Botulinum toxin injection into the intrinsic laryngeal muscles to treat spasmodic dysphonia: A multicenter, placebo-controlled, randomized, double-blinded, parallel-group comparison/open-label clinical trial

Masamitsu Hyodo, Asuka Nagao, Kento Asano, Masahiko Sakaguchi, Kenji Mizoguchi, Koichi Omori, Yasuhiro Tada, Hiromitsu Hatakeyama, Nobuhiko Oridate, Kensei Naito, Yoshihiro Iwata, Hirotaka Shinomiya, Hirotaka Hara, Tetsuji Sanuki, Eiji Yumoto

Research output: Contribution to journalArticlepeer-review

Abstract

Background and purpose: Botulinum toxin (BT) injection into the laryngeal muscles has been a standard treatment for spasmodic dysphonia (SD). However, few high-quality clinical studies have appeared, and BT is used off-label in most countries. Methods: We performed a multicenter, placebo-controlled, randomized, double-blinded, parallel-group comparison/open-label clinical trial to obtain approval for BT (Botox) therapy in Japan. Twenty-four patients (22 with adductor SD and two with abductor SD) were enrolled. The primary end point was the change in the number of aberrant morae (phonemes) at 4 weeks after drug injection. The secondary end points included the change in the number of aberrant morae, GRBAS scale, Voice Handicap Index (VHI), and visual analog scale (VAS) over the entire study period. Results: In the adductor SD group, the number of aberrant morae at 4 weeks after injection was reduced by 7.0 ± 2.30 (mean ± SE) in the BT group and 0.2 ± 0.46 in the placebo group (p = 0.0148). The improvement persisted for 12 weeks following BT injections. The strain element in GRBAS scale significantly reduced at 2 weeks after BT treatment. The VHI and VAS scores as subjective parameters also improved. In the abductor SD group, one patient responded to treatment. Adverse events included breathy hoarseness (77.3%) and aspiration when drinking (40.9%) but were mild and resolved in 4 weeks. Conclusions: Botulinum toxin injection was safe and efficacious for the treatment of SD. Based on these results, BT injection therapy was approved as an SD treatment in Japan.

Original languageEnglish
Pages (from-to)1548-1556
Number of pages9
JournalEuropean Journal of Neurology
Volume28
Issue number5
DOIs
Publication statusPublished - 05-2021

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

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