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Laryngeal abductor paralysis (LAP) and stridor are well known features that occur in over one third of patients with multiple system atrophy (MSA).1 The pathogenesis of LAP is thought to be crico-arytenoid abductor muscle denervation,2 although there is a lack of consistent evidence of motor cell loss in the nucleus ambiguus.2,3 More recently, dystonia of the laryngeal adductor muscle has also been proposed.4 LAP/stridor usually occurs in the advanced stages of the disease,6 and is considered to be a poor prognostic feature.1,2 In contrast, some MSA cases have shown LAP initially, with most of these reported by otolaryngology departments.5–7 However, there are no systematic surveys as to the extent to which MSA patients initially …
Published Online First 9 June 2005
Competing interests: none declared