title: Red flags for multiple system atrophy.
abstract: The clinical diagnosis of multiple system atrophy (MSA) is fraught with difficulty and there are no pathognomonic features to discriminate the parkinsonian variant (MSA-P) from Parkinson's disease (PD). Besides the poor response to levodopa, and the additional presence of pyramidal or cerebellar signs (ataxia) or autonomic failure as major diagnostic criteria, certain other clinical features known as "red flags" or warning signs may raise the clinical suspicion of MSA. To study the diagnostic role of these features in MSA-P versus PD patients, a standardized red flag check list (RFCL) developed by the European MSA Study Group (EMSA-SG) was administered to 57 patients with probable MSA-P and 116 patients with probable PD diagnosed according to established criteria. Those red flags with a specifity over 95% were selected for further analysis. Factor analysis was applied to reduce the number of red flags. The resulting set was then applied to 17 patients with possible MSA-P who on follow-up fulfilled criteria of probable MSA-P. Red flags were grouped into related categories. With two or more of six red flag categories present specificity was 98.3% and sensitivity was 84.2% in our cohort. When applying these criteria to patients with possible MSA-P, 76.5% of them would have been correctly diagnosed as probable MSA-P 15.9 (+/-7.0) months earlier than with the Consensus criteria alone. We propose a combination of two out of six red flag categories as additional diagnostic criteria for probable MSA-P.
authors.affiliation: Section for Clinical Neurobiology, Department of Neurology, Innsbruck Medical University, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Köllensperger
authors.forename: Felix
authors.initials: F
authors.lastname: Geser
authors.forename: Klaus
authors.initials: K
authors.lastname: Seppi
authors.forename: Michaela
authors.initials: M
authors.lastname: Stampfer-Kountchev
authors.forename: Martin
authors.initials: M
authors.lastname: Sawires
authors.forename: Christoph
authors.initials: C
authors.lastname: Scherfler
authors.forename: Sylvia
authors.initials: S
authors.lastname: Boesch
authors.forename: Joerg
authors.initials: J
authors.lastname: Mueller
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Koukouni
authors.forename: Niall
authors.initials: N
authors.lastname: Quinn
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Pellecchia
authors.forename: Paolo
authors.initials: P
authors.lastname: Barone
authors.forename: Nicole
authors.initials: N
authors.lastname: Schimke
authors.forename: Richard
authors.initials: R
authors.lastname: Dodel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Oertel
authors.forename: Erik
authors.initials: E
authors.lastname: Dupont
authors.forename: Karen
authors.initials: K
authors.lastname: Østergaard
authors.forename: Christine
authors.initials: C
authors.lastname: Daniels
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
authors.forename: Tanya
authors.initials: T
authors.lastname: Gurevich
authors.forename: Nir
authors.initials: N
authors.lastname: Giladi
authors.forename: Miguel
authors.initials: M
authors.lastname: Coelho
authors.forename: Cristina
authors.initials: C
authors.lastname: Sampaio
authors.forename: Christer
authors.initials: C
authors.lastname: Nilsson
authors.forename: Håkan
authors.initials: H
authors.lastname: Widner
authors.forename: Francesca Del
authors.initials: FD
authors.lastname: Sorbo
authors.forename: Alberto
authors.initials: A
authors.lastname: Albanese
authors.forename: Adriana
authors.initials: A
authors.lastname: Cardozo
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tolosa
authors.forename: Michael
authors.initials: M
authors.lastname: Abele
authors.forename: Thomas
authors.initials: T
authors.lastname: Klockgether
authors.forename: Christoph
authors.initials: C
authors.lastname: Kamm
authors.forename: Thomas
authors.initials: T
authors.lastname: Gasser
authors.forename: Ruth
authors.initials: R
authors.lastname: Djaldetti
authors.forename: Carlo
authors.initials: C
authors.lastname: Colosimo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Meco
authors.forename: Anette
authors.initials: A
authors.lastname: Schrag
authors.forename: Werner
authors.initials: W
authors.lastname: Poewe
authors.forename: Gregor K
authors.initials: GK
authors.lastname: Wenning
mesh_terms: D000368:Aged; D002524:Cerebellar Ataxia / Q000175:diagnosis; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000145:classification / Q000175:diagnosis*; D009460:Neurologic Examination / Q000706:statistics & numerical data*; D010300:Parkinson Disease / Q000145:classification / Q000175:diagnosis*; D020734:Parkinsonian Disorders / Q000145:classification / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D012791:Shy-Drager Syndrome / Q000175:diagnosis