Objective: This study aimed to review the characteristics of large cohort of MSA patients diagnosis in our center, confirming previous clinical and imaging data from the literature.

Background: MSA is a rare neurodegenerative disease, classified into two subtypes, MSA-P and MSA-C. Beyond the core symptoms, many non-motor features can be part of the clinical picture. The diagnosis in the early stages can be challenging.

Method: We examined a cohort of 71 patients with probable MSA, according to the Gilman criteria [1], assessed at the Movement Disorders clinic of Ospedale Maggiore Policlinico between 2012 and 2022.

Results: All patients are European. 37 patients had MSA-P and 34 MSA-C. The two sexes were equally distributed. Age at onset was slightly lower in MSA-C (58 years) than in MSA-P (62 years). In MSA-P the symptoms at onset were equally distributed among motor (54%) and non-motor (46%), whereas in MSA-C there was a prevalence in the motor onset (80%). All patients experienced autonomic dysfunction, with 90% of MSA-P and 80% of MSA-C presenting orthostatic hypotension, and all patients having genitourinary disturbances; constipation was more common in MSA-C (96%) than in MSA-P (73%). A small subset of patients reported hyposmia.

The most common MRI findings were : atrophy of putamen (P 28%, C 9%), middle cerebellar peduncle (P 4%, C 21%), pons (P 4%, C 24%), cerebellum (P 16%, C 65%), and hot cross bun sign (P 8%, C 35%).

Conclusion: MSA is a rare and insidious disease. Careful characterization of clinical and radiological features may help improve the diagnostic accuracy, particularly in the early stages.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-and-radiological-characteristics-of-a-cohort-of-seventy-one-multiple-system-atrophy-patients/