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Can autonomic testing and imaging contribute to the early diagnosis of MSA? A systematic review and recommendations by the MDS multiple system atrophy (MoDiMSA) study group

Lookup NU author(s): Professor David BrooksORCiD

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This is the authors' accepted manuscript of an article that has been published in its final definitive form by John Wiley & Sons, Inc., 2020.

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Abstract

Diagnosis of MSA is made entirely on clinical grounds, while neuroimaging findings aid in more uncertain diagnoses of MSA according to the widely accepted diagnostic criteria. Overlapping phenotypes of MSA-parkinosonian type (MSA-P) with Parkinson's disease, progressive supranuclear palsy and dementia with Lewy bodie and MSA-cerebellar type (MSA-C) with sporadic adult onset ataxia lead to a notable delay in clinical diagnosis and to a significant proportion of misdiagnosed MSA cases during life. In light of an ongoing effort to revise the current consensus criteria for MSA, the Movement Disorders Society MSA (MoDiMSA) study group identified a need to review the utility of imaging and autonomic function tests and define specific findings that can assist in early diagnosis of MSA with autonomic, parkinsonian or cerebellar presentation at onset. The systematic review of original reports published before August 2019 was conducted. Inclusion required at least 10 MSA subjects per study (defined by post-mortem verification, clinically probable, or clinically probable plus possible MSA according to the diagnostic criteria) and at least one alternate reference group of patients (e.g. Parkinson's disease, progressive supranuclear palsy, dementia with Lewy bodies, sporadic adult onset ataxia). Based on a critical analysis of relevant studies we suggest that imaging and autonomic function tests significantly improve the accuracy of MSA diagnosis. The pitfalls and benefits of each test and specific recommendations of how to assess a new suspected MSA case are discussed.

Publication metadata

Author(s): Pellecchia MT, Stankovic I, Fanciulli A, Krismer F, Meissner W, Palma JA, Panicker J, Seppi K, Wenning GK

Publication type: Article

Publication status: Published

Journal: Movement Disorders Clinical Practice

Year: 2020

Volume: 7

Issue: 7

Pages: 750-762

Print publication date: 01/10/2020

Online publication date: 17/08/2020

Acceptance date: 12/08/2020

Date deposited: 12/08/2020

ISSN (print): 0885-3185

ISSN (electronic): 2330-1619

Publisher: John Wiley & Sons, Inc.

URL: https://doi.org/10.1002/mdc3.13052

DOI: 10.1002/mdc3.13052

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