Background: Dysphagia is a major clinical
concern in multiple system atrophy (MSA). A detailed
evaluation of its major endoscopic features compared
with Parkinson’s disease (PD) is lacking.
Objective: This study systematically assessed dysphagia
in MSA compared with PD and correlated subjective dysphagia
to objective endoscopic findings.
Methods: Fifty-seven patients with MSA (median, 64 [interquartile
range (IQR): 59–71] years; 35 women) underwent
flexible endoscopic evaluation of swallowing using a specific
MSA–flexible endoscopic evaluation of swallowing task protocol.
Findings were compared with an age-matched cohort
of 57 patients with PD (median, 67 [interquartile range:
60–73] years; 28 women). In a subcohort, subjective dysphagia
was assessed using the Swallowing Disturbance
Questionnaire and correlated to endoscopy findings.
Results: Patients with MSA predominantly showed symptoms
suggestive of oral-phase disturbance (premature spillage,
75.4%, piecemeal deglutition, 75.4%). Pharyngealphase
symptoms occurred less often (pharyngeal residues,
50.9%; penetration/aspiration, 28.1%). In contrast, pharyngeal
symptoms were the most common finding in PD (pharyngeal
residues, 47.4%). Oral symptoms occurred less
frequently in PD (premature spillage, 15.8%, P < 0.001;
piecemeal deglutition, 1.8%, P < 0.01). Patients with MSA
had a greater risk for oral-phase disturbances with increased
disease severity (P < 0.05; odds ratio, 3.15). Patients with
MSA showed a significantly higher intraindividual interswallow
variability compared with PD. When correlating
Swallowing Disturbance Questionnaire scores with endoscopy
results, its cutoff, validated for PD, was not sensitive
enough to identify patients with MSA with dysphagia. We
developed a subscore for identifying dysphagia in MSA and
calculated a new cutoff (sensitivity 85%, specificity 100%).
Conclusions: In contrast with patients with PD, patients
with dysphagic MSA more frequently present with oralphase
symptoms and a significantly higher intraindividual
interswallow variability. A novel Swallowing Disturbance
Questionnaire MSA subscore may be a valuable tool to
identify patients with MSA with early oropharyngeal dysphagia.Projekt DEAL 202
