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Song SA, Go CL, Acuna PB, De Guzman JKP, Sharma N, Song PC. Progressive Decline in Voice and Voice-Related Quality of Life in X-Linked Dystonia Parkinsonism. J Voice 2023; 37:134-138. [PMID: 33334627 PMCID: PMC10222671 DOI: 10.1016/j.jvoice.2020.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To characterize the evolution of swallowing and voice in patients with X-linked dystonia parkinsonism (XDP). STUDY DESIGN Retrospective case series. METHODS Retrospective review of 59 patients with XDP from January 2016 to January 2018. All patients underwent complete examinations and quality of life (QOL) surveys (Swallowing Quality of Life questionnaire [SWAL-QOL], Voice-Related Quality of Life [V-RQOL], and Voice Handicap Index [VHI]), and functional endoscopic examination of swallowing. We excluded patients with incomplete records or patients lost to follow-up. Univariate analysis was used to compare 2016 to 2018 Penetration-Aspiration Scale (PAS), SWAL-QOL, V-RQOL, and VHI scores. RESULTS Ten patients met the inclusion criteria. Nine patients had oromandibular dystonia. Voice-related measures significantly worsened with an increase in mean VHI from 81 to 109.9 (P = 0.026) and decrease in mean V-RQOL from 58 to 28 (P = 0.013). Vocal strain also significantly worsened 0.4 to 1.4 (P = 0.001). Mean PAS scores increased from 4.2 to 5.1 (P = 0.068) and mean SWAL-QOL decreased from 50.4 to 43.5 (P = 0.157). In the SWAL-QOL, the mean Eating Duration score worsened from 0.9 to 0.4 (P = 0.052) and Mental Health score declined from 10.1 to 6.1 (P = 0.077). CONCLUSIONS Both vocal strain and voice-related QOL measures considerably worsened over the 2-year interval in our limited group of XDP patients with no significant change in PAS scores or swallowing QOL. The findings demonstrated that the pace of disease affecting voice symptoms was different from swallowing symptoms in our study group and that changes in communication ability may be a more sensitive marker for disease progression than swallowing dysfunction.
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Affiliation(s)
- Sungjin A Song
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts; Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.
| | - Criscely L Go
- Department of Neurology, Jose Reyes Memorial Medical Center, Manila, Philippines; The Collaborative Center for X-linked Dystonia Parkinsonism, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Patrick B Acuna
- The Collaborative Center for X-linked Dystonia Parkinsonism, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jan Kristopher Palentinos De Guzman
- Department of Neurology, Jose Reyes Memorial Medical Center, Manila, Philippines; The Collaborative Center for X-linked Dystonia Parkinsonism, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nutan Sharma
- The Collaborative Center for X-linked Dystonia Parkinsonism, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Phillip C Song
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts; Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
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Zaninotto AL, de Guzman JK, Stipancic KL, Perry BJ, Supnet ML, Go C, Sharma N, Green JR. Speech and swallowing deficits in X-Linked Dystonia-Parkinsonism. Parkinsonism Relat Disord 2021; 89:105-10. [PMID: 34274618 DOI: 10.1016/j.parkreldis.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/25/2021] [Accepted: 07/06/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION X-linked Dystonia-Parkinsonism (XDP) is a progressive, disabling disease characterized by the devastating impairment of bulbar function, including speech and swallowing. Despite these detrimental impacts, bulbar impairments in this population are not well characterized. OBJECTIVES To identify impairments in the bulbar system measured by oromotor performance in individuals with XDP relative to healthy controls. Secondarily, to detect diagnostic bulbar markers that are sensitive and specific to the initial years of XDP. METHODS This case-control study included 25 healthy controls and 30 participants with XDP, divided into two subgroups based on the median of their disease length. Multiple clinical and instrumental oromotor tasks and measures were used to evaluate bulbar motor function. RESULTS Differences were found between both the subgroups with XDP and healthy controls on almost all measures, including maximum performance tasks such as tongue strength, alternating motion rate (AMR), and sequential motion rate (SMR) (p < 0.05). Differences were found between the XDP subgroups and the control group for the percentage of pause time during the speech, a rating of speech severity, and a swallowing task (ps < 0.05). Scores on self-reported questionnaires, tongue strength, the number of repetitions produced during an AMR, percent pause, and speech severity demonstrated good sensitivity and specificity to differentiate the initial years of XDP onset from healthy controls. CONCLUSIONS Our findings revealed impairments across bulbar functions in participants within the first 7 years of the XDP onset. Highly sensitive and specific bulbar impairment measures were detected in instrumental and self-reported measures that are fundamental for monitoring disease.
