title: Second consensus statement on the diagnosis of multiple system atrophy.
abstract: BACKGROUND
  A consensus conference on multiple system atrophy (MSA) in 1998 established criteria for diagnosis that have been accepted widely. Since then, clinical, laboratory, neuropathologic, and imaging studies have advanced the field, requiring a fresh evaluation of diagnostic criteria. We held a second consensus conference in 2007 and present the results here.
  
  
  METHODS
  Experts in the clinical, neuropathologic, and imaging aspects of MSA were invited to participate in a 2-day consensus conference. Participants were divided into five groups, consisting of specialists in the parkinsonian, cerebellar, autonomic, neuropathologic, and imaging aspects of the disorder. Each group independently wrote diagnostic criteria for its area of expertise in advance of the meeting. These criteria were discussed and reconciled during the meeting using consensus methodology.
  
  
  RESULTS
  The new criteria retain the diagnostic categories of MSA with predominant parkinsonism and MSA with predominant cerebellar ataxia to designate the predominant motor features and also retain the designations of definite, probable, and possible MSA. Definite MSA requires neuropathologic demonstration of CNS alpha-synuclein-positive glial cytoplasmic inclusions with neurodegenerative changes in striatonigral or olivopontocerebellar structures. Probable MSA requires a sporadic, progressive adult-onset disorder including rigorously defined autonomic failure and poorly levodopa-responsive parkinsonism or cerebellar ataxia. Possible MSA requires a sporadic, progressive adult-onset disease including parkinsonism or cerebellar ataxia and at least one feature suggesting autonomic dysfunction plus one other feature that may be a clinical or a neuroimaging abnormality.
  
  
  CONCLUSIONS
  These new criteria have simplified the previous criteria, have incorporated current knowledge, and are expected to enhance future assessments of the disease.
authors: Department of Neurology, University of Michigan, 300 N. Ingalls St., 3D15, Ann Arbor, MI 48109-5489, USA. sgilman@umich.edu
authors: S
authors: S
authors: Gilman
authors: G K
authors: GK
authors: Wenning
authors: P A
authors: PA
authors: Low
authors: D J
authors: DJ
authors: Brooks
authors: C J
authors: CJ
authors: Mathias
authors: J Q
authors: JQ
authors: Trojanowski
authors: N W
authors: NW
authors: Wood
authors: C
authors: C
authors: Colosimo
authors: A
authors: A
authors: Dürr
authors: C J
authors: CJ
authors: Fowler
authors: H
authors: H
authors: Kaufmann
authors: T
authors: T
authors: Klockgether
authors: A
authors: A
authors: Lees
authors: W
authors: W
authors: Poewe
authors: N
authors: N
authors: Quinn
authors: T
authors: T
authors: Revesz
authors: D
authors: D
authors: Robertson
authors: P
authors: P
authors: Sandroni
authors: K
authors: K
authors: Seppi
authors: M
authors: M
authors: Vidailhet
mesh_terms: D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000503:physiopathology; D001479:Basal Ganglia / Q000473:pathology / Q000503:physiopathology; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D002524:Cerebellar Ataxia / Q000175:diagnosis* / Q000503:physiopathology; D002531:Cerebellum / Q000473:pathology / Q000503:physiopathology; D003937:Diagnosis, Differential; D002479:Inclusion Bodies / Q000378:metabolism / Q000473:pathology; D019578:Multiple System Atrophy / Q000175:diagnosis* / Q000503:physiopathology; D020734:Parkinsonian Disorders / Q000175:diagnosis* / Q000503:physiopathology; D051844:alpha-Synuclein / Q000378:metabolism
chemical_list: D051844:alpha-Synuclein