rTMS in Spasmodic Dysphonia
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Neurology, Orthopedic |
| Therapuetic Areas: | Neurology, Orthopedics / Podiatry |
| Healthy: | No |
| Age Range: | 21 - 75 |
| Updated: | 4/27/2018 |
| Start Date: | January 2017 |
| End Date: | December 2018 |
Repetitive Transcranial Magnetic Stimulation in Spasmodic Dysphonia
Focal dystonia is a neurological movement disorder characterized by excessive involuntary
muscle contractions of any body part. Spasmodic dysphonia (SD) is a type of focal dystonia
characterized by excessive contraction of intrinsic muscles in the larynx, leading to
difficulty in speaking and affecting effective communication. The cause of SD is unknown and
there are no treatments that produce long-term benefits. Previous studies have suggested that
SD and other focal dystonias are associated with decreased inhibition in sensorimotor areas
in the brain. However, no studies have investigated the effects of modulating excitability of
the laryngeal motor cortex in healthy individuals or SD. The goal of this pilot project is to
determine if brain excitability of the laryngeal motor cortex can be changed with
low-frequency inhibitory repetitive transcranial magnetic stimulation (rTMS) in individuals
with SD and healthy controls. Considering that rTMS at low frequencies (≤1 Hz) produces
lasting inhibition in the brain, and that SD is associated with decreased cortical
inhibition, the purpose of this pilot study is to determine safety, feasibility and response
to 1Hz rTMS to the laryngeal motor cortex in individuals with SD and healthy people. The
results will help understand changes associated with the disorder, as well as contribute to
the development of future clinical interventions for SD.
muscle contractions of any body part. Spasmodic dysphonia (SD) is a type of focal dystonia
characterized by excessive contraction of intrinsic muscles in the larynx, leading to
difficulty in speaking and affecting effective communication. The cause of SD is unknown and
there are no treatments that produce long-term benefits. Previous studies have suggested that
SD and other focal dystonias are associated with decreased inhibition in sensorimotor areas
in the brain. However, no studies have investigated the effects of modulating excitability of
the laryngeal motor cortex in healthy individuals or SD. The goal of this pilot project is to
determine if brain excitability of the laryngeal motor cortex can be changed with
low-frequency inhibitory repetitive transcranial magnetic stimulation (rTMS) in individuals
with SD and healthy controls. Considering that rTMS at low frequencies (≤1 Hz) produces
lasting inhibition in the brain, and that SD is associated with decreased cortical
inhibition, the purpose of this pilot study is to determine safety, feasibility and response
to 1Hz rTMS to the laryngeal motor cortex in individuals with SD and healthy people. The
results will help understand changes associated with the disorder, as well as contribute to
the development of future clinical interventions for SD.
Inclusion Criteria:
- Primary inclusion for spasmodic dysphonia:
1. Diagnosis of adductor spasmodic dysphonia
2. Symptoms at worst severity if receiving regular botulinum injections
- Primary inclusion for healthy participants (controls):
1. Absence of vocal fold pathology
Exclusion Criteria:
- Primary exclusion for participants with spasmodic dysphonia:
1. Other forms of dystonia
2. Vocal fold pathology or paralysis
3. Diagnosis of voice tremor
4. Laryngeal surgery
5. Laryngeal cancer or neurological condition other than dystonia
6. Contraindication to TMS
7. Medications with effect on central nervous system
8. Inability to complete tasks associated with study
9. Adult lacking ability to consent
- Primary exclusion for healthy participants (controls):
1. Any health condition or disability that would interfere with participation
2. Contraindications to TMS
3. Medications with effect on central nervous system
4. Adult lacking ability to consent
TMS contraindications:
- The only absolute contraindication to TMS/rTMS is the presence of metallic hardware in
close contact to the discharging coil (such as cochlear implants, deep brain
stimulator, or medication pumps). In such instances there is a risk of inducing
malfunctioning of the implanted devices.
- Conditions classified as of increased or uncertain risk are listed below (Rossi et
al., 2009; Rossini et al., 2015). Persons under those circumstances will be excluded
from the study.
1. Pregnancy
2. Bipolar disorder
3. Epilepsy or history of seizure episodes in the past two years
4. Vascular, traumatic, tumoral, infectious, or metabolic lesion of the brain, even
without history of seizure, and without anticonvulsant medication
5. Use of medications that potentially lower seizure threshold
6. Severe or recent heart disease
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