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Lack of efficacy: case report A 40-year-old man exhibited lack of efficacy during treatment with escitalopram and midazolam for functional dysphonia [routes not stated; not all dosages stated]. The man presented with dysphonia for 3 months. His medical history was signigficant for a road traffic accident 5 days prior to the onset of symptoms. On the evening of the accident, he received unspecified benzodiazepines. However, he continued with dizziness, nausea, insomnia, anxiety and loss of appetite for the next 5 days. On day 6, he was able to pronounce sounds; however, he had lost the ability to modulate sounds into meaningful words. His brain MRI and CT scan revealed normal limits. Hence, he was admitted for further investigation. The differential diagnosis included embolic stroke, endovascular ischaemic stroke or haemorrhagic stroke, autoimmune encephalitis, myasthenia gravis or multiple sclerosis. Following examinations, a diagnosis of functional dysphonia was made. He received treatment with escitalopram 10mg once a day. After 3 months of therapy, he did not show any improvement. He continued receiving escitalopram during the hospitalisation and upto 6 months after discharge. Then, drug-assisted interview procedure was decided to use. He was treated with lorazepam diluated with sodium chloride [normal saline] solution. He required high dose of lorazepam in the first interview; hence, two subsequent interviews were conducted with equivalent doses of midazolam but failed to elicit effect. Then, he received lorazepam and he was able to pronounce slightly better. After 12 sessions with lorazepam and on the day 35 of admission, he was able to speak completely. Subsequently, he was discharged home. Modak T, et al. Lorazepam-Assisted Interview in a Resistant Case of Functional Dysphonia. Journal of Voice 34: 811e7-811e11, No. 5, Sep 2020. Available from: URL: http:/ /doi.org/10.1016/j.jvoice.2019.01.002 803517985

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Reactions 28 Nov 2020 No. 1832