Treatment

Fanciulli, Alessandra; Wenning, Gregor K.

doi:10.1007/978-3-7091-0687-7_10

Cited by 4 publications

(3 citation statements)

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“…These survival periods are longer than those reported in 2 recent studies [1, 2, 11], and slightly longer than those cited in a number of other reports [3-5, 10, 23]. Our findings of a higher survival were unexpected: they might have been due to different criteria for the time of initial symptom onset or they might reflect the longer life expectancy in the general population of Israel [24] and the referral of most MSA patients to be treated and followed in a multidisciplinary specialized MSA clinic [25]. Our finding of a similar survival for MSA-P and MSA-C patients is in line with most of the other reports [1, 3-5, 10], with one exception [26].…”

Section: Discussionmentioning

confidence: 49%

Interrelationships between Survival, Sex, and Blood Pressure in Patients with Multiple System Atrophy

et al. 2021

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Objective: The aim of this study is to estimate survival among patients with multiple system atrophy-parkinsonian type (MSA-P) or cerebellar type MSA (MSA-C) in relation to blood pressure (BP) measurements, by sex. Methods: A cohort of 99 MSA patients was studied retrospectively. Their BP measurements were obtained during prolonged (40 min, vertical position) drug-free tilt testing. We used K-M survival curves and Cox regression to calculate adjusted (to age of onset) hazard ratios (HRs) of BP measurements on time to death by MSA subtype and sex. Results: Fifty-two MSA patients were males and 47 were females. Sixty-three of them had MSA-P and 36 had MSA-C. The mean age at motor symptom onset was 61.1 ± 10.4 years, and mean disease duration at the time of BP assessment was 8.0 ± 4.7 years. The 2 study groups (MSA-P and MSA-C) did not differ significantly in age at MSA onset, sex ratio, or disease duration. Survival time did not differ between the groups {medians: 12 years (95% confidence interval [CI]: 8–28) and 10 years (95% CI: 8–13), respectively}. The MSA-P group showed a trend towards better survival for males (log-rank p = 0.0925). The maximal diastolic orthostatic BP decline during tilt testing had a borderline positive association with death risk among MSA-C males (adjusted HR = 1.18, p = 0.0665), and systolic BP after 10 min in a supine position had a significant positive association with death risk among MSA-P males (adjusted HR = 1.06, p = 0.0354). Conclusions: The findings of a sex-based difference in the effect of BP on death risk may be important for adjusting the therapeutic approach to MSA patients.

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Section: Discussionmentioning

confidence: 49%

Interrelationships between Survival, Sex, and Blood Pressure in Patients with Multiple System Atrophy

et al. 2021

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“…Multiple system atrophy is a rare neurological disorder, which is characterized by cerebellar, extrapyramidal and autonomic features in any combination. 1 Besides motor and cardiovascular autonomic symptoms, lower urinary tract (LUT) dysfunction is a cardinal feature. It often arises early in the course of the disease and is a predictor of reduced survival in MSA.…”

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confidence: 99%

Urodynamic Evaluation in Multiple System Atrophy: A Retrospective Cohort Study

Eschlböck

Kiss

Krismer

et al. 2021

Movement Disord Clin Pract

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BackgroundBackground: Urological dysfunction in patients with multiple system atrophy (MSA) is one of the main manifestations of autonomic failure. Urodynamic examination is clinically relevant since underlying pathophysiology of lower urinary tract (LUT) dysfunction can be variable. Objective Objective: Evaluation of the pathophysiology of urological symptoms and exploration of differences in urodynamic patterns of LUT dysfunction between MSA-P and MSA-C. Methods Methods: Retrospective study of patients with possible and probable MSA who were referred for urodynamic studies between 2004 and 2019. Demographic data, medical history, physical examination and urodynamic studies assessing storage and voiding dysfunction were obtained. ResultsResults: Seventy-four patients were included in this study (MSA-P 64.9% n = 48; median age 62.5 (IQR 56.8-70) years). Detrusor overactivity during filling phase was noted in 58.1% (n = 43) of the patients. In the voiding phase, detrusor sphincter dyssynergia and detrusor underactivity were observed in 24.6% (n = 17) and in 62.1% (n = 41) of the patients, respectively. A postmicturition residual volume of over 100 ml was present in 71.4% (n = 50) of the patients. Comparison of MSA subtypes showed weaker detrusor contractility in MSA-P compared to MSA-C [pdetQmax 26.2 vs. 34.4 cmH20, P = 0.04]. In 56.2% (n = 41) of patients pathophysiology of LUT dysfunction was deemed to be neurogenic and consistent with the diagnosis of MSA. In 35.6% (n = 26) urodynamic pattern suggested other urological co-morbidities. Conclusion Conclusion:Urodynamic evaluation is an important tool to analyze the pattern of LUT dysfunction in MSA. Impaired detrusor contractility was seen more in MSA-P which needs to be investigated in further studies.

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“…Distinguishing between the two α-synucleinopathies, Parkinson's disease (PD), and multiple system atrophy (MSA), is difficult, especially early in the disease, as PD and MSA share many clinical features (Fanciulli and Wenning, 2015). Early diagnosis would have a tremendous impact on treatment options.…”

Section: Introductionmentioning

confidence: 99%