Neurogenic Paradoxical Vocal Fold Motion: A Systematic Review of Central and Pheripheral Nervous System Disorders.

In 30 seconds

This PRISMA-guided systematic review examined paradoxical vocal fold motion (PVFM) associated with confirmed central or peripheral neurological disorders. It included 11 case reports, case series, or observational studies, covering 102 patients overall; 42 had PVFM linked to a neurological disorder. Causes ranged from brainstem malformations and epilepsy to neuromuscular and neurodegenerative diseases. The review could not estimate how often neurological disease occurs among all PVFM cases. In individual cohorts, neurological disease was identified in 54% of infants with PVFM, while PVFM was documented in 33% of patients with multiple system atrophy.

Key findings

• Of 102 patients across the included studies, 42 had PVFM associated with a confirmed neurological disorder.
• Neurological disease was identified in 54% of infants with PVFM in one cohort.
• PVFM was documented in 33% of patients with multiple system atrophy in one cohort.
• Most reversible cases improved substantially or resolved with treatment of the underlying neurological disorder; symptoms often persisted in progressive diseases.

Why it matters

The review broadens the clinical framing of PVFM by documenting its association with diverse neurological disorders, rather than only functional conditions. Recognizing possible disruption of neural control may help explain atypical or refractory presentations and supports considering neurological causes when assessing PVFM. Outcomes differed by disease course, with improvement more common in reversible conditions than in progressive neurodegenerative disease.

What to keep in mind

The evidence comprised only 11 case reports, case series, and observational studies, and the review could not estimate the prevalence of neurological causes among all PVFM cases.