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Parkinsonism in multiple system atrophy: natural history, severity (UPDRS-III), and disability assessment compared with Parkinson's disease.
Mov Disord. 2002 Jul; 17(4):701-9.MD

Abstract

We analyzed parkinsonian features in multiple system atrophy (MSA) compared with age- and disease duration-matched Parkinson's disease (PD) patients, and assessed the applicability of the Unified Parkinson's Disease Rating Scale (UPDRS) -III motor scale as a means of rating their severity. Cross-sectional analysis of parkinsonism was done using UPDRS-III, International Cerebellar Atatia Rating Scale, and disability scales (Hoehn and Yahr [H&A], Schwab and England, Katz and Lawton) in 50 unselected MSA patients and in 50 matched PD patients. At symptom onset, falls occurred 10 times more frequently in MSA, whereas limb tremor was 10 times more common in PD. At first visit (10.2 months), hemiparkinsonism and pill-rolling rest tremor were less common in MSA. Hypomimia, atypical rest, postural or action tremor, as well as postural instability were more frequent in MSA. At study examination (62.4 months), parkinsonian signs in MSA patients were more frequently symmetrical and associated with axial rigidity, antecollis and postural instability. A levodopa response of >50% was seen in <10% of MSA patients. Modified H&Y stages (3.2 +/- 1.3 vs. 2.2 +/- 0.78) and UPDRS-III scores (48.14 +/- 19.5 vs. 31.74 +/- 12.9) were significantly (P = 0.0001) higher in MSA. The internal consistency of the UPDRS-III was fair in MSA patients (Cronbach's alpha >0.90), and correlated well with marked dependency on the Schwab and England and Katz and Lawton scales. Factor structure analysis of UPDRS-III in MSA showed five clinically distinct subscores accounting for 74% of the variance, differing from PD by the dependency of the face-speech and limb bradykinesia items and independence of the postural-action tremor from the rest tremor items. There was a significant correlation (R(2) = 0.70, P = 0.001) between ICARS ataxia and UPDRS-III scores in MSA patients. Results confirm a distinct profile of parkinsonism in MSA and greater severity and disability compared with PD. It also indicates that the UPDRS-III provides a useful severity measure of parkinsonism in MSA, albeit contaminated by additional cerebellar dysfunction.

Authors+Show Affiliations

Fédération de Neurologie, Epidémiologie et Biostatistiques Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France. francois.tison@chu-bordeaux.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12210859

Citation

Tison, François, et al. "Parkinsonism in Multiple System Atrophy: Natural History, Severity (UPDRS-III), and Disability Assessment Compared With Parkinson's Disease." Movement Disorders : Official Journal of the Movement Disorder Society, vol. 17, no. 4, 2002, pp. 701-9.
Tison F, Yekhlef F, Chrysostome V, et al. Parkinsonism in multiple system atrophy: natural history, severity (UPDRS-III), and disability assessment compared with Parkinson's disease. Mov Disord. 2002;17(4):701-9.
Tison, F., Yekhlef, F., Chrysostome, V., Balestre, E., Quinn, N. P., Poewe, W., & Wenning, G. K. (2002). Parkinsonism in multiple system atrophy: natural history, severity (UPDRS-III), and disability assessment compared with Parkinson's disease. Movement Disorders : Official Journal of the Movement Disorder Society, 17(4), 701-9.
Tison F, et al. Parkinsonism in Multiple System Atrophy: Natural History, Severity (UPDRS-III), and Disability Assessment Compared With Parkinson's Disease. Mov Disord. 2002;17(4):701-9. PubMed PMID: 12210859.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Parkinsonism in multiple system atrophy: natural history, severity (UPDRS-III), and disability assessment compared with Parkinson's disease. AU - Tison,François, AU - Yekhlef,Farid, AU - Chrysostome,Virginie, AU - Balestre,Eric, AU - Quinn,Niall P, AU - Poewe,Werner, AU - Wenning,Gregor K, PY - 2002/9/5/pubmed PY - 2002/11/26/medline PY - 2002/9/5/entrez SP - 701 EP - 9 JF - Movement disorders : official journal of the Movement Disorder Society JO - Mov Disord VL - 17 IS - 4 N2 - We analyzed parkinsonian features in multiple system atrophy (MSA) compared with age- and disease duration-matched Parkinson's disease (PD) patients, and assessed the applicability of the Unified Parkinson's Disease Rating Scale (UPDRS) -III motor scale as a means of rating their severity. Cross-sectional analysis of parkinsonism was done using UPDRS-III, International Cerebellar Atatia Rating Scale, and disability scales (Hoehn and Yahr [H&A], Schwab and England, Katz and Lawton) in 50 unselected MSA patients and in 50 matched PD patients. At symptom onset, falls occurred 10 times more frequently in MSA, whereas limb tremor was 10 times more common in PD. At first visit (10.2 months), hemiparkinsonism and pill-rolling rest tremor were less common in MSA. Hypomimia, atypical rest, postural or action tremor, as well as postural instability were more frequent in MSA. At study examination (62.4 months), parkinsonian signs in MSA patients were more frequently symmetrical and associated with axial rigidity, antecollis and postural instability. A levodopa response of >50% was seen in <10% of MSA patients. Modified H&Y stages (3.2 +/- 1.3 vs. 2.2 +/- 0.78) and UPDRS-III scores (48.14 +/- 19.5 vs. 31.74 +/- 12.9) were significantly (P = 0.0001) higher in MSA. The internal consistency of the UPDRS-III was fair in MSA patients (Cronbach's alpha >0.90), and correlated well with marked dependency on the Schwab and England and Katz and Lawton scales. Factor structure analysis of UPDRS-III in MSA showed five clinically distinct subscores accounting for 74% of the variance, differing from PD by the dependency of the face-speech and limb bradykinesia items and independence of the postural-action tremor from the rest tremor items. There was a significant correlation (R(2) = 0.70, P = 0.001) between ICARS ataxia and UPDRS-III scores in MSA patients. Results confirm a distinct profile of parkinsonism in MSA and greater severity and disability compared with PD. It also indicates that the UPDRS-III provides a useful severity measure of parkinsonism in MSA, albeit contaminated by additional cerebellar dysfunction. SN - 0885-3185 UR - https://www.unboundmedicine.com/medline/citation/12210859/Parkinsonism_in_multiple_system_atrophy:_natural_history_severity__UPDRS_III__and_disability_assessment_compared_with_Parkinson's_disease_ L2 - https://doi.org/10.1002/mds.10171 DB - PRIME DP - Unbound Medicine ER -