What causes Xiao RFK's small voice to be nervous and shaky? Neurologist explains this little-known disease

Secretary of Health and Human Services Robert F. Kennedy Jr.

Kennedy, 71, said he developed a neurological disease in his 40s that “deprived him of his strong voice.” Kennedy first spoke publicly about the tremor he noticed in his voice during a 2004 interview with journalist Diane Rehm, who also suffers from spastic irritability.

In 2005, Kennedy received footage of Botox, a neurotoxin that has been used in Botox and is used every four months to treat migraines and other diseases. This first-line treatment for dysphagia helps weaken the vocal folds that contract abnormally with the disease. He used Botox for 10 years and then stopped using them, saying they were “inappropriate.”

Kennedy initially developed symptoms in public eye teaching at Pace University in New York. Some viewers wrote to him, suggesting he suffered from spastic irritability and he should contact Dr. Andrew Blitzer, a prominent expert in the disease. He followed this advice and confirmed the diagnosis.

I am a motor disorder neurologist and have long been passionate about the psychological and social harm that patients such as irritable patients have caused to my patients.

Types of dysphagia

In North America, an estimated 50,000 people suffer from spastic irritability. This condition involves involuntary pulling of muscles that open and close the vocal cords, causing the sound to be nervous and strangled, sometimes with the mass of breathing. About 30 to 60% of people with this condition will also experience sound tremors, which will change the sound of the sound.

Often, neurologists may suspect the disease by identifying the characteristic speech ruptures of the patient while he speaks. The diagnosis can be confirmed with the help of ears, nose and throat experts, who can insert a smaller range into the throat, examine vocal folds and rule out any other abnormalities.

Because the disease is unknown to the public, many patients have delayed diagnosis and may be misdiagnosed by gastric reflux or allergies.

The most common type of spastic dysphagia is called plus adductor muscle, accounting for 80% of cases. It is characterized by sudden breaks on the vowel due to overload or abnormally closed vocal folds, tight sound quality or strangulation.

In contrast, a form of disease called the irritability of the kidnapper causes breathing sounds, causing consonants to be interrupted due to uncontrolled kidnapping – meaning apart of the folds of sounds.

Potential treatment

Spastic irritation is usually not treated with oral medications, and sometimes it becomes better to inject botulinum toxin to control the muscles that control the vocal cords. This is a lifelong disease that cannot be cured at present. Phonetic therapy that works with speech pathologists with botulinum toxin administration can also be beneficial.

For patients with failed Botox treatment, surgical treatment may be an option, although the surgery is risky and may be effective. Surgical techniques are being refined and require broader evaluation and long-term follow-up data before being considered as the standard treatment for spastic dysphagia.

Dysphagia falls into the broader category of dysphagia

Spastic dysphagia is classified as a focal dystonia that, in the case of spastic stimulation, affects a part of the body – the vocal cords. Dystonia is a umbrella procedure for dyskinesia, characterized by persistent or repeated muscle contractions that lead to abnormal posture or movement.

The most common dystonia is cervical dystonia, which can affect the neck and may pull the head to one side.

Another type, called bone spasm, involves involuntary muscle contractions and spasms of the eyelid muscles, which can cause forced eye closure and in some cases even affect vision. There may be other muscle tone muscles, such as writers’ cramps, which can cause manual cramps while writing. Musicians can develop muscle tone by overuse of certain body parts (such as violinists who develop dystonia in their hands) or trumpet athletes who develop muscle tone on their lips.

Stigma and psychological distress

Dystonia can cause great psychological distress.

Often, many dystonia and dysmotic disorders, including Parkinson's disease and other diseases that cause tremors, face huge stigma. In Africa, for example, there is a misunderstanding that affected people are cursed by witchcraft or that movement disorders are infectious. People with this condition may be hiding from society or isolated from others due to fear of contracting the disease.

As far as spastic irritability is concerned, affected people may feel that they appear nervous or underprepared when speaking publicly. They may feel embarrassed or ashamed and are isolated from talking to others.

My patients are very frustrated by the unpredictable nature of the symptoms and must avoid certain sounds that may cause irritability. They may then have to reorganize word choices and vocabulary to avoid causing irritability, which may be mentally taxed.

Some irritable patients believe that their abnormal voice problems can affect their relationships and their ability to perform leadership or public-oriented roles. Kennedy said in an interview that he found his voice unbearable and apologized for having to listen.

A 2005 study explored the biopsychosocial consequences of spastic dysphagia through interviews with patients to gain insight into the experiences of people with this disease.

One patient in the study said their voice sounded “like some kind of pheasant screaming words”, and another said, “It feels like you have to grab a word and push it away from your throat.” Another felt like “I have a rubber band around my neck. Someone is shrinking.” Another said, “It feels like you have a sore throat all the time…it’s like the original feeling in your throat.”

The patients in the study described feelings of feeling hopeless and depressed, confident and competent. Emotional damage can be great. One patient said, “I used to be outgoing, and now I find myself avoiding these situations.” Another said, “People are no longer capable because you’re not saying that.”

As diseases like spastic dysphagia become better recognized, I hope not only treatment will improve, but the stigma surrounding this disease will be reduced.