Progression of Motor and Non-Motor Symptoms in Multiple System Atrophy: A Prospective Study from the Catalan-MSA Registry

Article type: Research Article

Authors: Pérez-Soriano, Alexandra^a | Giraldo, Darly M.^a | Ríos, Jose^k | Muñoz, Esteban^a | Compta, Yaroslau^a | Martí, María José^{a; *} | Catalán MSA Registry (CMSAR)

Collaborators: Pagonabarraga, Javier^b | Valldeoriola, Francesc^a | Hernández-Vara, Jorge^c | Classen, Serge Jauma^d | Puente, Victor^e | Pont, Claustre^f | Caballol, Núria^g | Tolosa, Eduardo^a | Bayes, Angels^h | Campdelacreu, Jaume^d | de Fábregues, Oriol^c | Ávila, Asunción^g | Calopa, Matilde^d | Gaig, Carles^l | Pastor, Pauⁱ | Pujol, Montserrat^j | Garrido, Alicia^a | Painous, Celia^a | Planellás, Lluís^a | Cámara, Ana^a

Affiliations: [a] Parkinson’s Disease and Movement Disorders Unit, Neurology Service, ICN, Hospital Clínic, IDIBAPS, CIBERNED CB06/05/0018, European Reference Network for Rare Neurological Diseases - Project ID No 739510, University of Barcelona, Barcelona, Catalonia, Spain | [b] Movement Disorders Unit, Hospital de Sant Pau, Barcelona, Catalonia, Spain | [c] Movement Disorders Unit, Hospital Vall d’Hebron, Barcelona, Catalonia, Spain | [d] Movement Disorders Unit, Hospital de Bellvitge, Barcelona, Catalonia, Spain | [e] Movement Disorders Unit, Hospital del Mar, Barcelona, Catalonia, Spain | [f] Movement Disorders Specialist, Hospital General de Granollers, Granollers, Catalonia, Spain | [g] Movement Disorders Unit, Hospital de Sant Joan Despi, Moisès Broggi-Consorci Sanitari integra, L’Hospitalet de Llobregat, Catalonia, Spain | [h] Movement Disorders Unit, Centre Mèdic Teknon, Barcelona, Catalonia, Spain | [i] Movement Disorders Unit, Department of Neurology, Hospital Universitari Mutua de Terrassa, Terrassa, Catalonia, Spain | [j] Movement Disorders Specialist, Hospital Santa María de Lleída, Lleída, Catalonia, Spain | [k] Medical Statistics Core Facility, IDIBAPS, and Hospital Clinic, Barcelona, Spain. Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona | [l] Multidisciplinary Sleep Disorders Unit, Hospital Clínic, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain

Correspondence: [*] Correspondence to: María José Martí, Carrer de Villarroel, 170, 08036 Barcelona, Spain. Tel.: +34 932275785; Fax: +34 932275783; E-mail: mjmarti@clinic.cat.

Abstract: Background/Objective:Multiple system atrophy (MSA) is a highly debilitating, rare neurodegenerative disorder with two clinical motor variants (parkinsonian or MSA-P and cerebellar or MSA-C). There is a wide span of motor and non-motor symptoms (NMS) that progress over time. We studied the cohort from the Catalan Multiple System Atrophy Registry (CMSAR) to determine which symptoms are most likely to progress throughout a 2-year follow-up. Methods:We analyzed baseline, 12-month, and 24-month follow-up evaluations from the 80 cases recruited by the CMSAR. Evaluations included the UMSARS assessment, cognitive and neuropsychiatric evaluations, and a non-motor scale (NMSS-PD). Statistical analysis was done using a Generalized Estimated Equations (GEE) model. Results:Both UMSARS I and II sub-scores significantly increased at 12- and 24-month follow-ups (p < 0.001), with a median total score increase of 11 and 12.5 points, respectively. Items on UMSARS I that significantly worsened were mostly motor affecting daily activities. NMS, including urinary and sexual dysfunction, as well as sleep difficulties showed a significant progression on the NMSS-PD; however, other NMS such as postural hypotension, gastrointestinal, and mood dysfunction, although prevalent, did not show a clear progression on clinical scales. Conclusion:Within 24 months and as early as 12 months, MSA cases may experience significant motor worsening, affecting basic daily activities. NMS are prevalent; however, not all clinical scales register a clear progression of symptoms, perhaps suggesting that they are not sensitive enough for non-motor evaluation.

Keywords: MSA, prospective changes, motor symptoms, non-motor symptoms

DOI: 10.3233/JPD-202332

Journal: Journal of Parkinson's Disease, vol. 11, no. 2, pp. 685-694, 2021