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Song PC, Le H, Acuna P, De Guzman JKP, Sharma N, Francouer TN, Dy ME, Go CL. Voice and swallowing dysfunction in X‐linked dystonia parkinsonism. Laryngoscope 2019; 130:171-177. [DOI: 10.1002/lary.27897] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/15/2019] [Accepted: 02/05/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Phillip C. Song
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Hoai Le
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Patrick Acuna
- The Collaborative Center for X‐linked Dystonia ParkinsonismDepartment of Neurology, Massachusetts General Hospital Boston Massachusetts U.S.A
- Sunshine Care Foundation Roxas City Philippines
| | - Jan Kristopher Palentinos De Guzman
- The Collaborative Center for X‐linked Dystonia ParkinsonismDepartment of Neurology, Massachusetts General Hospital Boston Massachusetts U.S.A
| | - Nutan Sharma
- The Collaborative Center for X‐linked Dystonia ParkinsonismDepartment of Neurology, Massachusetts General Hospital Boston Massachusetts U.S.A
| | - Taylor N. Francouer
- Department of NeurologyMassachusetts General Hospital Boston Massachusetts U.S.A
| | - Marisela E. Dy
- Department of NeurologyBoston Children's Hospital/Massachusetts General Hospital Boston Massachusetts U.S.A
| | - Criscely L. Go
- Department of NeurologyJose R. Reyes Memorial Medical Center Manila Philippines
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Bin Asnawi SA, Bin Mohamed MH, Bin Doi M. A Rare Presentation of Bilateral Vocal Cord Paralysis in Late Stage Parkinson’s Disease. Integr J Med Sci 2018; 5. [DOI: 10.15342/ijms.v5ir.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Introduction: Vocal cord paralysis often causes mortality by upper airway obstruction in some neurodegenerative diseases such as Parkinson’s disease and multiple system atrophy. Vocal cord paralysis is uncommon in Parkinson’s disease (PD) on the contrary it is more common in multiple system atrophy (MSA). The pathogenesis of vocal cord paralysis in Parkinson’s disease is not well understood but may involve degeneration of the nucleus ambiguous. In terms of managing patients with bilateral vocal cord paralysis in PD, it can either perform a tracheostomy to relieve the upper airway obstruction or optimize the medical treatment. There are very few available reported cases whereby patients are treated with medical treatment alone.Case Report: We report a case of 65 years old lady who presented with stridor resulting from bilateral vocal cord paralysis and has been diagnosed with Parkinson’s disease for more than 10 years. She had her antiparkinson medication optimized and requiring no surgical intervention to relieve the upper airway obstruction.Conclusion: In conclusion, we would like to emphasize that it is important to recognize bilateral vocal cord paralysis in Parkinson’s disease and early optimization of medical treatment could avoid a need for tracheostomy.
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Rai V, Goyal V, Shukla G, Rath G, Behari M. Adductor laryngeal breathing dystonia in NBIA treated with botulinum toxin-A. Ann Indian Acad Neurol 2013; 16:409-10. [PMID: 24101831 PMCID: PMC3788295 DOI: 10.4103/0972-2327.116919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 06/20/2012] [Accepted: 08/23/2012] [Indexed: 11/04/2022] Open
Abstract
We report a rare case of neurodegeneration with brain iron accumulation (NBIA) presented with episodic inspiratory stridor. A 10-year-old boy presented with 3-year history of gradually progressive spastic gait and generalized dystonia (involving all four limbs, neck, jaw, and speech). MRI brain showed “Eye of Tiger” sign. He recently developed severe inspiratory stridor associated with almost gasping respiration. Direct video laryngoscopy showed paradoxical vocal cord closure during inspiration. He was treated with EMG-guided botulinum toxin-A injection given into bilateral thyroarytenoid muscles, resulting in dramatic response with complete disappearance of the stridor within a week. The effect lasted 18 months.
