1. Vocal cord electromyographic correlates of stridor in multiple system atrophy phenotypes.
- Author
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Todisco M, Alfonsi E, Isaias IU, Zangaglia R, Minafra B, Cosentino G, Terzaghi M, Pozzi NG, Manni R, and Pacchetti C
- Subjects
- Aged, Cerebellar Diseases complications, Dystonia etiology, Female, Humans, Male, Middle Aged, Multiple System Atrophy complications, Parkinsonian Disorders complications, Phenotype, Polysomnography, Respiratory Sounds etiology, Single-Blind Method, Cerebellar Diseases physiopathology, Dystonia physiopathology, Electromyography methods, Laryngeal Muscles physiopathology, Multiple System Atrophy physiopathology, Parkinsonian Disorders physiopathology, Respiratory Sounds physiopathology, Vocal Cords physiopathology
- Abstract
Introduction: Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by dysautonomia in combination with parkinsonian and cerebellar signs. Stridor may also occur and it is associated with life-threatening events and poor prognosis. The pathophysiology of stridor in MSA is still debated., Objective: To define correlations between diurnal electromyographic (EMG) abnormalities of vocal cord muscles and stridor in MSA phenotypes., Methods: We recruited 60 patients with "probable" MSA (45 with parkinsonian [MSA-P] and 15 with cerebellar phenotype [MSA-C]). Nocturnal stridor was detected with video-polysomnography, whereas diurnal stridor was clinically noted when present. A diurnal kinesiologic EMG study of the adductor thyroarytenoid and the abductor posterior cricoarytenoid muscles was also performed., Results: Among subjects with nocturnal stridor, MSA-P patients predominantly showed a paradoxical burst-like activation of the adductor thyroarytenoid muscle during inspiration. This dystonic pattern was associated with nocturnal stridor in MSA-P (odds ratio [OR] = 23.64, 95% confidence interval [CI] 3.42-70.77, p < 0.001). Conversely, MSA-C patients with nocturnal stridor mainly had additional neurogenic findings of vocal cord muscles. This dystonic-plus pattern correlated with nocturnal stridor in MSA-C (OR = 17.21, 95% CI 4.17-74.92, p < 0.01). The findings of diurnal stridor paralleled the observations for nocturnal stridor., Conclusions: The pathophysiology of stridor may differ between MSA phenotypes, possibly related to dysfunctional supranuclear mechanisms in MSA-P (dystonic pattern) and to additional nuclear damage in MSA-C (dystonic-plus pattern)., (Copyright © 2019 Elsevier Ltd. All rights reserved.)
- Published
- 2020
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