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Identifying clinical markers that help distinguish MSA from forms of parkinsonism is essential to promptly implement the most appropriate management plan. In the context of a thorough neurological evaluation, the presence of a vocal flutter might be considered a potential feature of MSA\u2010parkinsonian type (MSA\u2010P).<\/jats:p><\/jats:sec><jats:sec><jats:title>Cases<\/jats:title><jats:p>This case series describes clinical histories of 3 individuals with MSA\u2010P. In each case, vocal flutter was detected during neurological and motor speech evaluations. It seemed to be a concomitant feature with the constellation of other signs and symptoms that led to the clinical diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Literature review<\/jats:title><jats:p>The vocal flutter may be described as pitch and loudness fluctuations during phonation. Different from a vocal tremor, the flutter phenomenon has higher oscillation frequencies. The neuropathological underpinnings of vocal flutter may be related to generalized laryngeal dysfunction that is commonly described in MSA\u2010P.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Vocal flutter may be a unique speech feature in some individuals who have MSA\u2010P. Future studies using perceptual and acoustic measures of speech are warranted to quantify these observations and directly compare to other MSA variants, PD, and a control group.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mdc3.13988","type":"journal-article","created":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T02:05:01Z","timestamp":1707271501000},"page":"403-410","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Vocal Flutter of Multiple System Atrophy: A <scp>Parkinsonian\u2010Type<\/scp> Phenomenon?"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7594-5453","authenticated-orcid":false,"given":"Michela J.","family":"Mir","sequence":"first","affiliation":[{"name":"Department of Physical Therapy BREATHE Center, University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole E.","family":"Herndon","sequence":"additional","affiliation":[{"name":"Department of Speech, Language, and Hearing Sciences College of Public Health and Health Professions, University of Florida  Gainesville Florida USA"},{"name":"UF Health Norman Fixel Institute for Neurological Diseases  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparna","family":"Wagle Shukla","sequence":"additional","affiliation":[{"name":"UF Health Norman Fixel Institute for Neurological Diseases  Gainesville Florida USA"},{"name":"Department of Neurology College of Medicine, University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Wheeler\u2010Hegland","sequence":"additional","affiliation":[{"name":"Department of Speech, Language, and Hearing Sciences College of Public Health and Health Professions, University of Florida  Gainesville Florida USA"},{"name":"UF Health Norman Fixel Institute for Neurological Diseases  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaus R.","family":"McFarland","sequence":"additional","affiliation":[{"name":"UF Health Norman Fixel Institute for Neurological Diseases  Gainesville Florida USA"},{"name":"Department of Neurology College of Medicine, University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,5]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000324625.00404.15"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2990.2011.01234.x"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1311488"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1212\/CON.0000000000000348"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0037-1602422"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40478-021-01173-y"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.68.4.434"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00218-X"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.00180"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.21992"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.21236"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.58.2.259"},{"key":"e_1_2_8_14_1","first-page":"9","article-title":"Speech and voice deficits in parkinsonian plus syndromes: can they be treated?","volume":"6","author":"Countryman S","year":"1996","journal-title":"National Center for Voice and Speech: Status and Progress Report"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-019-09271-7"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(09)70288-1"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1044\/jshr.1202.246"},{"key":"e_1_2_8_18_1","volume-title":"Motor Speech Disorders: Substrates, Differential Diagnosis, and Management","author":"Duffy JR","year":"2005"},{"key":"e_1_2_8_19_1","first-page":"1","volume-title":"Clinical Management of Sensorimotor Speech Disorders","author":"Van der Merwe A","year":"2008"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2020.02.005"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.29005"},{"key":"e_1_2_8_22_1","unstructured":"BoersmaP WeeninkD.Praat: doing phonetics by computer [Computer program];2022. 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