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Affiliation(s)
- Vinod Rai
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Lee LV, Rivera C, Teleg RA, Dantes MB, Pasco PMD, Jamora RDG, Arancillo J, Villareal-Jordan RF, Rosales RL, Demaisip C, Maranon E, Peralta O, Borres R, Tolentino C, Monding MJ, Sarcia S. The Unique Phenomenology of Sex-Linked Dystonia Parkinsonism (XDP, DYT3, “Lubag”). Int J Neurosci 2010; 121 Suppl 1:3-11. [DOI: 10.3109/00207454.2010.526728] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
The clinical phenotype of X-Linked Dystonia Parkinsonism (XDP) is typically one that involves a Filipino adult male whose ancestry is mostly traced in the Philippine island of Panay. Dystonia usually starts focally in the lower limbs or oromandibular regions, then spreads to become generalized eventually. Parkinsonism sets in later into the disease and usually in combination with dystonia. /DYT3/ and /TAF1/ are the two genes associated with XDP. An SVA retrotransposon insertion in an intron of /TAF1/ may reduce neuron-specific expression of the /TAF1/ isoform in the caudate nucleus, and subsequently interfere with the transcription of many neuronal genes. Polypharmacy with oral benzodiazepines, anticholinergic agents and muscle relaxants leaves much to be desired in terms of efficacy. The medications to date that may appear beneficial, especially in disabling dystonias, are zolpidem, muscle afferent block with lidocaine-ethanol and botulinum toxin type A. Despite the few cases undergoing deep brain stimulation, this functional surgery has shown the greatest promise in XDP. An illustrative case of XDP in a family depicts the variable course of illness, including a bout of “status dystonicus,” challenges in therapy, reckoning with the social impact of the disease, and eventual patient demise. Indeed, there remains some gaps in understanding some phenomenological, genetic and treatment aspects of XDP, the areas upon which future research directions may be worthwhile.
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Affiliation(s)
- Raymond L Rosales
- Department of Neurology and Psychiatry, University of Santo Tomas, Manila, Philippines ; CNS-Center for Neurodiagnostic and Therapeutic Services, Metropolitan Medical Center, Manila, Philippines
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Abstract
AbstractObjectives:(1) To present a rare case of stridor secondary to prolonged laryngospasm in a patient with Parkinson's disease, and (2) to review the literature on stridor in Parkinson's disease.Methods:We report a 73-year-old Parkinson's disease patient who developed acute stridor due to prolonged laryngospasm triggered by overspill of excessive secretions. The literature was reviewed, following a Medline search using the keywords ‘Parkinson's disease’ and ‘stridor’ or ‘airway obstruction’ or ‘laryngospasm’ or ‘laryngeal dystonia’ or ‘bilateral vocal cord palsy’.Result:Only 12 previously reported cases of stridor in Parkinson's disease patients were identified. Causes included bilateral vocal fold palsy (eight cases), laryngospasm (five), and dystonia of the jaw and neck muscles (two). The mechanism of laryngospasm in our patient was similar to ‘dry drowning’, and has not previously been described.Conclusion:Laryngospasm can be triggered in Parkinson's disease by excessive secretions entering the larynx. The mechanism is similar to ‘dry drowning’. Treatment focuses on reducing secretions. The use of botulinum toxin to reduce spasm is inappropriate in this situation. This case emphasises the importance of recognising different causes of stridor in Parkinson's disease patients, as this affects management.
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Abstract
Movement disorder emergencies include any movement disorder which evolves over hours to days, in which failure to appropriately diagnose and manage can result in patient morbidity or mortality. It is crucial that doctors recognize these emergencies with accuracy and speed by obtaining the proper history and by being familiar with the phenomenology of frequently encountered movements. These disorders will be discussed based on the most common associated involuntary movement, either parkinsonism, dystonia, chorea, tics or myoclonus, and, when available, review the workup and treatment options based on the current literature.
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Kishore A, Lang AE. Normalization of voice in spasmodic dysphonia during transient global amnesia. Mov Disord 2005; 20:1228-9. [PMID: 15954130 DOI: 10.1002/mds.20569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report on the case of a 69-year-old woman with Parkinson's disease and long-standing history of spasmodic dysphonia that reversed during an episode of transient global amnesia (TGA). To our knowledge, this phenomenon has not been reported before. We suggest possible mechanisms by which the pathophysiology of dystonia could reverse during TGA.
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Affiliation(s)
- Asha Kishore
- Division of Neurology, Department of Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
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Frucht SJ. Movement disorder emergencies. Curr Neurol Neurosci Rep 2005; 5:284-93. [PMID: 15987612 DOI: 10.1007/s11910-005-0073-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
For the past 4 years, Dr. Stanley Fahn and I have given a course at the American Academy of Neurology annual meeting on the topic of movement disorder emergencies. The purpose of this review article is to summarize the topic and to present it to readers of this journal. The text of this article has appeared in nearly the same form as the Academy syllabus accompanying our course. It is being presented here so that readers of the journal may review the material.
