Stridor in multiple system atrophy
Open Access
- 1 October 2019
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 93 (14), 630-639
- https://doi.org/10.1212/wnl.0000000000008208
Abstract
Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by a combination of autonomic failure, cerebellar ataxia, and parkinsonism. Laryngeal stridor is an additional feature for MSA diagnosis, showing a high diagnostic positive predictive value, and its early occurrence might contribute to shorten survival. A consensus definition of stridor in MSA is lacking, and disagreement persists about its diagnosis, prognosis, and treatment. An International Consensus Conference among experts with methodological support was convened in Bologna in 2017 to define stridor in MSA and to reach consensus statements for the diagnosis, prognosis, and treatment. Stridor was defined as a strained, high-pitched, harsh respiratory sound, mainly inspiratory, occurring only during sleep or during both sleep and wakefulness, and caused by laryngeal dysfunction leading to narrowing of the rima glottidis. According to the consensus, stridor may be recognized clinically by the physician if present at the time of examination, with the help of a witness, or by listening to an audio recording. Laryngoscopy is suggested to exclude mechanical lesions or functional vocal cord abnormalities related to different neurologic conditions. If the suspicion of stridor needs confirmation, drug-induced sleep endoscopy or video polysomnography may be useful. The impact of stridor on survival and quality of life remains uncertain. Continuous positive airway pressure and tracheostomy are both suggested as symptomatic treatment of stridor, but whether they improve survival is uncertain. Several research gaps emerged involving diagnosis, prognosis, and treatment. Unmet needs for research were identified.This publication has 53 references indexed in Scilit:
- Effect of Laser Arytenoidectomy on Respiratory Stridor Caused by Multiple System AtrophyJournal Of Clinical Sleep Medicine, 2012
- The Global Evidence Mapping Initiative: Scoping research in broad topic areasBMC Medical Research Methodology, 2011
- Methods of Formal Consensus in Classification/Diagnostic Criteria and Guideline DevelopmentSeminars in Arthritis and Rheumatism, 2011
- Second consensus statement on the diagnosis of multiple system atrophyNeurology, 2008
- Red flags for multiple system atrophyMovement Disorders, 2008
- Tracheostomy abolishes paradoxical activation of the vocal cord adductor in multiple system atrophyAuris Nasus Larynx, 2006
- Laryngeal abductor paralysis can be a solitary manifestation of multiple system atrophyJournal of Neurology, Neurosurgery & Psychiatry, 2005
- Continuous positive airway pressure for sleep-related breathing disorders in multiple system atrophy: long-term acceptanceSleep Medicine, 2005
- Pathogenesis of laryngeal narrowing in patients with multiple system atrophyThe Journal of Physiology, 2001
- Sleep‐related breathing disorders in the Shy–Drager syndrome. Observations on investigation and managementEuropean Journal of Neurology, 1996