2 results
6 - Cervical dystonia
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- By Khalid Anwar, Hunters Moor Regional Neurological Rehabilitation Centre, Newcastle upon Tyne, UK
- Edited by Anthony B. Ward, Michael P. Barnes
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- Book:
- Clinical Uses of Botulinum Toxins
- Published online:
- 02 December 2009
- Print publication:
- 22 March 2007, pp 80-110
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- Chapter
- Export citation
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Summary
Introduction
The term dystonia is defined as a sustained, involuntary contraction of muscle that produces an abnormal posture and frequently causes twisting and turning. Cervical dystonia is the most common form of adult-onset focal dystonia. It is defined as involuntary twisting and turning of the neck caused by abnormal involuntary muscle contractions. This abnormal posture may be associated with spasms, jerks or tremors or a combination of these features. Cervical dystonia also has been referred to as spasmodic torticollis but this term does not reflect the dystonic nature of the problem. It implies that spasms are an essential feature of the disease although these can be absent in 25–30 per cent of the patients with cervical dystonia. Torticollis on the other hand is the physical sign of the twisted neck and may result from many non-dystonic causes.
It is well known that due to variable presentation of this disease cervical dystonia is frequently misdiagnosed and accurate diagnosis is often delayed. The aetiology and pathogenesis of cervical dystonia remains unclear. However it is generally agreed that genetic factors, trauma, altered sensory input, primary vestibular abnormality and impaired basal ganglia function may all have some role in the development of this disease. Adult-onset cervical dystonia usually does not become generalized although there may be segmental spread with involvement of arms jaws or trunk. A small percentage of patients can have a spontaneous remission but it is usually short lived and incomplete.
7 - The use of botulinum toxin in otolaryngology
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- By Maurice Hawthorne, James Cook University Hospital, Middlesbrough, UK, Khalid Anwar, Hunters Moor Regional Neurological Rehabilitation Centre, Newcastle upon Tyne, UK
- Edited by Anthony B. Ward, Michael P. Barnes
-
- Book:
- Clinical Uses of Botulinum Toxins
- Published online:
- 02 December 2009
- Print publication:
- 22 March 2007, pp 111-121
-
- Chapter
- Export citation
-
Summary
Introduction
In this chapter, the therapeutic use of botulinum toxin for disorders that predominately manifest themselves in the larynx and pharynx will be covered. The treatment of laryngeal dystonia with botulinum toxin remains the best documented use of botulinum toxin in this field but it has been successfully used to treat other laryngeal and pharyngeal disorders (Table 7.1).
Laryngeal dystonia/spasmodic dysphonia
The term dystonia is defined as a sustained, involuntary contraction of muscle that produces an abnormal posture and frequently causes twisting and turning. It is a chronic neurological disorder of the central nervous system characterized by action induced muscle spasms and can be generalized or focal. Dystonia that affects the larynx is usually focal and mainly results in speech disorders but can also, albeit rarely, cause breathing difficulties.
Laryngeal dystonia begins in middle age and is more common in females than males. Adductor dysphonia, which causes strangled voice quality, is much more common than abductor dysphonia, which results in breathy voice. Voice is obviously extremely important in social interactions and in spasmodic dysphonia, voice impairment can be long lasting, which has significant negative social consequences. Patients with spasmodic dysphonia have a high incidence of anxiety and depression and can suffer significant psychological problems. The condition can have a direct effect on their quality of life and work place performance.