Objective: To quantify the use and variation of the motor part of Unified Multiple System Rating Scale (UMSARS II) on prospectively planned studies.

Background: Despite its availability for nearly 20 years,[1] many studies including patients with multiple system atrophy (MSA) still use scales developed to assess ataxia (ATX) or parkinsonism (PARK), but the extent to which this occurs remains uncertain.

Method: Structured, PRISMA-compliant literature search on clinical studies including patients with MSA and motor assessment using clinical rating scales for MSA (UMSARS), for ATX (e.g., ICARS, SARA), or for PARK (MDS-UPDRS, UPDRS). We classified studies according to design in experimental/interventional or observational, and prospective or retrospective, and compared UMSARS use between each category; then, we compared the frequency of UMSARS use considering two research milestones: the publication of the Second consensus statement on diagnosis of MSA (2nd consensus)[2] and the establishment of Movement Disorders Society MSA Study Group (MoDiMSA).[3]

Results: We included 261 articles, most frequently of prospective (233, 89.3%) and observational (221, 87.4%) design. Scales used were UMSARS in 149 (57.1%), PARK in 67 (25.7%), ATX in 27 (10.3%), both PD and ATX in 16 (6.1%), and other scales in 2 (0.8%). We found UMSARS use to be higher in prospective (94.0% vs 83.0%, p<0.01), lower in retrospective (6.0% vs 17.0%, p<0.01), and similar in experimental (15.4% vs 15.2%, p>0.05) and observational (84.6% vs 84.8, p>0.05). Use of UMSARS was significantly higher in studies including only patients with MSA (71.1% vs 23.2%, p<0.001), whereas it was lower in studies including patients with disorders other than MSA, as parkinsonism (26.2% vs 58.0%, p<0.01) and ataxia (2.0% vs 17.0%, p<0.01). We found an increase in the rate of UMSARS use after the 2nd consensus (25.0% vs 60.5%, p<0.01) and the establishment of MoDiMSA (38.3% vs 62.2%, p<0.05), with decrease in the use of other scales, significant only for PD scales after 2nd consensus (57.1% vs 21.9%, p<0.01).

Conclusion: Although UMSARS use has greatly increased since its publication, misuse of PARK and ATX related scales in MSA patients persists in prospectively planned trials. This under-application of the scale could be overcome by joint efforts on promoting its use.

References: [1] Wenning GK, Tison F, Seppi K, et al. Development and validation of the Unified Multiple System Atrophy Rating Scale (UMSARS). Mov Disord 2004;19(12):1391-1402.
[2] Gilman S, Wenning GK, Low PA, et al. Second consensus statement on the diagnosis of multiple system atrophy. Neurology 2008;71(9):670-676.
[3] Fanciulli A, Stankovic I, Krismer F, Seppi K, Levin J, Wenning GK. Multiple system atrophy. Int Rev Neurobiol 2019;149:137-192.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/use-and-misuse-of-the-unified-multiple-system-atrophy-rating-scale/