Deep Brain Stimulation for Laryngeal Dystonia: From Mechanism to Optimal Application

Inclusion Criteria:

• Patients with ADLD and ADLD plus tremor, as diagnosed by routine clinicalexamination by laryngologist, speech language pathologist, and neurologist.

• Patients undergoing globus pallidus interna (GPi) deep brain stimulation (DBS) forADLD with tremor

• Age range of 18-80 years

• Native speakers of American English will be recruited since there are knowndifferences in voice and neural signals of native and non-native speakers

• No evidence for dementia as assessed by neurologist.

• No evidence for severe untreated mood disorder as assessed by neurologist, or asevident on self-report (Beck Depression Inventory-II score > 29, Beck AnxietyInventory Score > 26.

• At least 3 months since last botulinum toxin injection and the patients would needto be fully symptomatic with no residual effects of botulinum toxin on voicequality.

Exclusion Criteria:

• Individuals younger than 18 years and older than 80 years of age.

• Women who plan to become pregnant during the study period or are currentlybreastfeeding.

• Prior history of stroke, brain surgery, or other neurological disorder besides theone under study.

• Prior laryngeal framework surgeries or other disorders affecting the vocal folds

• Patients who are asymptomatic due to treatment with botulinum toxin into the vocalfolds.

• Presence of ferromagnetic implants and cardiac implants that would becontraindicated to MRI

• Gagging or discomfort that would preclude the placement of the endoscope tovisualize the larynx

• Dementia, severe depression or severe anxiety.

• Any clinical condition or medication judged by the investigators to potentiallypreclude the patient from safely completing awake brain surgery and researchprotocols.