Involuntary Phonation in a Patient with Parkinson's Disease.
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Accession number;03A0140980
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| Title;Involuntary Phonation in a Patient with Parkinson's Disease. |
| Author;
ISHII KOSUKE
(Jichi Medical School, Omiya Medical Center, JPN)
KUMADA MASANOBU
(National Rehabilitation Center for Disabled, JPN)
UEKI AKIRA
(Jichi Medical School, Omiya Medical Center, JPN)
ABE KOICHI
(Jichiidai Jibiinkoka)
TSUBAKI KEIJU
(Jichi Medical School, Omiya Medical Center, JPN)
YAMAMOTO MASANORI
(Jichi Medical School, Omiya Medical Center, JPN)
OTA YASUSHI
(Jichi Medical School, Omiya Medical Center, JPN)
HIROSE HAJIME
(Kitasato Univ. School of Allied Health Sci.)
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Journal Title;Journal of the Japan Broncho-Esophagological Society
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Journal Code:Z0674A
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ISSN:0029-0645
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VOL.54;NO.1;PAGE.43-47(2003)
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| Figure&Table&Reference;FIG.3, TBL.2, REF.6 |
| Pub. Country;Japan |
| Language;Japanese |
| Abstract;We report a case of involuntary phonation caused by abnormal vocal cord movements during expiration in a patient with Parkinson's desease. A 60-year-old female had been treated for Parkinsonism at the outpatient clinic of Omiya Medical Center, Jichi Medical School since August 1999. She began to groan involuntarily in the day-time in September 2001. She could not eat well while groaning. Stridor was not noted during sleep at night. Endoscopic examination of the larynx revealed insufficient abduction of the bilateral vocal cords, although the glottis was not so small as to cause stridor during inspiration. During expiration, however, the vocal cords adducted, resulting in the production of involuntary voice. Electromyography showed an increase in the activity of the thyroarytenoid and lateral cricoarytenoid muscles. This muscle activity was further enhanced during inspiration. The involuntary phonation disappeared after a decrease in the patient's dose of L-Dopa, although she also experienced a decrease in her other behavior as well. When her dose of L-Dopa was increased to the therapeutic level, the involuntary phonation recurred, but her behavioral activity improved. In the present case, we believe that dopaminergic denervation occurred excessively in the nerve innervating the laryngeal adductors. The involuntary voice was thus probably due to hypertonus of the laryngeal adductors with a decreased threshold level for L-Dopa, although the drug was administered at the usual dose. Since there was no optimal dose of L-Dopa which could maintain behavioral activity as desired while simultaneously causing no involuntary phonation, the patient has been treated with L-Dopa at a dose that maintains good behavioral activity, which seems to be more important for her daily life. We are considering therapy with botulinus toxin injections into the laryngeal muscles to treat this case of involuntary phonation. (author abst.) |
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