Abstract
Essential vocal tremor (EVT) is the presence of a tremulous voice that is commonly associated with essential tremor. Patients with EVT often report a necessary increase in vocal effort that significantly worsens with stress and anxiety and can significantly impact quality of life despite optimal medical and behavioral treatment options. Deep brain stimulation (DBS) has been proposed as an effective therapy for vocal tremor, but very few studies exist in the literature that comprehensively evaluate the efficacy of DBS for specifically addressing EVT. We present a technical report on our multidisciplinary, comprehensive operative methodology for treatment of EVT with frameless, awake deep brain stimulation (DBS).
Highlights
Tremulous voice is a characteristic feature of several different movement disorders, including essential tremor and Parkinson's disease, as well as other neurological diseases, such as stroke
We present a technical report on our multidisciplinary, comprehensive operative methodology for treatment of essential vocal tremor (EVT) with frameless, awake deep brain stimulation (DBS)
EVT is a difficult-to-treat voice disorder that significantly interferes with the quality of life of many afflicted patients despite optimal medical and behavioral treatment options [1]
Summary
Tremulous voice is a characteristic feature of several different movement disorders, including essential tremor and Parkinson's disease, as well as other neurological diseases, such as stroke. Botulinum toxin injected into the thyroarytenoid and extralaryngeal muscles is commonly employed for treatment of EVT and has been shown to be effective in 5680% of patients [4] This treatment results in a decrease in tremor amplitude; effects are transient, necessitating repeat injections, and a complete resolution of vocal instability is not achieved. For evaluation of EVT, rate and magnitude of the f0 and amplitude modulations, which tend to co-occur, are measured and recorded [1, 12] These measurements are the most common acoustic characteristics of vocal tremor and improvement from baseline preoperative. Programming of the bilateral VIM DBS are performed two weeks from implantation with both neurophysiologic and comprehensive speech analysis (see below) to confirm adequate control of vocal tremor
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