Advertisement

Movement Disorder Emergencies of the Upper Aerodigestive Tract

  • Lesley Childs
  • Scott Rickert
  • Boris Bentsianov
  • Ajay Chitkara
  • Anthony Cultrara
  • Andrew BlitzerEmail author
Chapter
Part of the Current Clinical Neurology book series (CCNEU)

Abstract

Movement disorder emergencies of the aerodigestive tract are dramatic and often life threatening. With appropriate, timely evaluation and intervention, most patients can be effectively managed and major morbidity avoided. This chapter provides a comprehensive review of both the causes and appropriate treatment of breathing disturbances secondary to primary disorders and iatrogenic causes, as well as swallowing emergencies. Additionally, basic physiology, anatomy, and various methods for assessment of the upper aerodigestive tract are provided for review. Specific disorders that are addressed include: spasmodic dysphonia, adductor laryngeal breathing dystonia, Shy–Drager abductor weakness, drug-induced tardive ­dystonia, oromandibulolingual dystonia, multiple system atrophy, multiple sclerosis, amyotrophic lateral sclerosis, Parkinson’s disease, Huntington’s disease, and palatal myoclonus.

Keywords

Multiple System Atrophy Percutaneous Endoscopic Gastrostomy Amyotrophic Lateral Sclerosis Patient Vocal Fold Central Sleep Apnea 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Brin MF, Fahn S, Blitzer A, Ramig LO, Stewart C. Movement disorders of the larynx. In: Blitzer A, Brin MF, Sasaki CT, Fahn S, Harris KS, editors. Neurologic disorders of the larynx. New York: Thieme Medical Publishers Inc.; 1992. p. 248–78.Google Scholar
  2. 2.
    Braun N, Abd A, Baer J, Blitzer A, Stewart C, Brin M. Dyspnea in dystonia; a functional evaluation. Chest. 1995;107:1309–16.PubMedCrossRefGoogle Scholar
  3. 3.
    Marion MH, Klap P, Perrin A, Cohen M. Stridor and focal laryngeal dystonia. Lancet. 1992;339:815.CrossRefGoogle Scholar
  4. 4.
    Grillone GA, Blitzer A, Brin MF, Annino Jr DJ, Saint-Hilaire MH. Treatment of adductor laryngeal breathing dystonia with botulinum toxin type A. Laryngoscope. 1994;104:30–2.PubMedCrossRefGoogle Scholar
  5. 5.
    Lew MF, Shindo M, Moscowitz CB, Wilhemsen KC, Fahn S, Waters CH. Adductor laryngeal breathing dystonia in a patient with lubag (X-linked dystonia-Parkinsonism syndrome). Mov Disord. 1994;9:318–20.PubMedCrossRefGoogle Scholar
  6. 6.
    Merlo IM, Occhini A, Pacchetti C, Alfonsi E. Not paralysis, but dystonia causes stridor in multiple system atrophy. Neurology. 2002;58:649–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Panegyres PK, Hillman D, Dunne JW. Laryngeal dystonia causing upper airway obstruction in progressive supranuclear palsy. J Clin Neurosci. 2007;14:380–1.PubMedCrossRefGoogle Scholar
  8. 8.
    Smith RL, Brown DH. Shy-Drager syndrome: an otolaryngology perspective. J Otolaryngol. 2000;29:59–61.PubMedGoogle Scholar
  9. 9.
    Tousi B. Movement disorder emergencies in the elderly: recognizing and treating an often-iatrogenic problem. Cleve Clin J Med. 2008;75:449–57.PubMedCrossRefGoogle Scholar
  10. 10.
    Deguchi K, Ikeda K, Goto R, et al. The close relationship between life-threatening breathing disorders and urine storage dysfunction in multiple system atrophy. J Neurol. 2010;257(8):1287–92.PubMedCrossRefGoogle Scholar
  11. 11.
    Yoshihara T, Yamamura Y, Kaneko F, et al. Neuromuscular junctions of the posterior cricoarytenoid muscle in multiple system atrophy: a case study. Acta Otolaryngol Suppl. 2009;562:115–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Kuzniar TJ, Morgenthaler TI, Prakash UB, et al. Effects of continuous positive airway pressure on stridor in multiple system atrophy-sleep laryngoscopy. J Clin Sleep Med. 2009;15:65–7.Google Scholar
  13. 13.
