Objective: To systematically assess frequency and nature of laryngeal dysfunction in multiples system atrophy (MSA) compared to Parkinson’s disease (PD) and to identify a potential clinical biomarker that allows for differentiating MSA-patients from patients with PD.

Background: The MoDiMSA study group recently addressed the importance of securing an early diagnosis in MSA. Despite laryngeal dysfunction being associated with decreased life expectancy and quality of life in MSA, a systematic evaluation of laryngeal movement disorders in a large MSA cohort has not been performed so far. Previously, only few studies with small sample sizes reported on single laryngeal findings.

Method: At two German specialised centres, eligible participants with probable or possible MSA underwent flexible endoscopic evaluation of the swallowing (FEES) performing a systematic task-protocol(MSA-FEES task-protocol). Findings were compared to an age-matched cohort of PD-patients.

Results: Between September 2017 and January 2020, 57 consecutive MSA-patients (median age 64 [IQR 59 – 71] years, 35 women) were included and MSA-FEES task-assessments compared to 57 PD-patients (age 67 [60 – 73] years; 28 women). MSA-patients had a shorter disease duration (4 [3-5] years vs. 7 [5-10] years; p<0.0001) and greater disease severity expressed by Hoehn&Yahr stage (4 [3-4] vs. 3 [2-4]; p<0.0001). 43.9% of MSA-patients showed clinically overt laryngeal dysfunction with inspiratory stridor. During the MSA-FEES task-assessment however, 93% of MSA-patients demonstrated laryngeal dysfunction in contrast to only 1.8% PD-patients (p<0.0001). Irregular arytenoid cartilages movements (iACM) were present in 91.2% MSA-patients but in no PD-patient (p<0.0001), resulting in a specificity of 1.0 and a sensitivity of 0.9. Further findings included vocal fold motion impairment (VFMI, 75.4%), paradoxical vocal fold motion (33.3%) and vocal fold fixation (19.3%). One PD-patient showed VFMI.

Conclusion: Laryngeal movement disorders are highly prevalent in MSA-patients when assessed by a specific MSA-FEES task-protocol despite the lack of overt clinical symptoms. Our data suggest that iACM could be used as a clinical biomarker to delineate MSA from PD with high specificity and sensitivity.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/laryngeal-movement-disorders-as-a-potential-clinical-biomarker-in-multiple-system-atrophy-results-from-the-lapd-study/