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Neurology 2002;58:649-652
© 2002 American Academy of Neurology
Brief Communications

Not paralysis, but dystonia causes stridor in multiple system atrophy

Ilaria Maria Merlo, MD;, Antonio Occhini, MD;, Claudio Pacchetti, MD; and Enrico Alfonsi, MD

From the Spinal and Cranial Reflexes Laboratory (Drs. Merlo and Alfonsi), and Movement Disorders and Parkinson’s Disease Unit (Dr. Pacchetti), Istituto Neurologico C. Mondino I.R.C.C.S., Università di Pavia; and Department of Otorhinolaryngology (Dr. Occhini), Policlinico S. Matteo I.R.C.C.S., Università di Pavia, Italy.

Address correspondence and reprint requests to Dr. Enrico Alfonsi, Spinal and Cranial Reflexes Laboratory, Istituto Neurologico C. Mondino I.R.C.C.S., Università di Pavia, Via Palestro, 3, 27100 Pavia, Italy; e-mail: enricoalfonsi{at}virgilio.it

Electromyography (EMG) was performed in 10 patients with multiple system atrophy, laryngeal or pharyngeal symptoms, or both. In patients with stridor, EMG during quiet breathing revealed persistent tonic activity in both abductor and adductor vocal cord muscles. In patients with dysphagia, the cricopharyngeal muscle showed persistent EMG activity throughout all phases of swallowing. Botulinum toxin injection into the adductor muscle determined subjective improvement and reduced tonic EMG activity. Therefore, the cause of stridor in multiple system atrophy is dystonia of the vocal cords.




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