American Journal of Psychiatry and Neuroscience 2019; 7(3): 52-56 http://www.sciencepublishinggroup.com/j/ajpn doi: 10.11648/j.ajpn.20190703.11 ISSN: 2330-4243 (Print); ISSN: 2330-426X (Online) Laryngeal Dystonia, New Approaches for Direct Botulinum Toxin Administration Luis Javier López Del Val 1, * , José Miguel Sebastián Cortes 2 , Elena Bellosta Diago 1 , Sonia Santos Lasaosa 1 , Paúl Ricardo Vinueza Buitron 1 , Yolanda Lois Ortega 2 , Héctor Valles Varea 2 , Elena López García 1 1 Neurology Service, Movement Disorders Unit, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain 2 Servicio de Otorrinolaringología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain Email address: * Corresponding author To cite this article: Luis Javier López Del Val, José Miguel Sebastián Cortes, Elena Bellosta Diago, Sonia Santos Lasaosa, Paúl Ricardo Vinueza Buitron, Yolanda Lois Ortega, Héctor Valles Varea, Elena López García. Laryngeal Dystonia, New Approaches for Direct Botulinum Toxin Administration. American Journal of Psychiatry and Neuroscience. Vol. 7, No. 3, 2019, pp. 52-5. doi: 10.11648/j.ajpn.20190703.11 Received: June 27, 2019; Accepted: August 12, 2019; Published: August 29, 2019 Abstract: To describe our experience in the treatment of laryngeal dystonia (in abduction and adduction), with special emphasis given to the technical aspects (approach procedure, dosage and type of botulinum toxin type A used), as well as treatment response and possible side effects. We conducted a cross-sectional descriptive study of a sample of patients with laryngeal dystonia treated by means of transoral administration of onabotulinumtoxinA or incobotulinumtoxinA over a period of 10 years (2007-2017). Data collected include demographic and clinical variables, treatment response (based on a self-rating scale), the duration of treatment and the appearance of side effects. Sample size: 15 patients (11 women; mean age: 44.06 years) with laryngeal dystonia (mean time since onset of 40 months; 12 patients with dystonia in adduction) and 174 administrations (92% incobotulinumtoxinA; average dosage of 5 U in each vocal cord). The procedure took an average of 11.7 minutes to perform. Response was good in 31% of the procedures and very good in 57.5%. Side effects were recorded in 14.4% of the procedures, although always mild and transitory, with a predominance of dysphagia and dysphonia. In our experience, transoral administration of botulinum toxin type A to treat laryngeal dystonia has proved to be a simple, quick, effective and safe technique. Keywords: Botulinum Toxin A, Incobotulinumtoxin, Dystonia, Laryngeal Dystonia, Therapeutic Administration 1. Introduction Laryngeal dystonia or spasmodic dysphonia (SD) has been included in the group of focal dystonias [1, 2]. There are two main subtypes of SD with different symptoms: adductor SD and abductor SD. Adductor SD, the most common subtype, is caused by inappropriate hyper-adduction of the vocal cords leading to a strained and strangled voice quality, such that patients sound as though they are “trying to talk whilst being choked” (Crtichley M 1939; Jankovic and Fahn 2007). [3, 4]. (Abductor SD is less frequently observed and is caused by inappropriate hyper-abduction of the vocal cords leading to intermittent whispered, breathy phonation or aphonia. Laryngeal dystonia, also known as spasmodic dysphonia (SD), is a focal dystonia, which affects 18% of patients with focal dystonia [5]. SD affects a small muscular area, which is not easily accessible by direct visual examination, and shares clinical and epidemiological characteristics, including tremor, circadian fluctuations and methods for relieving symptoms (e.g. “sensory tricks” such as singing or reciting to improve speech) with other focal dystonias [6]. Therefore, the diagnosis of SD relies on an experienced physician and should include a direct laryngeal examination to exclude any local pathology, together with a detailed medical history and