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Red flags for multiple system atrophy

Koellensperger, Martin; Geser, Felix; Seppi, Klaus; Stampfer-Kountchev, Michaela; Sawires, Martin; Scherfler, Christoph; Boesch, Sylvia; Mueller, Joer; Koukouni, Vasiliki and Quinn, Niall, et al. (2008) In Movement Disorders 23(8). p.1093-1099
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... (More)
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. (C) 2008 Movement Disorder Society. (Less)
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@article{06a9e7c5-e869-49ef-a152-79201540a1cc,
  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. (C) 2008 Movement Disorder Society.},
  author       = {Koellensperger, Martin and Geser, Felix and Seppi, Klaus and Stampfer-Kountchev, Michaela and Sawires, Martin and Scherfler, Christoph and Boesch, Sylvia and Mueller, Joer and Koukouni, Vasiliki and Quinn, Niall and Pellecchia, Maria Teresa and Barone, Paolo and Schimke, Nicole and Dodel, Richard and Oertel, Wolfgang and Dupont, Erik and Ostergaard, Karen and Daniels, Christine and Deuschl, Guenther and Gurevich, Tanya and Giladi, Nir and Coelho, Miguel and Sampaio, Cristina and Nilsson, Christer and Widner, Håkan and Del Sorbo, Francesca and Albanese, Alberto and Cardozo, Adriana and Tolosa, Eduardo and Abele, Michael and Klockgether, Thomas and Kamm, Christoph and Gasser, Thomas and Djaldetti, Ruth and Colosimo, Carlo and Meco, Giuseppe and Schrag, Anette and Poewe, Wemer and Wenning, Gregor K.},
  issn         = {0885-3185},
  keyword      = {warning signs,red flags,multiple system atrophy,diagnosis},
  language     = {eng},
  number       = {8},
  pages        = {1093--1099},
  publisher    = {John Wiley & Sons},
  series       = {Movement Disorders},
  title        = {Red flags for multiple system atrophy},
  url          = {http://dx.doi.org/10.1002/mds.21992},
  volume       = {23},
  year         = {2008},
}