Objective: We investigated the interest of a quick and non-invasive assessment of sweating as a marker of autonomic failure (AF) in Multiple System Atrohpy (MSA).

Background: MSA is a rare neurodegenerative disabling disease combining poorly levodopa-responsive parkinsonism, cerebellar ataxia, and AF. Severe cardiovascular AF is associated with poor prognosis. Sweating dysfunction has been less well studied.

Method: 129 patients of the French Reference center for MSA with an annual follow-up including the Unified MSA Rating Scale (UMSARS) and measurements of electrochemical skin conductance (ESC) of feet and hands participated to this study. Sixty-seven patients had annual follow-up data (mean±SD follow-up was 29.2±18.0 months). Statistical analysis included: (i)correlations between ESC and MSA type, age, disease duration, BP (supine and standing), autonomic symptoms (COMPASS), (ii) comparisons between groups with normal or abnormal ESC, and (iii) multivariate analysis by logistic regression. Relationship between MSA severity progression during follow-up with ESC and other variables were modeled by Generalized Estimating Equation (GEE).

Results: Feet or hand ESC were abnormal at the first visit in 72 (57%) and 103 (81%) patients. Abnormal ESC were related to greater systolic BP fall upon standing and UMSARS II scores. Significant and independent predictors of worsening were female gender, a probable diagnosis, longer disease duration and lower feet and hand ESC [table1]. Abnormal ESC baseline values were significant predictors of future worsening independently from other factors [figure1].

Conclusion: Feet and skin ESC were significantly related to MSA severity and orthostatic hypotension. Furthermore, baseline ESC results could predict more severe disease progression.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/electrochemical-skin-conductance-as-a-marker-of-autonomic-failure-in-patients-with-multiple-system-atrophy/