Treatment of VNS-Induced Laryngospasm With Botulinum Toxin

Kumar, Sumit; Sharafkhaneh, Amir; Edmonds, Janalyn Cantey; Schultz, Rebecca; Hopkins, Bobbi

doi:10.1212/wnl.0b013e3181c34ae3

Cited by 7 publications

(11 citation statements)

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“…However, another possible mechanism could be VNS-induced activation of vagal afferents synapsing on the dorsal medullary vagal complex including nucleus tractus solitarius, mediating dysfunction of the central control of vagal branchiomotor efferents and resultant paradoxical contraction of laryngeal adductors during inspiration similar to adductor dysphonia seen in MSA-associated, sleep-related stridor (Merlo et al , 2002; Vetrugno et al , 2007). The recent report of directly visualized VNS-induced laryngospasm during laryngoscopy subsequently relieved by botulinum toxin injection of the left thyroarytenoid muscle supports hypotheses of VNS-induced local efferent or central modulation of vocal fold functioning (Kumar et al , 2009). …”

Section: Discussionmentioning

confidence: 72%

Reversible sleep‐related stridor during vagus nerve stimulation

Louis¹,

Faber²

2010

Epileptic Disorders

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A 23-year-old woman without history of antecedent vocal, respiratory, or sleep disorders received vagus nerve stimulation (VNS) therapy for refractory partial epilepsy and developed sleep-related stridor during the course of parameter titration. Reduction of VNS current during polysomnography completely eliminated stridor. We conclude that VNS may cause sleep-related stridor in rare cases, expanding the spectrum of known sleep-disordered breathing disorders associated with VNS therapy. Parameter adjustment during polysomnography may resolve nocturnal stridor caused by VNS.

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Section: Discussionmentioning

confidence: 72%

Reversible sleep‐related stridor during vagus nerve stimulation

Louis¹,

Faber²

2010

Epileptic Disorders

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“…Vocal fold botulinum toxin injection has been described as a treatment option for refractory PVFMD symptoms . Most of the reports demonstrating efficacy of vocal fold botulinum toxin injection for dyspnea have been single‐patient case studies . There has not been a standardized approach or treatment regimen reported to guide clinicians on best care for patients with refractory PVFMD.…”

Section: Discussionmentioning

confidence: 99%

“…3,[7][8][9][10][11][12] Most of the reports demonstrating efficacy of vocal fold botulinum toxin injection for dyspnea have been single-patient case studies. 8,[10][11][12] There has not been a standardized approach or treatment regimen reported to guide clinicians on best care for patients with refractory PVFMD. Goldstein et al described a patient with severe PVFMD with partial improvement in symptoms following injection of 10 units of botulinum toxin to both thyroarytenoid muscles and 2.5 units to both false vocal folds.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, these patients have limited options for treatment when they fail therapy. For patients who have severe symptoms of dyspnea or refractory PVFMD after all other traditional therapeutic techniques have been trialed, the use of botulinum toxin injection to the vocal folds has been described as a treatment option . Brin and Altman both described the use of botulinum toxin injection for PVFMD, but those reports included patients with concurrent head and neck or other laryngeal dystonia .…”

Section: Introductionmentioning

confidence: 99%

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Vocal fold botulinum toxin injection for refractory paradoxical vocal fold motion disorder

et al. 2018

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Objective Demonstrate efficacy of vocal fold botulinum toxin injection for treatment of refractory paradoxical vocal fold motion disorder (PVFMD). Methods A retrospective review was completed of patients diagnosed with PVFMD who underwent vocal fold botulinum toxin injection for dyspnea symptoms that persisted despite laryngeal control therapy, medical management, and biofeedback therapy. Outcomes measured included overall improvement and resolution of dyspnea symptoms, number of botulinum toxin injections and dose range, change in dyspnea severity index (DSI) scores, and adverse effects of injection therapy. Results Thirteen patients (9 female/4 male) underwent vocal fold botulinum toxin injection for refractory PVFMD. The average dose was 2.55 units per vocal fold (range 1.75–5.5 units). The average number of injections was 3.85 (range 1–12 injections). Eleven of 13 (84.6%) patients experienced improvement in dyspnea symptoms, with two of 11 (18.2%) having complete resolution of symptoms. There was a statistically significant improvement in DSI scores because the mean preinjection DSI was 30.43 and improved to 17.43 postinjection (P = 0.017). Temporary breathy voice quality was experienced by all patients with no other adverse side effects. Conclusion Vocal fold botulinum toxin injection is a safe and effective treatment option for PVFMD and should be considered in patients with refractory dyspnea symptoms following appropriate medical therapy and respiratory retraining protocols. Level of Evidence 4 Laryngoscope, 129:808–811, 2019

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“…Laryngospasm causing SDB has been reported in patients with epilepsy, and in patients affected by refractory epilepsy with vagus nerve stimulator (VNS) . In 2009, Kumar reported a 16‐year old boy with persistent laryngospasm after VNS placement, causing OSAS and daytime somnolence, which was treated successfully with botulinum toxin …”

Section: Discussionmentioning

confidence: 99%

Sleep‐related adductor Laryngeal dystonia causing sleep apnea

Marchese‐Ragona

Vianello²,

Restivo

et al. 2013

The Laryngoscope

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Obstructive sleep apnea syndrome (OSAS) is a chronic condition, characterized by recurrent episodes of upper airway collapse during sleep, which affects up to 5% of adults in the Western population. The muscle tone of the human body ordinarily relaxes during sleep, thus causing airway obstruction and leading to sleep apnea. We report a case of a 68-years old male in which dystonic closure of the larynx during sleep caused OSAS. The sleep endoscopy was crucial in establishing the diagnosis of laryngeal dystonia. A botulinum toxin injection in the vocal cord improved the OSAS. These findings define a novel sleep-related breathing disorder.

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Treatment of VNS-Induced Laryngospasm With Botulinum Toxin

Cited by 7 publications

References 0 publications

Reversible sleep‐related stridor during vagus nerve stimulation

Reversible sleep‐related stridor during vagus nerve stimulation

Vocal fold botulinum toxin injection for refractory paradoxical vocal fold motion disorder

Sleep‐related adductor Laryngeal dystonia causing sleep apnea

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