Central Pathology in Spasmodic Dysphonia.

Abstract

Introduction: Spasmodic dysphonia a voice disorder characterized by loss of voluntary control of vocal fold movements during speech production. The pathophysiology is not well understood, but there have been proposed connections to areas within the brain such as the reticular formation surrounding the tractus solitarius, spinal trigeminal and ambiguus nuclei, inferior olive, and pyramids.

Objective: To determine whether there are differences on brain Magnetic resonance imaging (MRI) with and without gadolinium in patients affected by spasmodic dysphonia compared with those without to determine whether there is a central process involved in spasmodic dysphonia (SD) pathophysiology.

Methods: This was a retrospective review of patients from January 1995 through January 2023. Information from patient charts included age, sex, chief complaint, present and past medical/surgical history, social history, laryngeal Electromyography, and MRI scan results. MRI of the head had to have been performed with and without gadolinium. MRI scan reports were evaluated for the presence or absence of hyperintensities and or hypointensities on T1, T2, or Fluid-attenuated inversion recovery within specific regions of the brain. This information was compared between groups to determine whether SD patients have an increased prevalence of Central nervous system pathology and to determine the location of pathology. Data were analyzed for relationships and significance.

Results: Seventy-two SD patients were included. Most study patients had adductor SD, with a 2.6:1 ratio of adductor to abductor. The SD patients were age and sex matched with patients who had otologic and laryngologic complaints. MRI abnormalities were found in the periventricular white matter, cerebral white matter, and frontal white matter.

Conclusions: There are no significant differences in the locations of hyperintensities and hypointensities on MRI of the brain with and without gadolinium in spasmodic dysphonia patients when compared to otologic and laryngologic controls.