Objective: Compare two different cohorts of patients with the same pathology differentiated by age of onset.

Background: Multiple system atrophy (MSA) is a rare neurodegenerative disease and coordinated efforts are required to improve understanding, diagnosis, and treatment. Recently, Walsh RR et al. published some recommendations for Global MSA research including the creation of a unified dataset for MSA and implementation of a global international registry. In an attempt to reduce the knowledge gap in our region in 2014 we reported the preliminary data from PANMSA cohort. Two years later we implemented, a system with web domain database with a restricted access for site investigators to collect de-identified information to protect patient confidentiality that meets the required the Global MSA Registry (MDS MSA study Group) standards.

Method: Demographic and clinical data from MSA patients were collected until June 2018 and included in the new encrypted database.Inclusion criteria: >21 years old, fulfilling clinical diagnosis of MSA on the basis of the current consensus criteria for the disease. Exclusion criteria: Patients with any other causes of Parkinsonism.

Results: Hundred ten patients met criteria, We compare two cohorts: early onset MSA (40-49y/o) and late onset MSA (70- + y/o). Seven patients met criteria for e-MSA (6 Probable/Possible C; 1 Probable P). disautonomic failure were observed in all of them with Urinary Incontinence and orthostatism as most frecuent feature. Severe disability in HyY scale in 85%. The mean UMSARSII was 37.5. Unresponsive to levodopa was observed in 57%. Falls were reported in all of e-MSA. Four patient l-MSA (2 Probable/Possible C; 2 Probable/Possible), all of them with postural tremor. Autonomic disfunction was reported in 25%, only one with urinary failure, blue hands was present in 50%. Severe disability in HyY scale 25%. The mean UMSARSII was 15. Unresponsive to levodopa was observed in 75%.

Conclusion: The early cohort of MSA in the panamerican group looks to have more agressive clinical evolution. Urinary dysfunction, postural instability as well as falls were very disabling in the early cohort, with more impact on the Qol and clinical complications.

References: 1.- Wenning GK, & Stefanova N (2009) Recent developments in multiple system atrophy. J Neurol, 256, 1791-1808. 2.- Wenning GK, Geser F, Krismer F, Seppi K, Duerr S, Boesch S, K¨ollensperger M, Goebel G, Pfeiffer KP, Barone P, Pellecchia MT, Quinn NP, Koukouni V, Fowler CJ, Schrag A, Mathias CJ, Giladi N, Gurevich T, Dupont E, Ostergaard K, Nilsson CF,Widner H, Oertel W, Eggert KM, Albanese A, del Sorbo F, Tolosa E, Cardozo A,Deuschl G, Hellriegel H, Klockgether T, Dodel R, Sampaio C, Coelho M, Djaldetti R, Melamed E, Gasser T,KammC, Meco G, Colosimo C, Rascol O, Meissner WG,Tison F, PoeweW&European Multiple System Atrophy Study Group (2013) The natural history of multiple system atrophy: A prospective European cohort. Lancet Neurol, 12, 264-274. 3.- Kuzdas-Wood D, Stefanova N, Jellinger KA, Seppi K, Schlossmacher MG, PoeweW, & Wenning GK (2014) Towards translational therapies for ultiple system atrophy. Prog Neurobiol, 118C, 19-35. 4.- Yabe I, Soma H, Takei A, Fujiki N, Yanagihara T, & Sasaki H (2006) MSA-C is the predominant clinical phenotype of MSA in Japan: Analysis of 142 patients with probable MSA. J Neurol Sci, 249 115-121 5.- Gilman S, May SJ, Shults CW, Tanner CM, Kukull W, Lee VM, Masliah E, Low P, Sandroni P, Trojanowski JQ, Ozelius L, Foroud T & North American Multiple System Atrophy Study Group (2005) The north American multiple system atrophy study group. J Neural Transm, 112, 1687-1694

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MDS Abstracts - https://www.mdsabstracts.org/abstract/to-compare-early-late-onset-msa-from-the-pan-american-msa-panmsa-database/