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Short- and Long-term Central Action of Botulinum Neurotoxin Treatment in Laryngeal Dystonia

BACKGROUND AND OBJECTIVES: Laryngeal dystonia (LD) is isolated task-specific focal dystonia selectively impairing speech production. The first choice of LD treatment is botulinum neurotoxin (BoNT) injections into the affected laryngeal muscles. However, whether BoNT has a lasting therapeutic effect...

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Autores principales: O'Flynn, Lena C., Simonyan, Kristina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9536744/
https://www.ncbi.nlm.nih.gov/pubmed/35764404
http://dx.doi.org/10.1212/WNL.0000000000200850
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author O'Flynn, Lena C.
Simonyan, Kristina
author_facet O'Flynn, Lena C.
Simonyan, Kristina
author_sort O'Flynn, Lena C.
collection PubMed
description BACKGROUND AND OBJECTIVES: Laryngeal dystonia (LD) is isolated task-specific focal dystonia selectively impairing speech production. The first choice of LD treatment is botulinum neurotoxin (BoNT) injections into the affected laryngeal muscles. However, whether BoNT has a lasting therapeutic effect on disorder pathophysiology is unknown. We investigated short-term and long-term effects of BoNT treatment on brain function in patients with LD. METHODS: A total of 161 participants were included in the functional MRI study. Statistical analyses examined central BoNT effects in patients with LD who were stratified based on the effectiveness and duration of treatment. RESULTS: Patients with LD who were treated and benefited from BoNT injections had reduced activity in the left precuneus compared with BoNT-naive and treatment nonbenefiting patients. In addition, BoNT-treated patients with adductor LD had decreased activity in the right thalamus, whereas BoNT-treated abductor patients with LD had reduced activity in the left inferior frontal cortex. No statistically significant differences in brain activity were found between patients with shorter (1–5 years) and longer (13–28 years) treatment durations. However, patients with intermediate treatment duration of 6–12 years showed reduced activity in the right cerebellum compared with patients with both shorter and longer treatment durations and reduced activity in the right prefrontal cortex compared with patients with shorter treatment duration. DISCUSSION: Our findings suggest that the left precuneus is the site of short-term BoNT central action in patients with LD, whereas the prefrontal-cerebellar axis is engaged in the BoNT response in patients with intermediate treatment duration of 6–12 years. Involvement of these structures points to indirect action of BoNT treatment on the dystonic sensorimotor network through modulation of motor sequence planning and coordination.
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spelling pubmed-95367442022-10-11 Short- and Long-term Central Action of Botulinum Neurotoxin Treatment in Laryngeal Dystonia O'Flynn, Lena C. Simonyan, Kristina Neurology Research Articles BACKGROUND AND OBJECTIVES: Laryngeal dystonia (LD) is isolated task-specific focal dystonia selectively impairing speech production. The first choice of LD treatment is botulinum neurotoxin (BoNT) injections into the affected laryngeal muscles. However, whether BoNT has a lasting therapeutic effect on disorder pathophysiology is unknown. We investigated short-term and long-term effects of BoNT treatment on brain function in patients with LD. METHODS: A total of 161 participants were included in the functional MRI study. Statistical analyses examined central BoNT effects in patients with LD who were stratified based on the effectiveness and duration of treatment. RESULTS: Patients with LD who were treated and benefited from BoNT injections had reduced activity in the left precuneus compared with BoNT-naive and treatment nonbenefiting patients. In addition, BoNT-treated patients with adductor LD had decreased activity in the right thalamus, whereas BoNT-treated abductor patients with LD had reduced activity in the left inferior frontal cortex. No statistically significant differences in brain activity were found between patients with shorter (1–5 years) and longer (13–28 years) treatment durations. However, patients with intermediate treatment duration of 6–12 years showed reduced activity in the right cerebellum compared with patients with both shorter and longer treatment durations and reduced activity in the right prefrontal cortex compared with patients with shorter treatment duration. DISCUSSION: Our findings suggest that the left precuneus is the site of short-term BoNT central action in patients with LD, whereas the prefrontal-cerebellar axis is engaged in the BoNT response in patients with intermediate treatment duration of 6–12 years. Involvement of these structures points to indirect action of BoNT treatment on the dystonic sensorimotor network through modulation of motor sequence planning and coordination. Lippincott Williams & Wilkins 2022-09-13 /pmc/articles/PMC9536744/ /pubmed/35764404 http://dx.doi.org/10.1212/WNL.0000000000200850 Text en Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Research Articles
O'Flynn, Lena C.
Simonyan, Kristina
Short- and Long-term Central Action of Botulinum Neurotoxin Treatment in Laryngeal Dystonia
title Short- and Long-term Central Action of Botulinum Neurotoxin Treatment in Laryngeal Dystonia
title_full Short- and Long-term Central Action of Botulinum Neurotoxin Treatment in Laryngeal Dystonia
title_fullStr Short- and Long-term Central Action of Botulinum Neurotoxin Treatment in Laryngeal Dystonia
title_full_unstemmed Short- and Long-term Central Action of Botulinum Neurotoxin Treatment in Laryngeal Dystonia
title_short Short- and Long-term Central Action of Botulinum Neurotoxin Treatment in Laryngeal Dystonia
title_sort short- and long-term central action of botulinum neurotoxin treatment in laryngeal dystonia
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9536744/
https://www.ncbi.nlm.nih.gov/pubmed/35764404
http://dx.doi.org/10.1212/WNL.0000000000200850
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