Author/Editor     Hočevar-Boltežar, Irena; Pirtošek, Zvezdan
Title     Zdravljenje laringealne distonije z botulinom: prikaz bolnice
Translated title     Treatment of laryngeal dystonia with botulinum toxin: a case report
Type     članek
Source     Zdrav Vestn
Vol. and No.     Letnik 71, št. 7-8
Publication year     2002
Volume     str. 461-5
Language     slo
Abstract     Background. Laryngeal dystonia (LD) is a form of focal dystonia, involving laryngeal muscles and causing disturbed phonation. Adductor, abductor and mixed forms of LD are described. Methods. Largely unsuccessful treatments include voice therapy, psychotherapy, biofeedback, section of the laryngeal recurrent nerve, laryngeal framework surgery and the use of centrally acting drugs. Botulinum toxin proved to be the most efficient treatment of LD; it acts by chemically denervating hyperactive laryngeal muscles. Case report. Authors report on the first use of botulinum toxin in a patient with LD in Slovenia. A female patient with a degenerative disease of extrapyramidal, cerebellar and autonomous system (probable multiple system atrophy) and severe adductor form of LD is presented. By gradually increasing dose, the optimal dosage of botulinum has been established that greatly the patients speech for four months and causes transient mild adverse effects (dysphagia). Botulinum is injected percutaneously under endoscopic control, using the method, which has been described in literature for the first time. Conclusions. Treatment of LD with botulinum toxin demonstrated good results. It improves patients communication with others and the quality of his/her life.
Summary     Izhodišča. Laringealna distonija (LD) je žariščna distonija, ki zajame grlne mišice in povzroči motnjo fonacije. Ločimo adduktorno, abduktorno in mešano obliko. Metode. Manj uspešni poskusi zdravljenja LD vključujejo glasovno terapijo, psihoterapijo, biofeedback, zdravila s centralnim učinkom, operativni poseg na povratnem grlnem živcu ali grlnem ogrodju. Najuspešnejša je terapija z botulinom, ki farmakološko denervira hiperaktivne grlne mišice. Prikaz bolnice. Avtorja poročata o prvi uporabi botulina pri zdravljenju LD v Sloveniji. Predstavljena je bolnica z degenerativno boleznijo ekstrapiramidnega, cerebelarnega in avtonomnega sistema (verjetno multiplo sistemno atrofijo), v okviru katere se je pojavila huda adduktorna LD. S postopnim večanjem odmerka toksina je bil določen za bolnico optimalni odmerek, ki ji znatno izboljša govor za štiri mesece, neugodni stranski učinki (disfagija) pa so blagi in kratkotrajni. Botulin je injiciran perkutno pod endoskopsko kontrolo, na način, ki doslej v literaturi še ni bil opisan. Zaključki. Zdravljenje adduktorne oblike LD z botulinom je pokazalo dobre rezultate, saj izboljša bolnikovo sporazumevanje z okolico in s tem kakovost njegovega življenja.
Descriptors     VOICE DISORDERS
BOTULINUM TOXINS
MIDDLE AGE
LARYNGEAL MUSCLES
DYSTONIA