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July 2010

Bilateral Vocal Cord Paralysis: A Rare Onset of Amyotrophic Lateral Sclerosis—Reply

Author Affiliations

Author Affiliations: Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands.

Arch Neurol. 2010;67(7):897-899. doi:10.1001/archneurol.2010.142

In reply

We thank Bigliardi and colleagues for their comments. The authors identified 1 case among 350 patients diagnosed with ALS in the province of Modena from 1990 to now that presented with stridor and hoarseness due to a bilateral vocal cord abductor paralysis at onset. Therefore, based on their own experience, they conclude that vocal cord dysfunction is quite rare at onset. Furthermore, Bigliardi et al refer to a publication by Puls et al1 in which a large family is described with lower motor neuron disease caused by a dynactin mutation. Affected members of this family developed early bilateral vocal cord paralysis. Bigliardi et al hypothesize that vocal cord dysfunction in ALS may be specifically related to a dynactin dysfunction.

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