Effects of low-frequency repetitive transcranial magnetic stimulation in adductor laryngeal dystonia: a safety, feasibility, and pilot study

Cecilia N Prudente, Mo Chen, Kaila L. Stipancic, Katherine L. Marks, Sharyl Samargia-Grivette, George Goding, Jordan R. Green, Teresa J Kimberley, PT,

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Purpose: The effects of neuromodulation are virtually unexplored in adductor laryngeal dystonia (AdLD), a disorder characterized by involuntary contraction of intrinsic laryngeal muscles. Recent findings indicated that intracortical inhibition is reduced in people with AdLD. Low-frequency repetitive transcranial magnetic stimulation (rTMS) induces prolonged intracortical inhibition, but the effects in AdLD are unexplored. This pilot and feasibility study aimed to examine the safety, feasibility, and effects of a single session 1 Hz rTMS over the laryngeal motor cortex (LMC) in people with AdLD and healthy individuals. Methods: The stimulation location was individualized and determined through TMS-evoked responses in the thyroarytenoid muscles using fine-wire electrodes. 1200 pulses of 1 Hz rTMS were delivered to the left LMC in two groups: Control (n = 6) and AdLD (n = 7). Tolerance, adverse effects, intracortical inhibition, and voice recordings were collected immediately before and after rTMS. Voice quality was assessed with acoustic-based and auditory-perceptual measures. Results: All participants tolerated the procedures, with no unexpected adverse events or worsening of symptoms. No significant effects on intracortical inhibition were observed. In the AdLD group, there was a large-effect size after rTMS in vocal perturbation measures and a small-effect size in decreased phonatory breaks. Conclusions: One rTMS session over the LMC is safe and feasible, and demonstrated trends of beneficial effects on voice quality and phonatory function in AdLD. These preliminary findings support further investigation to assess clinical benefits in a future randomized sham-controlled trial. ClinicalTrials.gov: NCT02957942, registered on November 8, 2016.

Original languageEnglish (US)
Pages (from-to)561-574
Number of pages14
JournalExperimental Brain Research
Issue number2
StatePublished - Feb 2022

Bibliographical note

Funding Information:
This work was partly supported by the National Institute on Deafness and Other Communication, National Institutes of Health (NIDCD, R21DC012344, R01DC015216, P50DC015446); Research Grant, National Spasmodic Dysphonia Association (NSDA), and Minnesota Discovery, Research and Innovation Economy (MnDRIVE) initiative.

Publisher Copyright:
© 2021, The Author(s).


  • Acoustics
  • Adductor laryngeal dystonia
  • Cortical silent period
  • Repetitive transcranial magnetic stimulation
  • Spasmodic dysphonia


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