RESEARCH: Parkinson's Rating Scales applied to Multiple System Atrophy

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Mov Disord 2002 Jul;17(4):701-709

Parkinsonism in multiple system atrophy: Natural history, severity

(UPDRS-III), and disability assessment compared with Parkinson's disease.

Tison F, Yekhlef F, Chrysostome V, Balestre E, Quinn NP, Poewe W, Wenning

GK.

Federation de Neurologie, Epidemiologie et Biostatistiques Centre

Hospitalo-Universitaire de Bordeaux, Bordeaux, France.

We analyzed parkinsonian features in multiple system atrophy (MSA) compared

with age- and disease duration-matched Parkinson's disease (PD) patients,

and assessed the applicability of the Unified Parkinson's Disease Rating

Scale (UPDRS) -III motor scale as a means of rating their severity.

Cross-sectional analysis of parkinsonism was done using UPDRS-III,

International Cerebellar Atatia Rating Scale, and disability scales (Hoehn

and Yahr [H&A], Schwab and England, Katz and Lawton) in 50 unselected MSA

patients and in 50 matched PD patients. At symptom onset, falls occurred 10

times more frequently in MSA, whereas limb tremor was 10 times more common

in PD. At first visit (10.2 months), hemiparkinsonism and pill-rolling rest

tremor were less common in MSA. Hypomimia, atypical rest, postural or action

tremor, as well as postural instability were more frequent in MSA. At study

examination (62.4 months), parkinsonian signs in MSA patients were more

frequently symmetrical and associated with axial rigidity, antecollis and

postural instability. A levodopa response of >50% was seen in <10% of MSA

patients. Modified H&Y stages (3.2 +/- 1.3 vs. 2.2 +/- 0.78) and UPDRS-III

scores (48.14 +/- 19.5 vs. 31.74 +/- 12.9) were significantly (P = 0.0001)

higher in MSA. The internal consistency of the UPDRS-III was fair in MSA

patients (Cronbach's alpha >0.90), and correlated well with marked

dependency on the Schwab and England and Katz and Lawton scales. Factor

structure analysis of UPDRS-III in MSA showed five clinically distinct

subscores accounting for 74% of the variance, differing from PD by the

dependency of the face-speech and limb bradykinesia items and independence

of the postural-action tremor from the rest tremor items. There was a

significant correlation (R(2) = 0.70, P = 0.001) between ICARS ataxia and

UPDRS-III scores in MSA patients. Results confirm a distinct profile of

parkinsonism in MSA and greater severity and disability compared with PD. It

also indicates that the UPDRS-III provides a useful severity measure of

parkinsonism in MSA, albeit contaminated by additional cerebellar

dysfunction. Copyright 2002 Movement Disorder Society

PMID: 12210859 [PubMed - as supplied by publisher]