Bigyan Raj Gyawali, Bibek Shrestha, Shreeram Paudel, Rashmi Gupta
PVFM is frequently associated with organic neurological disorders and should be recognized as a manifestation of disrupted neural control rather than solely a functional condition. Early neurological evaluation and disease-specific management may improve outcomes, particularly in atypical or refractory presentations.
OBJECTIVE(S): To systematically synthesize published evidence on paradoxical vocal fold motion associated with confirmed central or peripheral neurological disorders, with emphasis on neuroanatomic correlations, clinical presentation, management strategies, and treatment outcomes.
METHODS: A systematic review was conducted following PRISMA 2020 guidelines and registered in PROSPERO. Six databases (PubMed/MEDLINE, Embase, Scopus, Cochrane Library, ScienceDirect, and Google Scholar) were searched from inception to December 2025. Studies reporting PVFM associated with a confirmed neurological disorder in patients of any age were included. Eligible designs comprised case reports, case series, and observational studies. Data extraction was performed using predefined criteria, and risk of bias was assessed using Joanna Briggs Institute (JBI) critical appraisal tools and the ROBINS-I framework.
RESULTS: Eleven studies were included, enrolling 102 patients, of whom 42 (19 pediatric, 23 adult) had paradoxical vocal fold motion in association with a confirmed neurological disorder. Neurological etiologies encompassed brainstem malformations, epilepsy, cerebral palsy, neuromuscular junction disorders, basal ganglia diseases, neurodegenerative disorders, and ion-channelopathies. The review design precluded estimation of the prevalence of neurological causes among all PVFM cases; within individual cohorts, neurological disease was identified in 54% of infants with PVFM, and paradoxical vocal fold motion was documented in 33% of patients with multiple system atrophy. Six of the nine studies with classifiable etiologies involved reversible or treatable conditions and three involved progressive neurodegenerative disease, although most individual patients fell into the latter group because the neurodegenerative cohorts were larger. Treatment directed at the underlying neurological disorder resulted in substantial improvement or resolution in most reversible cases, whereas symptoms often persisted in progressive diseases.
CONCLUSION: PVFM is frequently associated with organic neurological disorders and should be recognized as a manifestation of disrupted neural control rather than solely a functional condition. Early neurological evaluation and disease-specific management may improve outcomes, particularly in atypical or refractory presentations.