    Suzuki M, Saigusa H, Shibasaki K, et al. Multiple system atrophy manifesting as complex sleep-disordered breathing. Auris Nasus Larynx. 2010;37:110–3.PubMedCrossRefGoogle Scholar
  14. 14.
    Moreno-Lopez C, Santamaria J, Salamero M, et al. Excessive daytime sleepiness in multiple system atrophy (SLEEMSA study). Arch Neurol. 2011;68:223–30.PubMedCrossRefGoogle Scholar
  15. 15.
    Wirshing WC. Movement disorders associated with neuroleptic treatment. J Clin Psychiatry. 2001;21:15–8.Google Scholar
  16. 16.
    Glazer WM. Extrapyramidal side effects, tardive dyskinesia, and the concept of atypicality. J Clin Psychiatry. 2000;61:16–21.PubMedCrossRefGoogle Scholar
  17. 17.
    Marsden CD, Jenner P. The pathophysiology of extrapyramidal side effects of neuroleptic drugs. Psychol Med. 1980;10:55–72.PubMedCrossRefGoogle Scholar
  18. 18.
    Rowley H, Lynch T, Keogh I, Russell J. Tardive dystonia of the larynx in a quadriplegic patient: an unusual cause of stridor. J Laryngol Otol. 2001;115:918–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Fines RE, Brady Jr WJ, Martin ML. Acute laryngeal dystonia related to neuroleptic agents. Am J Emerg Med. 1999;17:319–20.PubMedCrossRefGoogle Scholar
  20. 20.
    Miller AJ. Neurophysiological basis of swallowing. Dysphagia. 1986;1:91–100.CrossRefGoogle Scholar
  21. 21.
    Logemann J. Manual for the videoflouroscopic study of swallowing. Austin, TX: Proed; 1993.Google Scholar
  22. 22.
    Bastien RW. Videoendoscopic evaluation of patients with dysphagia: an adjunct to the modified barium swallow. Otolaryngol Head Neck Surg. 1991;104:339–50.Google Scholar
  23. 23.
    Aviv JE, Kin T, Sacco RL, et al. FEESST: a new bedside endoscopic test of the motor and sensory components of swallowing. Ann Otol Rhinol Laryngol. 1998;107:378–87.PubMedGoogle Scholar
  24. 24.
    Aviv JE. Prospective randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia. Laryngoscope. 2000;110:563–74.PubMedCrossRefGoogle Scholar
  25. 25.
    Setzen M, Cohen MA, Mattucci KF, Perlman PW, Ditkoff MK. Laryngopharyngeal sensory deficits as a predictor of aspiration. Otolaryngol Head Neck Surg. 2001;124:622–4.PubMedCrossRefGoogle Scholar
  26. 26.
    McConnel FMS. Analysis of pressure generation and bolus transit during pharyngeal swallowing. Laryngoscope. 1988;98:71–8.PubMedGoogle Scholar
  27. 27.
    McConnel FMS, Cevenko D, Mendelsohn MS. Manofluorographic analysis of swallowing. Otolaryngol Clin North Am. 1988;21:625–35.PubMedGoogle Scholar
  28. 28.
    Flint PW, Purcell LL, Cummings CW. Pathophysiology and indications for medialization thyroplasty in patients with dysphagia and aspiration. Otolaryngol Head Neck Surg. 1997;16:349–54.CrossRefGoogle Scholar
  29. 29.
    Strome SE. Aspiration. In: Gates G, editor. Current therapy in otolaryngology head and neck surgery. 6th ed. St. Louis: Mosby; 1998. p. 453–6.Google Scholar
  30. 30.
    Wisdom G, Krespi YP, Blitzer A. Surgical therapy for chronic aspiration. Oper Tech Otolaryngol Head Neck Surg. 1997;8:199–208.CrossRefGoogle Scholar
  31. 31.
    Brin MF, Blitzer A, Herman S, Stewart C. Oromandibular dystonia: treatment of 96 patients with botulinum toxin type A. In: Jankovic J, Hallett M, editors. Therapy with botulinum toxin. New York: Marcel Dekker, Inc.; 1994. p. 429–35.Google Scholar
  32. 32.
