title: Treatment for spasmodic dysphonia: limitations of current approaches.
abstract: OBJECTIVE
  Although botulinum toxin injection is the gold standard for treatment of spasmodic dysphonia, surgical approaches aimed at providing long-term symptom control have been advancing over recent years.
  
  
  RESULTS
  When surgical approaches provide greater long-term benefits to symptom control, they also increase the initial period of side effects of breathiness and swallowing difficulties. Recent analyses of quality-of-life questionnaires in patients undergoing regular injections of botulinum toxin demonstrate that a large proportion of patients have limited relief for relatively short periods due to early breathiness and loss-of-benefit before reinjection.
  
  
  CONCLUSIONS
  Most medical and surgical approaches to the treatment of spasmodic dysphonia have been aimed at denervation of the laryngeal muscles to block symptom expression in the voice, and have both adverse effects as well as treatment benefits. Research is needed to identify the central neuropathophysiology responsible for the laryngeal muscle spasms in order target treatment towards the central neurological abnormality responsible for producing symptoms.
authors.affiliation: Laryngeal and Speech Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive MSC 1416, Bethesda, MD 20892-1416, USA. ludlowc@ninds.nih.gov
authors.forename: Christy L
authors.initials: CL
authors.lastname: Ludlow