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Treating EMS induced Laryngospasm?

I read Electrotherapy 12th edition and am trying to find the recommended treatment for EMS induced laryngospasm. I've found 30+ references which unanimously agree EMS should not be placed front of neck, but haven't found any guidance on the best treatment after it's been done.

Background The Tokyo Neurology Center recommended I receive EMS treatment on my neck about 1.5 years ago to treat a tingling in my forearm after ruling out MS via an MRI. The technician placed two electrodes on the front/bottom of my neck, two on rear. All electrodes caused intense contractions with the exception of the right-front which had almost no response. Immediately after leaving the building my head turned right involuntarily and continued to do so for months. I went back to see if they could fix it and they attempted 2 more sessions of EMS on the front of my neck which only made it worse. They claimed to have never seen this issue before and suggested continued EMS on my neck might fix it. I stopped going, and have had to place a hand on my right jaw to counteract the rightward pull for the last 1.5 years. The muscle strain has become worse, and a couple months ago developed into laryngospasm (self diagnosed based on difficulty inhaling, no problem exhaling, and as the electrotherapy textbook suggested consequence of stimulation on front of neck; laryngospasm not yet professionally confirmed).

Returned to the U.S. last month and my physician hasn't had experience with EMS on the front of the neck. She referred me to a neurologist who had no EMS experience and found "nothing wrong", despite breathing and swallowing difficulty. Swallowing feels like it activates predominantly muscles on the left side. A physical therapist taught me to stretch my left sternocleidomastoid, which seems to activate more motion on the right side when swallowing (though with an uncomfortable clicking at the upper-right neck).

Appreciate any suggestions on how to proceed.

Michael A

1 month ago

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Cliff Eaton
Cliff Eaton

I agree with my learned colleagues.A strange use of NMES and not a typical electrotrode placement but they may of had their reasons. NMES can be used for dysphagia (difficulting swallowing) combined with swallowing exercises especiallyafter a stroke - see Vitalstim Therapy

patrick.debock99
patrick.debock99

Hi Michael,

Thank you for the information. It's still unsure but there are a few things that make me think it was a pain decreasing TENS. Nothing wrong with that except for the strange electrode position. On the other hand, I wouldn't blame the electrode position for the laryngospasm. I can't explain it but neither can I suspect the electrotherapy treatment for causing it. I get the feeling that there is something at facet joint level in your cervical spine, some kind of a restricted motion. A TENS will only in rare cases resolve that problem. Would you consider seeing an osteopath first?

As to your question in the latest post, I'm not a radiologist but I think a MRI won't show nerve damage or tissue imbalances resulting from electrical stimulation.

Patrick De Bock

michael_a
michael_a

Related: Is a neck MRI typically able to reveal nerve damage or tissue imbalances resulting from electrical stimulation? Thank you again for any suggestions.

michael_a
michael_a

Thank you both for the replies. I will ask my physician about seeing an otolaryngologist and trying biofeedback.

Regarding purpose of treatment: I had minor tingling in both forearms and my right jaw that came and went. No painful. MS runs in the family, but an MRI of the brain ruled it out. The neurologist mentioned my symptoms might be explained by anxiety, which would make sense due to DNA test results I learned about at the time. He said it might also be poor blood circulation, but didn't think it was anything serious. He mentioned electrical treatment of the neck as a "low-risk" approach to try that may increase blood circulation.

Regarding the device and settings: I am not certain whether it was an EMS, NMES, or TENS. I read that TENS doesn't necessarily induce muscle contractions while EMS does, and inferred it was more similar to an EMS. The electrodes were small, circular, and appeared rubber. The same facility also placed two larger circular rubber electrodes between my shoulder blades that caused my shoulders to bounce, but this was not simultaneous with the neck electrodes and did not appear to have any negative effect.

Regarding pulse: neck muscles contracted between 2-3 times per second.

Regarding current: electrodes on the lower back of my neck were strong enough to pull the skin from the top of my head down towards my neck. Presumably the front was similar.

There was only one English speaking technician and he appeared undertrained. When I pointed out my right-front neck wasn't responding to electricity on my 2nd visit I asked for the name of the muscles he placed the electrodes on so I could inform the neurologist. He could not name any muscles in the neck. On my 2nd visit, I asked him to monitor treatment longer to see what we could learn and he dialed up the current on the right higher than the left. When the current was turned "high", my right/front neck finally showed a small reaction, but nothing like the left.

When I told the neurologist about the experience and how my head was now turning right, he mentioned nothing could have possibly hurt me and that the device focused on "muscles only." He said any imbalance in reaction was due purely to the placement of the electrodes. (note: this neurologist also explained that Alzheimer's disease is caused by "too much water in the brain", which brought his expertise into question in my mind)

I mentioned the electrode placement to the technician on my 3rd visit for electrical stimulation and he tried placing the electrodes in a few different areas on my lower right/front neck, none of which had much reaction. At one point he invited me to try testing different positions myself, which is when I decided to end the treatment early and left.

I've asked my girlfriend to call and ask whether the device was EMS, TENS, or NMES, and will follow up when I learn more.

Appreciate any more suggestions regarding what may have been affected and what tests or treatment you suggest.

patrick.debock99
patrick.debock99

Hi Michael,

I agree with Prof Gad Alon, the electrode position you described looks very strange. But in order to find a solution for you, let's try to find out more details about the treatment. If this is possible I may be able to understand what the purpose of this treatment was and what side effects it may have caused. I am not too surprised by the contractions caused by the technique, so many currents do that. But are you sure about the EMS? In order to treat symptoms in your forearm I would rather use a pain decreasing TENS current than an EMS current (which could have been a TENS but with different parameters). So my question is, did you ever get more details on the used current. A current name, an abbreviation or things like frequency, pulse width, ...? Did you see numbers on the screen of the device?

Patrick De Bock, PT. University of Antwerp, Belgium

Last updated 1 month ago

Prof Gad Alon
Prof Gad Alon

Indeed this is an exceptionally unusual description. Being in the field for a long time I never heard on application of "two electrodes in the front of the neck and two electrodes on the back" and I am unaware of any rationale how such setting is suppose to stop "tingling" in the arms. Only one time in my career I was ask to see a patient (in the USA) who underwent treatment for neck pain where the clinician placed 4 electrodes on the back of the neck which caused oscillating movements of the head/neck that continued after the stimulation was stopped for several years! Neither I, nor several world renowned neurologists in several medical centers were able to explain the phenomenon. The reality is that in medicine there are many things we simply do not know or able to explain. Personally, I do not believe physical therapists can help resolve your problem. Biofeedback to relax the spasm might be an option- but I doubt it will help. You may wish to consult your neurologist or an otolaryngologist . My experience suggests that they should have more effective treatment options. The sooner you get is resolved the better.

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