Abstract：
OBJECTIVE: Laryngeal dystonia (LD), previously termed spasmodic dysphonia, is an isolated focal dystonia that involves involuntary, uncontrolled contractions of the laryngeal muscles during speech. It is a severely disabling condition affecting patients\' work and social lives through prevention of normal speech production. Our understanding of the pathophysiology of LD and available therapeutic options are currently limited. The aim of this short review is to provide an up-to-date summary of what is known about the central mechanisms and the pathophysiology of LD.
METHODS: A systematic review of the literature was performed searching Embase, CINHAL, Medline, and Cochrane with the cover period January 1990-October 2023 with a search strategy ((\"Laryngeal dystonia\" OR \"Spasmodic dysphonia\") AND (\"Central Mechanism\" OR \"Pathophysiology\")). Original studies involving LD patients that discussed central mechanisms and/or pathophysiology of LD were chosen.
RESULTS: Two hundred twenty-six articles were identified of which 27 articles were included to formulate this systematic review following the screening inclusion and exclusion criteria. LD is a central neurological disorder involving a multiregional altered neural network. Affected neural circuits not only involve the motor control circuit, but also the feedforward, and the feedback circuits of the normal speech production neural network, involving higher-order planning, somatosensory perception and integration regions of the brain.
CONCLUSIONS: Speech production is a complex process, and LD is a central neurological disorder involving multiregional neural network connectivity alteration reflecting this. Neuromodulation targeting the central nervous system could therefore be considered and explored as a new potential therapeutic option for LD in the future, and should assist in elucidating the underlying central mechanisms responsible for causing the condition.
METHODS: A systematic review of the literature was performed searching Embase, CINHAL, Medline, and Cochrane with the cover period January 1990-October 2023 with a search strategy ((\"Laryngeal dystonia\" OR \"Spasmodic dysphonia\") AND (\"Central Mechanism\" OR \"Pathophysiology\")). Original studies involving LD patients that discussed central mechanisms and/or pathophysiology of LD were chosen.
RESULTS: Two hundred twenty-six articles were identified of which 27 articles were included to formulate this systematic review following the screening inclusion and exclusion criteria. LD is a central neurological disorder involving a multiregional altered neural network. Affected neural circuits not only involve the motor control circuit, but also the feedforward, and the feedback circuits of the normal speech production neural network, involving higher-order planning, somatosensory perception and integration regions of the brain.
CONCLUSIONS: Speech production is a complex process, and LD is a central neurological disorder involving multiregional neural network connectivity alteration reflecting this. Neuromodulation targeting the central nervous system could therefore be considered and explored as a new potential therapeutic option for LD in the future, and should assist in elucidating the underlying central mechanisms responsible for causing the condition.
摘要：
目的：喉肌张力障碍（LD），以前称为痉挛性发声障碍，是一种孤立的局灶性肌张力障碍，涉及非自愿的，说话时喉部肌肉不受控制的收缩。这是一种严重的致残疾病，通过防止正常的言语产生影响患者的工作和社会生活。目前，我们对LD的病理生理学和可用的治疗选择的了解有限。这篇简短评论的目的是提供有关LD的中枢机制和病理生理学的最新摘要。
方法：对文献进行了系统回顾，CINHAL,Medline,和Cochrane的覆盖期为1990年1月至2023年10月，并采用搜索策略（（\“喉肌张力障碍\”或\“痉挛性发声障碍\”）和（\“中央机制\”或\“病理生理学\”））。选择了涉及LD患者的原始研究，这些研究讨论了LD的中枢机制和/或病理生理学。
结果：根据筛选纳入和排除标准，确定了二百二十六篇文章，其中包括27篇文章，以制定本系统综述。LD是涉及多区域改变的神经网络的中枢神经障碍。受影响的神经电路不仅涉及电机控制电路，还有前馈，和正常语音产生神经网络的反馈电路，涉及高阶规划，大脑的体感感知和整合区域。
结论：语音生成是一个复杂的过程，LD是一种中枢神经疾病，涉及多区域神经网络连通性改变，反映了这一点。因此，靶向中枢神经系统的神经调节可以被认为和探索作为一种新的潜在的治疗方案，并应协助阐明导致这种情况的潜在中央机制。
方法：对文献进行了系统回顾，CINHAL,Medline,和Cochrane的覆盖期为1990年1月至2023年10月，并采用搜索策略（（\“喉肌张力障碍\”或\“痉挛性发声障碍\”）和（\“中央机制\”或\“病理生理学\”））。选择了涉及LD患者的原始研究，这些研究讨论了LD的中枢机制和/或病理生理学。
结果：根据筛选纳入和排除标准，确定了二百二十六篇文章，其中包括27篇文章，以制定本系统综述。LD是涉及多区域改变的神经网络的中枢神经障碍。受影响的神经电路不仅涉及电机控制电路，还有前馈，和正常语音产生神经网络的反馈电路，涉及高阶规划，大脑的体感感知和整合区域。
结论：语音生成是一个复杂的过程，LD是一种中枢神经疾病，涉及多区域神经网络连通性改变，反映了这一点。因此，靶向中枢神经系统的神经调节可以被认为和探索作为一种新的潜在的治疗方案，并应协助阐明导致这种情况的潜在中央机制。
