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Stridor in multiple system atrophy: Consensus statement on diagnosis, prognosis, and treatment
- Source :
- Neurology
- Publication Year :
- 2019
-
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.
- Subjects :
- medicine.medical_specialty
Stridor
medicine.medical_treatment
Consensus Development Conferences as Topic
Laryngoscopy
multiple system atrophy
consensus statement
Humans
Multiple System Atrophy
Prognosis
Respiratory Sounds
Treatment Outcome
NO
03 medical and health sciences
0302 clinical medicine
MSA
medicine
otorhinolaryngologic diseases
030212 general & internal medicine
Continuous positive airway pressure
Respiratory sounds
Intensive care medicine
Views & Reviews
medicine.diagnostic_test
Cerebellar ataxia
business.industry
Parkinsonism
medicine.disease
Dysphagia
stridor
3. Good health
medicine.anatomical_structure
Rima glottidis
Neurology (clinical)
medicine.symptom
business
030217 neurology & neurosurgery
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Neurology
- Accession number :
- edsair.doi.dedup.....f514fe6a3b5ee01c1689e13742290fb9