An open-label study of sodium oxybate in Spasmodic dysphonia.
Spasmodic dysphonia (SD) is a task-specific laryngeal dystonia that affects speech production. Co-occurring voice tremor (VT) often complicates the diagnosis and clinical management of SD. Treatment of SD and VT is largely limited to botulinum toxin injections into laryngeal musculature; other pharmacological options are not sufficiently developed.



Open-label study.



We conducted an open-label study in 23 SD and 22 SD/VT patients to examine the effects of sodium oxybate (Xyrem), an oral agent with therapeutic effects similar to those of alcohol in these patients. Blinded randomized analysis of voice and speech samples assessed symptom improvement before and after drug administration.



Sodium oxybate significantly improved voice symptoms (P = .001) primarily by reducing the number of SD-characteristic voice breaks and severity of VT. Sodium oxybate further showed a trend for improving VT symptoms (P = .03) in a subset of patients who received successful botulinum toxin injections for the management of their SD symptoms. The drug's effects were observed approximately 30 to 40 minutes after its intake and lasted about 3.5 to 4 hours.



Our study demonstrated that sodium oxybate reduced voice symptoms in 82.2% of alcohol-responsive SD patients both with and without co-occurring VT. Our findings suggest that the therapeutic mechanism of sodium oxybate in SD and SD/VT may be linked to that of alcohol, and as such, sodium oxybate might be beneficial for alcohol-responsive SD and SD/VT patients.



4 Laryngoscope, 127:1402-1407, 2017.
School of Health and Rehabilitation Sciences, Speech Pathology, University of Queensland, Brisbane, Queensland, Australia.
Anna F
AF
Rumbach
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.|Head and Neck Surgical Group, New York, New York, U.S.A.
Andrew
A
Blitzer
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
Steven J
SJ
Frucht
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
Kristina
K
Simonyan
D000328:Adult; D000368:Aged; D055154:Dysphonia / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D000431:Ethanol / Q000494:pharmacology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000008:administration & dosage*; D016037:Single-Blind Method; D012978:Sodium Oxybate / Q000008:administration & dosage*; D013060:Speech / Q000187:drug effects; D016896:Treatment Outcome; D014831:Voice / Q000187:drug effects; D014832:Voice Disorders / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
D018377:Neurotransmitter Agents; D000431:Ethanol; D012978:Sodium Oxybate
Laryngeal dystonia; Xyrem; alcohol