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Affiliation(s)
- Steven J Frucht
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY 10032, USA.
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Evidente VGH, Advincula J, Esteban R, Pasco P, Alfon JA, Natividad FF, Cuanang J, Luis AS, Gwinn-Hardy K, Hardy J, Hernandez D, Singleton A. Phenomenology of "Lubag" or X-linked dystonia-parkinsonism. Mov Disord 2002; 17:1271-7. [PMID: 12465067 DOI: 10.1002/mds.10271] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
X-linked dystonia-parkinsonism (XDP), or Lubag syndrome, is known to cause progressive dystonia, with or without parkinsonism, among Filipino male adults with maternal roots from the Philippine island of Panay. We present cinematographic material of 11 cases of Lubag carrying the XDP haplotypes who manifest with a wide spectrum of movement disorders, including dystonia, tremor, parkinsonism, myoclonus, chorea, and myorhythmia. Because of overlapping features, Lubag patients are commonly misdiagnosed as idiopathic dystonia, essential tremor, Parkinson's disease, or Parkinson's-plus syndromes. Thus, it is imperative to elicit an exhaustive family history in any Filipino male adult who presents with a movement disorder.
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Abstract
Parkinsonism and dystonia may coexist in a number of neurodegenerative, genetic, toxic, and metabolic disorders and as a result of structural lesions in the basal ganglia. Parkinson's disease (PD) and the 'Parkinson-plus' syndromes (PPS) account for the majority of patients with the parkinsonism-dystonia combination. Dystonia, particularly when it involves the foot, may be the presenting sign of PD or PPS and these disorders should be suspected when adults present with isolated foot dystonia. Young age, female gender, and long disease duration are risk factors for PD-related dystonia, but dystonia in patients with PD is usually related to levodopa therapy. The mechanism of dystonia in PD is not well understood and the management is often challenging because levodopa and other dopaminergic agents may either improve or worsen dystonia. Other therapeutic strategies include oral medications (baclofen, anticholinergics and benzodiazepines), local injections of botulinum toxin, intrathecal baclofen, and surgical lesions or high frequency stimulation of the thalamus, globus pallidus, or subthalamus.
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Affiliation(s)
- J Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
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Abstract
We describe clinical experiences in the management of three patients with laryngopharyngeal dystonia causing severe breathing problems. In contrast to spasmodic dysphonia, which presents with action-induced involuntary spasm of laryngeal muscles during speaking, all three patients showed laryngopharyngeal spasms primarily during respiration. In analogy to spasmodic dysphonia we propose the term spasmodic laryngeal dyspnea for this rare condition. Localized unilateral botulinum toxin injected into the thyroarytenoid muscle and/or ventricular folds reduced the quantity and quality of spasms and led to a pronounced improvement of breathing problems.
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Affiliation(s)
- P Zwirner
- Abt. Phoniatrie und Pädaudiologie, Georg-August-Universität Göttingen, Germany
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Lagueny A, Burbaud P, Le Masson G, Bergouignan FX, Ferrer X, Julien J. Involvement of respiratory muscles in adult-onset dystonia: a clinical and electrophysiological study. Mov Disord 1995; 10:708-13. [PMID: 8749989 DOI: 10.1002/mds.870100603] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Involvement of respiratory muscles is unusual in dystonia, but its occurrence may be underestimated either because it is not conspicuous or because it is improperly imputed to another cause. Three patients who had adult-onset dystonia and who were exhibiting respiratory problems were examined clinically and electrophysiologically. In the three patients the onset was focal-cervical in two and blepharospasm in one. The respiratory problems appeared later. The first patient had involuntary deep and loud inspirations combined with spasms of axial dystonia, the second complained of breathing arrests, and the third had deep inspirations mainly on speaking or reading aloud, thus causing broken speech. Electromyographic findings, including of the diaphragm, were quite consistent with a respiratory involvement in these three cases of dystonia. Assuming that respiratory troubles could be in the first sign of a focal dystonia, electrophysiological studies of respiratory muscles could be used to confirm this.
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Affiliation(s)
- A Lagueny
- Service de Neurologie Hôpital du Haut Lévêque, CHU Bordeaux, Pessac, France
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