Effectiveness of Lee Silverman Voice Treatment (LSVT-LOUD) in Parkinsonian-Type Multiple System Atrophy (MSA-P): A Case Report

We describe a case of Parkinsonian-type multiple system atrophy (MSA-P) treated with Lee Silverman Voice Treatment (LSVT-LOUD; LSVT Global, Inc., Phoenix, AZ, USA). At age 73, the patient developed motor symptoms, including gait disturbances with a tendency to fall, as well as swallowing difficulties and impaired dexterity in his right hand, prompting a visit to our hospital. Brain magnetic resonance imaging (MRI) revealed atrophy in the cerebellum and brainstem, particularly in the pons, along with enlargement of the fourth ventricle; however, the "cross sign" on the pons was not clearly visible. Dopamine transporter single-photon emission computed tomography (DAT-SPECT) showed decreased nuclide accumulation in the striatum. Additionally, 123I-MIBG cardiac scintigraphy demonstrated preserved nuclide accumulation in the heart. L-dopa challenge tests were conducted, but no significant improvement in motor symptoms was observed. Based on these findings, he was diagnosed with MSA-P. Over the following years, his condition progressively worsened, with increasing orthostatic hypotension, dysphagia, and falls. Various treatments, including anti-Parkinson’s medications and vasopressors, provided little relief. At age 75, due to severe dysphagia and hoarseness, he was admitted for LSVT-LOUD therapy. After LSVT-LOUD treatment, the patient improved voice volume, tongue pressures, alternating motion rates of "pa," "ta," and "ka," and the Frontal Assessment Battery (FAB) score. These results suggest that LSVT-LOUD may positively impact both speech and swallowing functions, as well as frontal lobe function. Larger studies are needed to validate these results.