Video 1
Case 1 before DBS.
Video 2
Case 1 at seven months after bilateral VIM DBS with stimulator on.
Video 3
Case 2 before DBS.
Video 4
Case 2 at one and a half years after bilateral VIM DBS with stimulator on.
Video 5
Case 3 at four years after bilateral VIM DBS with stimulator off.
Video 6
Case 3 at four years after bilateral VIM DBS with stimulator on.
Table 1
Blinded Unified Spasmodic Dysphonia Rating Scale (USDRS) evaluations.
| Case 1 PreDBS | Case 1 PostDBS (7 mos) | Case 2 PreDBS | Case 2 PostDBS (1 mos) | Case 2 Stim OFF PostDBS (1.5 yrs) | Case 2 Stim ON PostDBS (1.5.yrs) | Case 3 Stim OFF PostDBS (4 yrs) | Case 3 Stim ON PostDBS (4 yrs) | |
|---|---|---|---|---|---|---|---|---|
| USDRS item | ||||||||
| Overall severity*** | 5 | 3 | 5 | 4 | 3 | 2 | 4 | 2 |
| Rough voice quality*** | 5 | 4 | 5 | 4 | 3 | 2 | 4 | 2 |
| Breathy voice quality | 2 | 2 | 1 | 1 | 1 | 1 | 3 | 2 |
| Strain-Strangled voice quality*** | 6 | 3 | 5 | 3 | 3 | 2 | 4 | 2 |
| Abrupt voice initiation | 3 | 2 | 3 | 2 | 1 | 1 | 3 | 2 |
| Voice arrest | 4 | 2 | 2 | 1 | 1 | 1 | 3 | 2 |
| Aphonia | 1 | 1 | 1 | 1 | 1 | 1 | 2 | 1 |
| Voice loudness | 3 | 1 | 4 | 3 | 2 | 2 | 4 | 2 |
| Bursts of loudness | 1 | 1 | 1 | 1 | 1 | 1 | 3 | 2 |
| Voice tremor | 5 | 3 | 3 | 2 | 2 | 2 | 3 | 1 |
| Expiratory effort*** | 5 | 2 | 4 | 3 | 3 | 2 | 4 | 2 |
| Speech rate*** | 4 | 2 | 4 | 3 | 2 | 1 | 3 | 1 |
| Speech intelligibility reduced | 4 | 2 | 4 | 3 | 2 | 2 | 4 | 2 |
| Related movements and grimaces*** | 4 | 1 | 2 | 1 | 2 | 1 | 2 | 1 |
| TOTAL SCORE | 52 | 29 | 44 | 32 | 27 | 21 | 46 | 24 |
| % Improvement | 44% | 27% | 22% | 48% |
[i] LEGEND: 1) Columns highlighted in gray were subjectively assessed by the blinded rater & patient as being better overall. 2) *** signifies USDRS items that showed consistent trends comparing preDBS vs postDBS, and stimulation off vs stimulation on.
Table 2
Summary of published cases of adductor spasmodic dysphonia treated with deep brain stimulation.
| Authors, year published | Target | Coordinates (millimeters lateral to, posterior to, and inferior to the midcommissural point ) | Programming settings after optimization | Results | ||
|---|---|---|---|---|---|---|
| Lyons et al. 2009, 2010 | VIM nucleus (bilateral) | Left: 11.5 mm lateral to the 3rd ventricle | Right: 11.5 mm lateral to the 3rd ventricle | Left: 2(+), 0(–), 3.2V, 90 µsec, 130 Hz | Right: 3(+), 0(–), 2.3V, 90 µsec, 130 Hz | Efficacious at 6 months; efficacy sustained at 44 months |
| Patel et al., 2013 | VIM nucleus (unilateral) | Left – | Right (not reported) | – | (not reported) | Reduction of tension, spasms, fewer vocal breaks |
| Mure et al., 2014 | VLA nucleus (bilateral) | Left: 13.5, 1.5, 0.5 | Right: 13.5, 1.5, 0.5 | Left: 3(+), case(–), 3.6V, 120 µsec, 135 Hz | Right: 3(+), 2(–), 3.6V, 120 µsec, 135 Hz | >80% improvement of dysphonic symptoms at 2 year follow up |
| Pollogaindran et al., 2018 | VIM + VOA nucleus (unilateral) | Left: 12.6, 5.5, 0.0 | Right – | Left VIM + VOA: 3(+), 0(–), 2V, 60 µsec, 185 Hz Left VOA alone: 3(+), 2(–), 2V, 60 µsec, 185 Hz Left VIM alone: 1(+), 0(–), 2V, 60 µsec, 185 Hz | VIM alone or VIM + VOA were superior to VOA alone; VIM + VOA was not superior to VIM alone | |
| Kruger et al., 2020 (Patient 1) | VIM (bilateral) | Left 12.6, 5.5, 0.1 | Right 13.2, 5.6, 0.8 | Left: Case (+), 1(–), 2.8V, 90 µsec, 185 Hz | Right: 10(+), 11(–), 2.5V, 90µsec, 185 Hz, | 80% improvement with bilateral; 60% with left side only (patient is right handed); 20% with right side only |
| Kruger et al. 2020 (Patient 2) | VIM (bilateral) | Left 13.7, 6.1, 0.3 | Right 13.8, 5.9, 0.4 | Left: Case (+), 0(–), 1.6V, 60 µsec, 185Hz | Right: Case (+), 9(–), 2.5V, 60 µsec, 185 Hz | 71% improvement with bilateral; 57% with right side only (patient is mixed left handed); 14% with left side only |
| Evidente et al., 2020 (Case 1) (BH) | VIM nucleus (bilateral) | Left 14, 6.2, 0 | Right 14, 6.2, 0 | Left: case(+), 0(–), 3.9V, 90 µsec, 180 Hz | Right: 11(+), 8(–), 3.7V, 90 µsec,180 Hz | Sustained efficacy at 7 months post-DBS; blinded rating of pre-DBS USDRS was better than post-DBS USDRS |
| Evidente et al., 2020 (Case 2) (DN) | VIM nucleus (bilateral) | Left 15, 6, 0 | Right 15, 5, 0 | Left: 3(+), 0(–), 3.7V, 90 µsec, 185 Hz | Right: 11(+); 8(–), 3.5V, 90 µsec, 185 Hz | Sustained efficacy at 1.5 years post-DBS; blinded rating of pre-DBS USDRS was better than post-DBS USDRS; blinded rating of post-DBS Stim On USDRS was better than Stim Off USDRS |
| Evidente et al., 2020 (Case 3) (DW) | VIM nucleus (bilateral) | Left 14, 6, 0 | Right 14, 6, 0 | Left: 3(+), 0(–), 0.7V, 90 µsec, 185 Hz | Right: 11(+), 8(–), 3.5V, 90 µsec, 185 Hz. | Sustained efficacy at 4 years post-DBS; no longer required BTX injections; blinded rating of Stim On USDRS was better than Stim Off USDRS |
[i] * VIM- ventralis intermedius; DBS – deep brain stimulation; BTX – botulinum toxin; USDRS – Unified Spasmodic Dysphonia Rating Scale.