Multimodal Dystonia Study
In this study we are investigating how the brain controls different muscles. People with focal dystonia experience involuntary muscle contractions in their laryngeal, hand, neck or other muscles. People without the diagnosis of this disorder are also being recruited to serve as healthy controls in comparison to people with focal dystonia. We are studying the brain with two different types of measures to try to understand the difference between people with focal dystonia and healthy people.
This study is exploring a procedure called transcranial magnetic brain stimulation (TMS) combined with brain imaging techniques. TMS causes magnetic fields in the brain to form electrical currents. The weak stimulation allows researchers to measure the excitability of portions of the brain. A brain navigation system will use MRI pictures of your brain like a map to target specific areas in the brain. The purpose of the study is to use MRI to determine the structure of the brain while also using TMS to measure the excitability of the brain. Using this information, differences between healthy subjects and those diagnosed with focal dystonia may be identified and lead to a better understanding of the disorder.
rTMS for Laryngeal Dystonia
Laryngeal dystonia (LD) is a disorder that causes uncontrolled spasms of the laryngeal muscles during speech, causing severe speaking difficulty and a reduction in quality of life. Although the cause of the disorder is not fully understood and there are no treatments for LD that produce long-term benefits, recent findings have discovered that laryngeal dystonia is associated with a lack of neural inhibition that may be linked to the spasms. The purpose of this study is to determine if repetitive transcranial magnetic stimulation (rTMS) is effective for increasing neural inhibition, enhancing voice quality and function, and improving quality of life for people with laryngeal dystonia. rTMS is a safe and painless procedure that has been shown to regulate excitability by increasing inhibition in the brain. It is our hope that the outcomes of this study will facilitate the development of appropriate stimulation parameters to treat laryngeal dystonia, including identification of who may respond to this type of treatment.
This double-blinded, randomized study occurs in two phases: (1) a 5-day phase of rTMS intervention delivered to the left brain area, and (2) a 5- day control phase where research staff deliver a very low level of stimulation to the same brain area. There is an approximate 3 month waiting period in between phases.
If you have a diagnosis of laryngeal dystonia and have no history of seizure in the past 2 years, you may qualify for this study.
Dr. Kimberley (middle) with NewsCenter 5 co-anchor Emily Riemer and client Rick Doyle.
Participants undergo a six-week session of intensive rehabilitation therapy. The therapy sessions will include traditional rehabilitation exercises, but the patient will receive nerve stimulation while they are performing the exercises.
In order to receive the stimulation, patients are implanted with a device called a vagus nerve stimulator. It is similar to a cardiac pacemaker, but the stimulation lead is attached to the vagus nerve in the neck. The vagus is one of the 12 cranial nerves (nerves that provide information between the body and brain). Evidence from prior clinical trials suggests that paring vagus nerve stimulation (VNS) with rehabilitation can increase the rate at which the brain relearns tasks. Vagus nerve stimulation is not a new therapy, it has been used to treat epilepsy for over 20 years.
Researcher Teresa Kimberley’s research on how vagus nerve stimulation can help stroke patients recover the use of their hands was featured on WCVB’s NewsCenter5 on December 13. Read more about the news feature.