Pain in multiple system atrophy

Tison, François; Wenning, Gregor K.; Volontè, Maria Antonietta; Poewe, Werner; Henry, Patrick; Quinn, Niall

doi:10.1007/bf02444007

Cited by 55 publications

(41 citation statements)

References 21 publications

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“…Pain was reported mainly by MSA patients, followed by PD and VP patients. Recently, pain, including musculoskeletal and visceral pain, has been described as fairly common in MSA and PD, even at disease onset [4,10,29,32], and in VP, where it reflects the location of the cerebrovascular lesion. Interestingly, pain and other sensory disturbances are not included in the current diagnostic criteria of MSA, which conversely include, among NMS, urinary symptoms and orthostatic hypotension, which were actually present in 91 and 53% of our MSA patients, respectively [13].…”

Section: Discussionmentioning

confidence: 98%

Non-motor symptoms in atypical and secondary parkinsonism: the PRIAMO study

et al. 2009

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The PRIAMO study is a cross-sectional longitudinal observational study aimed at describing epidemiology and evolution of non-motor symptoms (NMS) in patients with different forms of parkinsonism recruited in 55 Italian centres and evaluated over 24 months. In this paper, we are reporting prevalence and clinical characteristics of NMS in patients with atypical and secondary parkinsonism. Out of 1307 consecutive patients with a diagnosis of parkinsonism, 83 patients had vascular parkinsonism (VP), 34 had multiple system atrophy (MSA), 30 had progressive supranuclear palsy (PSP), 14 had dementia with Lewy bodies (DLB) and 11 had corticobasal degeneration (CBD). MSA and DLB had the highest number of NMS domains and symptoms, respectively. Gastrointestinal symptoms, pain, urinary problems and postural instability due to orthostatic hypotension were most frequent in MSA. Sleep disturbances were also common with a prevalence of approximately 70% in all diagnostic groups but CBD (36%). Psychiatric symptoms and attention and memory impairment were frequently observed in all diagnoses but were most prevalent among DLB patients, whereas the prevalence of skin and respiratory disorders was rather low in all forms, ranging between 10 and 30%. Atypical parkinsonism patients also reported a low QoL, with no significant differences among the different forms, whereas PD and VP patients had a better QoL.

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Section: Discussionmentioning

confidence: 98%

Non-motor symptoms in atypical and secondary parkinsonism: the PRIAMO study

et al. 2009

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“…Dystonias were present in 12% of patients and appeared to be unrelated to levodopa therapy in all but one case. However, our own clinical observations suggest that levodopa induces painful dystonias in a substantial minority of prospectively followed MSA cases (126). Severe and disproportionate antecollis was the most common type of dystonia and has been suggested as a diagnostic (though not specific) indicator of MSA (127).…”

Section: G K Wennlng Et Almentioning

confidence: 97%

Multiple system atrophy: A review of 203 pathologically proven cases

Tison²,

et al. 1997

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We report the clinicopathological features of 203 cases of pathologically proven multiple system atrophy (MSA) from 108 publications up to February 1995. The majority of patients showed symptoms in their early fifties, and men were more commonly affected than women (ratio of 1.3:1). Most patients suffered from some degree of autonomic failure (74%). Parkinsonism was the most common motor disorder (87%), followed by cerebellar ataxia (54%) and pyramidal signs (49%). The response to levodopa was poor in most patients, but there was a subgroup with a good response, who also often developed axial levodopa-induced dyskinesias. Other characteristic features included severe dysarthria, stridor, and, in a few patients, contractures and dystonia (antecollis). Mild or moderate intellectual impairment occurred in some cases, but severe dementing illness was most unusual. The main pathological change comprised cell loss and gliosis in the putamen, caudate nucleus, external pallidum, substantia nigra, locus ceruleus, inferior olives, pontine nuclei, cerebellar Purkinje cells, and intermediolateral cell columns of the spinal cord. However, other neuronal populations were also involved to varying degrees, such as the thalamus, vestibular nucleus, dorsal vagal nucleus, corticospinal tracts, and anterior horn cells. Characteristic glial and/or neuronal cytoplasmic inclusions were identified in all cases in which they were sought, irrespective of clinical presentation. Akinesia correlated with the degree of nigral and putaminal cell loss, whereas rigidity was related only to the later. Tremor was unrelated to cell loss at any site. Ataxia correlated with the degree of olivopontocerebellar atrophy. Pyramidal signs were associated with pyramidal tract pallor. Our analysis also confirmed an association of postural hypotension with intermediolateral cell column degeneration.

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“…Pain is also a major symptom in patients with olivopontocerebellar ataxia [12]. In these patients, pain is present at the time of onset or prior to the other clinical features and is postulated to be associated with primary neurodegenerative progression [12]. Furthermore, patients with pre-existing neuronal compromise are more susceptible to injury when exposed to a secondary insult at another site [13].…”

Section: Discussionmentioning

confidence: 98%

“…Pain precedes ataxia or begins concomitantly with it in one third of patients and is thought to be related to the primary neurodegenerative process [11]. Pain is also a major symptom in patients with olivopontocerebellar ataxia [12]. In these patients, pain is present at the time of onset or prior to the other clinical features and is postulated to be associated with primary neurodegenerative progression [12].…”

Section: Discussionmentioning

confidence: 99%