Heightened risk of early vocal fold motion impairment onset and dysphagia in the parkinsonian variant of multiple system atrophy: a comparative study

Abstract

Objective We compared differences in frequency and timing of onset of the following clinical events between the cerebellar and parkinsonian variants of multiple system atrophy (MSA-C and MSA-P, respectively): type of operation including tracheostomy and/or aspiration prevention surgery, vocal fold motion impairment (VFMI), sleep apnea (SA), introduction of mechanical ventilation (MV), and dysphagia. The risks of these events cooccurring with either MSA-C or MSA-P were compared. Methods We retrospectively assessed clinical outcomes only of patients with MSA who presented at the Department of Otolaryngology of the University of Tokyo Hospital between 2008 and 2018. The proportion and timing of onset events between MSA-C and MSA-P and risks of onset were compared using chi-square tests and Cox proportional hazard models adjusted for age, sex, and disease severity, respectively. Results We identified 113 patients (median age: 60 years, 72 men [64%]). The frequency and timing of VFMI, SA, MV, dysphagia, and surgeries were 55 patients (49%) and 76 (95% CI 61–91) months after MSA onset, 85 (75%) and 41 (32–50), 36 (32%) and 100 (73–127), 77 (68%) and 43 (36–50), and 25 (22%) and 102 (84–120), respectively. Twenty-seven patients (24%) had MSA-P and higher risk of VFMI ( p < .001), SA ( p = .030), and dysphagia ( p = .017) than did patients with MSA-C. Conclusion While MSA-P is less common, it may involve heightened risk of VFMI and dysphagia early onset. Thus, careful follow-up for VFMI, SA, and dysphagia may be needed for these patients. Criteria for Rating Diagnostic Accuracy Studies Class II.

Esophageal Dysmotility is Common in Patients With Multiple System Atrophy

“…The causes of sudden death include upper airway obstruction and/or central respiratory disturbance, 19 and the causes of upper airway obstruction include floppy epiglottis, VFMI, increased sputum due to dysphagia, and aspiration and suffocation secondary to food regurgitation during sleep. 15,20,21 Furthermore, esophagopharyngeal regurgitation can induce secondary airway narrowing by bilateral vocal fold adduction to prevent food aspiration from the esophagus into the trachea. Sudden death due to regurgitation of intra-esophageal contents may be preventable.…”

Management and Treatment for Dysphagia in Neurodegenerative Disorders

“…MSA is categorized into two main subtypes: MSA-parkinsonian type (MSA-P), which is more like PD, and MSA-cerebellar type (MSA-C), which is associated with balance and coordination problems [ 17 ]. Dysphagia is a frequent and disabling symptom of MSA that occurs within five years [ 17 , 18 ]. Abnormalities in the oral and pharyngeal phases of swallowing, along with esophageal dysfunction and aspiration, occur in MSA and worsen as the disease progresses [ 17 , 19 , 20 ].…”