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Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
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Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
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Directly acting muscle relaxants like dantrolene and botulinum toxin (BoNT) have distinct mechanisms and applications. Dantrolene, a hydantoin derivative, acts on the ryanodine receptor (RYR1) in skeletal muscle cells. RYR1 are calcium channels present at the sarcoplasmic reticulum membrane. In response to excitation, they release calcium ions from the sarcoplasmic reticulum to the cytosol. Calcium promotes actin-myosin-mediated contraction of muscles.
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Nondepolarizing neuromuscular blockers induce paralysis by competitively blocking nicotinic acetylcholine receptors at the muscle end plate. Examples include pancuronium, mivacurium, vecuronium, and rocuronium. These quaternary ammonium derivatives are administered intravenously, are poorly absorbed, and are excreted via the kidneys.
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Neuromodulation for Laryngeal Dystonia: A Systematic Review.

Chang Woo Lee1, Marie T Krüger2, Harith Akram2

  • 1Department of Laryngology, National Voice Centre, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, United Kingdom; UCL Division of Surgery and Interventional Science, London, United Kingdom.

Journal of Voice : Official Journal of the Voice Foundation
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PubMed
Summary

This review explores neuromodulation therapies for laryngeal dystonia (LD). While early-stage, sodium oxybate and deep brain stimulation (DBS) show promise for treating LD symptoms.

Keywords:
Laryngeal dystoniaLaryngologyNeurolaryngologyNeuromodulationVoice

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Area of Science:

  • Neurology
  • Otolaryngology
  • Biomedical Engineering

Background:

  • Laryngeal dystonia (LD), also known as spasmodic dysphonia, is a debilitating neurological voice disorder.
  • Current treatment options for LD have limitations, necessitating exploration of novel therapeutic approaches.

Purpose of the Study:

  • To systematically review and evaluate neuromodulation therapies for laryngeal dystonia.
  • To assess the current evidence and potential of these therapies in clinical practice.

Main Methods:

  • A systematic literature review adhering to PRISMA guidelines was conducted.
  • Searches were performed on Embase, Medline, and Cochrane databases (1960-2024).
  • Included studies were assessed for bias using Joanna Briggs Institute checklists, and data on patient demographics, therapies, outcomes, and complications were extracted.

Main Results:

  • Twelve studies involving 130 patients evaluated therapies including vibro-tactile stimulation, laryngeal electrical stimulation, sodium oxybate, repetitive transcranial magnetic stimulation, and deep brain stimulation (DBS).
  • All studies reported some improvement in voice symptoms, but definitive conclusions on efficacy were limited by study design (case reports, pilot studies, Phase I trials) and lack of long-term follow-up.
  • No significant complications were reported for any of the investigated neuromodulation therapies.

Conclusions:

  • Neuromodulation therapies for LD are predominantly in early exploratory stages.
  • Further clinical trials are necessary to establish efficacy and safety.
  • Sodium oxybate and DBS demonstrate the most potential for future clinical application in treating laryngeal dystonia.