Category: Parkinsonism, Atypical: MSA
Objective: To investigate the prevalence of laryngeal motion abnormalities in patients with atypical Parkinsonism.
Background: Using a previously published FEES task-protocol[1-3], we identified irregular involuntary arytenoid cartilage movements (iACM) as a supportive biomarker for multiple system atrophy (MSA)[1,2]. Analysing dysphagia revealed a differing pattern between MSA and PD. In this international multicenter study, laryngeal motion abnormalities and swallowing function are systematically recorded in patients with MSA and 4repeat tauopathies (4RT).
Method: Patients with MSA or 4RT underwent routine endoscopic evaluation of the larynx and swallowing function (FEES), utilising our previously published MSA-FEES task protocol[1-3], recording laryngeal motion abnormalities and swallowing parameters.
Results: 206 MSA and 50 PSP patients were included until November 2022 at 14 international sites. We present an interim analysis on laryngeal movement abnormalities from 109 MSA patients (median age 66 [IQR 59-71] years, 63 women, disease duration 4 [3-6], MDS-UPDRS 42 [34-52], Hoehn&Yahr stage 4 [3-4]) and 50 PSP patients (age 73 [67-77] years; 17 women, duration of disease 5 [3-7], MDS-UPDRS 36 [30-41], Hoehn&Yahr stage 4 [3-4]).
During endoscopy, 106/109 (97.2%) MSA patients showed laryngeal movement abnormalities. Of these, iACM was observed most frequently in 102/109 (93.6%) of MSA patients, followed by vocal fold movement impairment (VFMI) with 62.4%, vocal fold fixation (VFF) with 9.2% and paradoxical vocal fold movement (PVFM) with 7.3%.
In the 4RT cohort, only 16/50 (32%) of patients showed laryngeal movement abnormalities, with VFMI being the most frequently observed with 28%, followed by iACM, VFF and PVFM with one patient (2%) each.
Conclusion: Laryngeal movement abnormalities are very common in MSA patients when examined with a specific MSA-FEES examination protocol. In contrast, laryngeal movement abnormalities are observed in only about one third of 4RT patients. The data support our previous findings [1,2] that iACM can be used as a supportive clinical biomarker to differentiate MSA from PD with high specificity and sensitivity. These preliminary results will be followed by a detailed analysis of swallow-specific parameters and a correlation analysis with laryngeal abnormalities.
References: 1. Warnecke T, Vogel A, Ahring S, Gruber D, Heinze HJ, Dziewas R, Ebersbach G, Gandor F. The Shaking Palsy of the Larynx-Potential Biomarker for Multiple System Atrophy: A Pilot Study and Literature Review. Front Neurol. 2019 Mar 26;10:241. doi: 10.3389/fneur.2019.00241. PMID: 30972002; PMCID: PMC6443854.
2. Gandor F, Vogel A, Claus I, Ahring S, Gruber D, Heinze HJ, Dziewas R, Ebersbach G, Warnecke T. Laryngeal Movement Disorders in Multiple System Atrophy: A Diagnostic Biomarker? Mov Disord. 2020 Dec;35(12):2174-2183. doi: 10.1002/mds.28220. Epub 2020 Aug 5. PMID: 32757231; PMCID: PMC7818263.
3. Vogel A, Claus I, Ahring S, Gruber D, Haghikia A, Frank U, Dziewas R, Ebersbach G, Gandor F, Warnecke T. Endoscopic Characteristics of Dysphagia in Multiple System Atrophy Compared to Parkinson’s Disease. Mov Disord. 2022 Mar;37(3):535-544. doi: 10.1002/mds.28854. Epub 2021 Nov 13. PMID: 34773420.
To cite this abstract in AMA style:F. Gandor, A. Vogel, L. Berger, D. Gruber, I. Claus, P. Corelli, G. Giannini, N. Madetko-Alster, G. Höglinger, M. Klietz, C. Schrader, B. Falkenburger, T. Shimohata, K. Kunieda, J. Kassubek, R. Kassubek, MJ. Marti, G. Wenning, A. Fanciulli, C. Pototschnig, T. Gurevich, Y. Manor, HJ. Kim, D. Weise, P. Urban, R. Dziewas, T. Warnecke. Laryngeal clinical biomarkers in atypical Parkinsonism – results from an international multicenter study [abstract]. Mov Disord. 2023; 38 (suppl 1). https://www.mdsabstracts.org/abstract/laryngeal-clinical-biomarkers-in-atypical-parkinsonism-results-from-an-international-multicenter-study/. Accessed September 28, 2023.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/laryngeal-clinical-biomarkers-in-atypical-parkinsonism-results-from-an-international-multicenter-study/