    Brin MF, Danisi F, Blitzer A. Blepharospasm, oromandibular dystonia, Meige’s syndrome and hemifacial spasm. In: Moore P, editor. Handbook of botulinum toxin treatment. 2nd ed. London: Blackwell Science; 2003. p. 119–41.Google Scholar
  33. 33.
    Parkes D, Schachter M. Meige, Breughel, or Blake. Neurology. 1981;31:498.PubMedGoogle Scholar
  34. 34.
    Gowers WR. Manual of diseases of the nervous system. 3rd ed. London: Churchill; 1899. p. 200.Google Scholar
  35. 35.
    Meige H. Les convusions de la face: une forme clinique de la convulsions faciales, bilateral et mediane. Rev Neurol (Paris). 1910;21:437–43.Google Scholar
  36. 36.
    Marsden CD. Blepharospasm-oromandibular dystonia syndrome (Brueghal’s syndrome). A variant of adult-onset torsion dystonia? J Neurol Neurosurg Psychiatry. 1976;39:1204–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Thompson PD, Obeso JA, Delgato G, Gallego J, Marsden CD. Focal dystonia of the jaw and the differential diagnosis of unilateral jaw and masticatory spasm. J Neurol Neurosurg Psychiatry. 1986;49:651–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Jankovic J. Blepharospasm and oromandibular-laryngeal-cervical dystonia: a controlled trial of botulinum A toxin therapy. Adv Neurol. 1988;50:583–91.PubMedGoogle Scholar
  39. 39.
    Tolosa E, Marti MJ. Blepharospasm-oromandibular dystonia (Meige’s syndrome): clinical aspects. Adv Neurol. 1988;49:73–84.PubMedGoogle Scholar
  40. 40.
    Tolosa E, Kulisevsky J, Fahn S. Meige syndrome: primary and secondary forms. Adv Neurol. 1988;50:509–15.PubMedGoogle Scholar
  41. 41.
    Tolosa ES. Clinical features of Meige’s disease (idiopathic orofacial dystonia). A report of 17 cases. Arch Neurol. 1981;38:147–51.PubMedCrossRefGoogle Scholar
  42. 42.
    Jankovic J, Ford J. Blepharospasm and orofacial-cervical dystonia: clinical and pharmacological findings in 100 patients. Ann Neurol. 1983;13:402–11.PubMedCrossRefGoogle Scholar
  43. 43.
    Berardelli A, Rothwell J, Day B, Marsden CD. Pathophysiology of blepharospasm and oromandibular dystonia. Brain. 1985;108:593–608.PubMedCrossRefGoogle Scholar
  44. 44.
    Nutt JG, Hammerstad JP. Blepharospasm and oromandibualr dystonia (Meige’s syndrome) in sisters. Ann Neurol. 1981;9:189–91.PubMedCrossRefGoogle Scholar
  45. 45.
    Marsden CD. Problems of adult-onset idiopathic torsion dystonia and other isolated dyskinesias in adult life. Adv Neurol. 1976;14:259–76.PubMedGoogle Scholar
  46. 46.
    Defazio G, Lamberti P, Lepore V, Livrea P, Ferrari E. Facial dystonia: clinical features, prognosis, and pharmacology in 31 patients. Ital J Neurol Sci. 1989;10:553–60.PubMedGoogle Scholar
  47. 47.
    Jordan DR, Patrinely JR, Anderson RL, Thiese SM. Essential blepharospasm and related dystonias. Surv Ophthalmol. 1989;34:123–32.PubMedCrossRefGoogle Scholar
  48. 48.
    Kirton CA, Riopelle RJ. Meige syndrome secondary to basal ganglia injury: a potential cause of acute respiratory distress. Can J Neurol Sci. 2001;28:167–73.PubMedGoogle Scholar
  49. 49.
    Brin MF. Advances in dystonia: genetics and treatment with botulinum toxin. In: Smith B, Adelman G, editors. Neuroscience year, supplement to the encyclopedia of neuroscience. Boston: Birkhauser; 1992. p. 56–8.Google Scholar
  50. 50.
