Category: Parkinsonism, Atypical: MSA
Objective: This study systematically assessed phenotypes of dysphagia in MSA compared to PD and correlated subjective dysphagia to objective endoscopic findings in MSA.
Background: Dysphagia is a major clinical concern in multiple system atrophy (MSA). A detailed evaluation of its major clinical features compared to Parkinson’s disease (PD) is lacking to date.
Method: 57 MSA patients (64 [59–71] years; 35 women) underwent flexible endoscopic evaluation of swallowing utilizing a MSA-specific task-protocol. Findings were compared to an age matched cohort of 57 PD (67 [60–73]; 28 women). In a sub-cohort, subjective dysphagia was assessed utilizing the Swallowing Disturbance Questionnaire, and results correlated to endoscopy findings.
Results: MSA patients predominantly showed symptoms suggestive of oral phase disturbance (premature spillage 91.2%, piecemeal deglutition 75.4%). Pharyngeal phase symptoms occurred less often (residues 78.9%; penetration/aspiration 28.1%). Contrastingly, symptoms of pharyngeal swallowing phase disturbance were the most common finding in PD (residues 50.9%). Oral phase symptoms occurred less frequently in PD compared to the MSA-cohort (premature spillage 33.3%, p<0.001; piecemeal deglutition 1.8%, p<0.001). When correlating Swallowing Disturbance Questionnaire-scores with endoscopy results, the cut-off, validated for PD, was not sensitive enough to identify MSA patients with dysphagia. We developed a MSA-specific sub-score and calculated a new cut-off which resulted in a sensitivity of 85% and specificity of 100% for identifying dysphagia in MSA patients.
Conclusion: In contrast to PD patients, dysphagic MSA patients more frequently present with oral phase symptoms. A novel MSA-Swallowing-Disturbance-Questionnaire sub-score may be a valuable tool to identify MSA patients with oropharyngeal dysphagia.
To cite this abstract in AMA style:
A. Vogel, I. Claus, S. Ahring, D. Gruber, A. Haghikia, U. Frank, R. Dziewas, G. Ebersbach, T. Warnecke, F. Gandor. Endoscopic Characteristics of Dysphagia in Multiple System Atrophy compared to Parkinson’s Disease [abstract]. Mov Disord. 2021; 36 (suppl 1). https://www.mdsabstracts.org/abstract/endoscopic-characteristics-of-dysphagia-in-multiple-system-atrophy-compared-to-parkinsons-disease/. Accessed June 16, 2025.« Back to MDS Virtual Congress 2021
MDS Abstracts - https://www.mdsabstracts.org/abstract/endoscopic-characteristics-of-dysphagia-in-multiple-system-atrophy-compared-to-parkinsons-disease/