Consensus statement on the diagnosis of multiple system atrophy

[Guest guest]

-- FOR THOSE STILL UNSURE OF A DIAGNOSIS MAKE SURE YOUR DOCTORS HAVE READ

THIS ARTICLE. THIS IS JUST A BRIEF SUMMARY AND THEY CAN FIND THE FULL

ARTICLE IN THE Journal of the Autonomic Nervous System.

http://www.wemove.org/ema/em_1999_012.html

Consensus statement on the diagnosis of multiple system atrophy

S Gilman, PA Low, N Quinn, A Albanese, Y Ben-Shlomo, CJ Fowler, H Kaufmann,

T Klockgether, AE Lang, PL Lantos, I Litvan, CJ Mathias, E Oliver, I Schatz,

GK Wenning

J Autonomic Nervous System 74 (1998) 189-192

MSA diagnostic criteria and terminology changes are offered by this

consensus conference, convened under the co-sponsorship of the American

Autonomic Society and the American Academy of Neurology.

The authors group MSA symptoms into four clinical domains–autonomic and

urinary dysfunction, parkinsonism, cerebellar dysfunction, and corticospinal

tract dysfunction–and describe the range of features consistent with MSA

within each domain. Criteria are then offered for establishing the

involvement of each domain as part of the MSA diagnosis.

Specifically:

Autonomic and urinary dysfunction: orthostatic fall in BP by > 30 mm Hg

systolic or 15 mmHg diastolic; OR urinary incontinence (persistent

involuntary partial or total bladder emptying, accompanied by erectile

dysfunction in men); OR both

Parkinsonism: bradykinesia, plus at least one of rigidity, postural

instability, or tremor

Cerebellar dysfunction: gait ataxia, plus at least one of ataxic dysarthria,

limb ataxia, or sustained gaze-evoked nystagmus

Corticospinal tract dysfunction: no features are used to define the

diagnosis.

They define two diagnostic categories– " possible " and " probable " MSA–based on

the number of features present plus poor response to levodopa.

" Definite " MSA is defined histopathologically. (-- WITH AUTOPSY)

Exclusion criteria(-- NOT LIKELY TO HAVE MSA IF ANY OF THESE ARE TRUE) are

also offered, including onset < 30 years of age, family history,

non-medication related hallucinations, and dementia.

The authors suggest replacing the term " striatonigral degeneration " with

" MSA-P " (for predominance of parkinsonian symptoms) and " sporadic

olivopontocerebellar atrophy " with " MSA-C " (for predominance of cerebellar

symptoms).

They write " The term Shy Drager syndrome has been widely misused, and is no

longer useful. "

--- SO ACCORDING TO THE CONSENSUS COMMITTEE THERE IS ONLY MSA-P & MSA-C

(POSSIBLE & PROBABLE)