    Blitzer A, Brin MF, Greene PE, Fahn S. Botulinum toxin injection for the treatment of oromandibular dystonia. Ann Otol Rhinol Laryngol. 1989;98:93–7.PubMedGoogle Scholar
  51. 51.
    Greene P, Shale H, Fahn S. Analysis of open-label trial in torsion dystonia using high dosages of anticholinergics and other drugs. Mov Disord. 1988;3:46–60.PubMedCrossRefGoogle Scholar
  52. 52.
    Gollomp SM, Fahn S, Burke RE, Reches A, Ilson J. Therapeutic trials in Meige syndrome. Adv Neurol. 1983;37:207–13.PubMedGoogle Scholar
  53. 53.
    Tan EK, Jankovic J. Botulinum toxin A in patients with oromandibular dystonia: long-term follow-up. Neurology. 1999;53:2102–7.PubMedCrossRefGoogle Scholar
  54. 54.
    Charous SJ, Comella CL, Fan W. Jaw-opening dystonia: quality of life after botulinum toxin injections. Ear Nose Throat J. 2011;90:E9.PubMedGoogle Scholar
  55. 55.
    Yoshida K, Kaji R, Shibasaki H, Iizuka T. Factors influencing the therapeutic effect of muscle afferent block for oromandibular dystonia and dyskinesia: implications for their distinct pathophysiology. Int J Oral Maxillofac Surg. 2002;31:499–505.PubMedCrossRefGoogle Scholar
  56. 56.
    Adler CH, Factor SA, Brin MF, Sethi KD. Secondary nonresponsiveness to botulinum toxin A in patients with oromandibular dystonia. Mov Disord. 2002;17:158–61.PubMedCrossRefGoogle Scholar
  57. 57.
    Brin MF, Blitzer A, Greene PE, Fahn S. Botulinum toxin therapy for the treatment of oromandibulolingual dystonia (OMD). Neurology. 1988;38 Suppl 1:294.Google Scholar
  58. 58.
    Blitzer A, Brin MF, Fahn S. Botulinum toxin injections for lingual dystonia. Laryngoscope. 1991;101:799.PubMedCrossRefGoogle Scholar
  59. 59.
    Charles PD, Davis TL, Shannon KM, Hook MA, Warner JS. Tongue protrusion dystonia: treatment with botulinum toxin. South Med J. 1997;90:522–5.PubMedCrossRefGoogle Scholar
  60. 60.
    Lyons MK, Birch BD, Hillman RA, et al. Long-term follow-up of deep brain stimulation for Meige syndrome. Neurosurg Focus. 2010;29(2):E5.PubMedCrossRefGoogle Scholar
  61. 61.
    Higo R, Tayama N, Watanabe T, et al. Vocal fold motion impairment in patients with multiple system atrophy: evaluation of its relationship with swallowing function. J Neurol Neurosurg Psychiatry. 2003;74:982–4.PubMedCrossRefGoogle Scholar
  62. 62.
    Abraham SS, Yun PT. Laryngopharyngeal dysmotility in multiple sclerosis. Dysphagia. 2002;16:69–74.CrossRefGoogle Scholar
  63. 63.
    Prosiegel M, Schelling A, Wagner-Sonntag E. Dysphagia and multiple sclerosis. Int MS J. 2004;11(1):22–31.PubMedGoogle Scholar
  64. 64.
    Eretkin C, Aydogdu I, Yuceyar N, et al. Pathophysiological mechanisms of oropharyngeal dysphagia in amyotrophic lateral sclerosis. Brain. 2000;123:125–40.CrossRefGoogle Scholar
  65. 65.
    Eretkin C, Tarlaci S, Aydogdu I, et al. Electrophysiological evaluation of pharyngeal phase of swallowing in patients with Parkinson’s disease. Mov Disord. 2002;17(5):942–9.CrossRefGoogle Scholar
  66. 66.
    Lever TE, Simon E, Cox KT, et al. A mouse model of pharyngeal dysphagia in amyotrophic lateral sclerosis. Dysphagia. 2010;25:112–26.PubMedCrossRefGoogle Scholar
  67. 67.
    Spataro R, Ficano L, Piccoli F, La Bella V. Percutaneous endoscopic gastrostomy in amyothrophic lateral sclerosis: effect on survival. J Neurol Sci. 2011;15:44–8.CrossRefGoogle Scholar
  68. 68.
