otolaryngology and School of Audiology and Speech Sciences, University of British Columbia, Canada , (Canada)
  • 5 Division of Otolaryngology, University of British Columbia, Canada , (Canada)
  • 6 Brain Mapping Unit, Department of Psychiatry, University of Cambridge, UK , (United Kingdom)
  • 7 The Alan Turing Institute, British Library, UK , (United Kingdom)
Type
Published Article
Journal
Neurosurgery
Publication Date
Apr 16, 2021
Volume
89
Issue
1
Pages
45–52
Identifiers
DOI: 10.1093/neuros/nyab095
PMID: 33862624
PMCID: PMC8223243
Source
PubMed Central
Keywords
Disciplines
  • Editor's Choice
License
Unknown

Abstract

BACKGROUND Adductor spasmodic dysphonia (SD) is a dystonia of the vocal folds causing difficulty with speech. The current standard of care is repeated botulinum toxin injections to weaken the adductor muscles. We sought to ameliorate the underlying neurological cause of SD with a novel therapy—deep brain stimulation (DBS). OBJECTIVE To assess the safety of DBS in SD through phase I trial, and to quantify the magnitude of any benefit. METHODS Six patients had left ventral intermediate nucleus (Vim) thalamic DBS and were randomized to 3 mo blinded-DBS “on” or “off” followed by a crossover. Primary outcomes were quality of life and quality of voice during the blinded phase. Patients continued with open-DBS “on.” Secondary outcomes were comparisons of pre- and 1-yr cognitive, mood, and quality of life. This trial was registered with ClinicalTrials.gov (NCT02558634). RESULTS There were no complications. Every patient reported an improvement in quality of life ( P  = .07) and had an improvement in quality of their voice ( P  = .06) when their blinded DBS was “on” versus “off.” The trend did not reach statistical significance with the small sample size. Secondary outcomes showed no difference in cognition, an improvement in mood, and quality of life at 1 yr. CONCLUSION This phase I randomized controlled trial confirmed that DBS can be performed safely in patients with SD. Blinded DBS produced a strong trend toward improved quality of life and objective quality of voice despite the small sample size. The cerebellar circuit, not the pallidal circuit, appears to be crucial for motor control of the vocal folds.

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