    Potulska A, Friedman A, Krolicki L, et al. Swallowing disorders in Parkinson’s disease. Parkinsonism Relat Disord. 2003;9:349–53.PubMedCrossRefGoogle Scholar
  69. 69.
    Cloud LJ, Greene JG. Gastrointestinal features of Parkinson’s disease. Curr Neurol Neurosci Rep. 2011;11(4):379–84.PubMedCrossRefGoogle Scholar
  70. 70.
    Pfeiffer RF. Gastrointestinal dysfunction in Parkinson’s disease. Parkinsonism Relat Disord. 2011;17:10–5.PubMedCrossRefGoogle Scholar
  71. 71.
    Fuh JL, Lee RC, Wang SJ, et al. Swallowing difficulty in Parkinson’s disease. Clin Neurol Neurosurg. 1997;99:106–12.PubMedGoogle Scholar
  72. 72.
    Edwards LL, Quigley EM, Pfeiffer RF. Gastrointestinal dysfunction in Parkinson’s disease: frequency and pathophysiology. Neurology. 1992;42:726–32.PubMedCrossRefGoogle Scholar
  73. 73.
    Sung HY, Kim JS, Lee KS, et al. The prevalence and patterns of pharyngoesophageal dysmotility in patients with early stage Parkinson’s disease. Mov Disord. 2010;25:2361–8.PubMedCrossRefGoogle Scholar
  74. 74.
    Menezes C, Melo A. Does levodopa improve swallowing dysfunction in Parkinson’s disease patients? J Clin Pharm Ther. 2009;34:673–6.PubMedCrossRefGoogle Scholar
  75. 75.
    Troche MS, Okun MS, Rosenbek JC, et al. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial. Neurology. 2010;75:1912–9.PubMedCrossRefGoogle Scholar
  76. 76.
    Heemskerk AW, Roos RA. Dysphagia in Huntington’s disease: a review. Dysphagia. 2011;26:62–6.PubMedCrossRefGoogle Scholar
  77. 77.
    Dubinsky RM. No going home for hospitalized Huntington’s disease patients. Mov Disord. 2005;20:1316–22.PubMedCrossRefGoogle Scholar
  78. 78.
    Kagel MC, Leopold NA. Dysphagia in Huntington’s disease: a 16-year retrospective. Dysphagia. 1992;7:106–14.PubMedCrossRefGoogle Scholar
  79. 79.
    Hamakawa S, Koda C, Umeno H, et al. Oropharyngeal dysphagia in a case of Huntington’s disease. Auris Nasus Larynx. 2004;31:171–6.PubMedCrossRefGoogle Scholar
  80. 80.
    Pappert E, Goetz C. Myoclonus. In: Kurlan R, editor. Treatment of movement disorders. Philadelphia: JB Lippincott; 1995. p. 247–336.Google Scholar
  81. 81.
    Rivest J. Myoclonus. Can J Neurol Sci. 2003;30:S53–8.PubMedGoogle Scholar
  82. 82.
    Drysdale AJ, Ansell J, Adeley J. Palato-pharyngo-laryngeal myoclonus: an unusual cause of dysphagia and dysarthria. J Laryngol Otol. 1993;107:746–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Lesley Childs
    • 1
  • Scott Rickert
    • 2
  • Boris Bentsianov
    • 3
  • Ajay Chitkara
    • 4
  • Anthony Cultrara
    • 5
  • Andrew Blitzer
    • 6
    Email author
  1. 1.Department of Otolaryngology—Head and Neck Surgery, Clinical Center for Voice CareUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Department of Pediatric OtolaryngologyNew York University Langone Medical CenterNew YorkUSA
  3. 3.Department of Otolaryngology and Division of Laryngology, Voice and Swallowing DisordersDownstate Medical Center, State University of New YorkBrooklynUSA
  4. 4.Department of Otolaryngology—Head and Neck SurgeryState University of New YorkStony BrookUSA
  5. 5.New York Center for Voice and Swallowing DisordersNew YorkUSA
  6. 6.Department of Clinical OtolaryngologyColumbia University College of Physicians and Surgeons, New York Center for Voice and Swallowing DisordersNew YorkUSA

Personalised recommendations