Parkinsonism in multiple system atrophy: Natural history, severity (UPDRS‐III), and disability assessment compared with Parkinson's disease
Identifieur interne : 000007 ( Istex/Corpus ); précédent : 000006; suivant : 000008Parkinsonism in multiple system atrophy: Natural history, severity (UPDRS‐III), and disability assessment compared with Parkinson's disease
Auteurs : François Tison ; Farid Yekhlef ; Virginie Chrysostome ; Eric Balestre ; Niall P. Quinn ; Werner Poewe ; Gregor K. WenningSource :
- Movement Disorders [ 0885-3185 ] ; 2002-07.
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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 α >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 (R2 = 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. © 2002 Movement Disorder Society
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DOI: 10.1002/mds.10171
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Quinn</name><affiliation><mods:affiliation>Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom</mods:affiliation></affiliation></author><author><name sortKey="Poewe, Werner" sort="Poewe, Werner" uniqKey="Poewe W" first="Werner" last="Poewe">Werner Poewe</name><affiliation><mods:affiliation>Klinik für Neurologie, University Hospital, Innsbruck, Austria</mods:affiliation></affiliation></author><author><name sortKey="Wenning, Gregor K" sort="Wenning, Gregor K" uniqKey="Wenning G" first="Gregor K." last="Wenning">Gregor K. Wenning</name><affiliation><mods:affiliation>Klinik für Neurologie, University Hospital, Innsbruck, Austria</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="ISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>New York</pubPlace><date type="published" when="2002-07">2002-07</date><biblScope unit="vol">17</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="701">701</biblScope><biblScope unit="page" to="709">709</biblScope></imprint><idno type="ISSN">0885-3185</idno></series><idno type="istex">1229E5C7D229E3791022ECCCACCBC9E6DC87648F</idno><idno type="DOI">10.1002/mds.10171</idno><idno type="ArticleID">MDS10171</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Parkinson's disease</term><term>UPDRS‐III</term><term>dependency</term><term>factor analysis</term><term>internal consistency</term><term>multiple system atrophy</term><term>parkinsonism</term><term>severity</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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 α >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 (R2 = 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. © 2002 Movement Disorder Society</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>François Tison MD, PhD</name><affiliations><json:string>Fédération de Neurologie, Epidémiologie et Biostatistiques Centre Hospitalo‐Universitaire de Bordeaux, Bordeaux, France</json:string></affiliations></json:item><json:item><name>Farid Yekhlef MD</name><affiliations><json:string>Fédération de Neurologie, Epidémiologie et Biostatistiques Centre Hospitalo‐Universitaire de Bordeaux, Bordeaux, France</json:string></affiliations></json:item><json:item><name>Virginie Chrysostome MD</name><affiliations><json:string>Fédération de Neurologie, Epidémiologie et Biostatistiques Centre Hospitalo‐Universitaire de Bordeaux, Bordeaux, France</json:string></affiliations></json:item><json:item><name>Eric Balestre Tec</name><affiliations><json:string>Institut National de la Santé et de la Recherche Médicale U‐330, Epidémiologie et Biostatistiques Centre Hospitalo‐Universitaire de Bordeaux, Bordeaux, France</json:string></affiliations></json:item><json:item><name>Niall P. Quinn FRCP</name><affiliations><json:string>Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom</json:string></affiliations></json:item><json:item><name>Werner Poewe MD</name><affiliations><json:string>Klinik für Neurologie, University Hospital, Innsbruck, Austria</json:string></affiliations></json:item><json:item><name>Gregor K. Wenning MD, PhD</name><affiliations><json:string>Klinik für Neurologie, University Hospital, Innsbruck, Austria</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>multiple system atrophy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>parkinsonism</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>severity</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>UPDRS‐III</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>internal consistency</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>factor analysis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>dependency</value></json:item></subject><language><json:string>eng</json:string></language><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 α >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 (R2 = 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. © 2002 Movement Disorder Society</abstract><qualityIndicators><score>8.5</score><pdfVersion>1.4</pdfVersion><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><refBibsNative>true</refBibsNative><abstractCharCount>2148</abstractCharCount><pdfWordCount>5534</pdfWordCount><pdfCharCount>35984</pdfCharCount><pdfPageCount>9</pdfPageCount><abstractWordCount>329</abstractWordCount></qualityIndicators><title>Parkinsonism in multiple system atrophy: Natural history, severity (UPDRS‐III), and disability assessment compared with Parkinson's disease</title><genre><json:string>Serial article</json:string></genre><host><volume>17</volume><pages><total>9</total><last>709</last><first>701</first></pages><issn><json:string>0885-3185</json:string></issn><issue>4</issue><subject><json:item><value>Research Article</value></json:item></subject><genre></genre><language><json:string>unknown</json:string></language><title>Movement Disorders</title><doi><json:string>10.1002/(ISSN)1531-8257</json:string></doi></host><publicationDate>2002</publicationDate><copyrightDate>2002</copyrightDate><doi><json:string>10.1002/mds.10171</json:string></doi><id>1229E5C7D229E3791022ECCCACCBC9E6DC87648F</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/1229E5C7D229E3791022ECCCACCBC9E6DC87648F/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/1229E5C7D229E3791022ECCCACCBC9E6DC87648F/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/1229E5C7D229E3791022ECCCACCBC9E6DC87648F/fulltext/tei"><teiHeader type="text"><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Parkinsonism in multiple system atrophy: Natural history, severity (UPDRS‐III), and disability assessment compared with Parkinson's disease</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>New York</pubPlace><availability><p>Wiley Subscription Services, Inc., A Wiley Company</p></availability><date>2002</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Parkinsonism in multiple system atrophy: Natural history, severity (UPDRS‐III), and disability assessment compared with Parkinson's disease</title><author><persName><forename type="first">François</forename><surname>Tison</surname><roleName type="degree">MD, PhD</roleName></persName><note type="correspondence"><p>Correspondence: Service de Neurologie, Hôpital du Haut‐Lévêque, 33600 Pessac, France</p></note><affiliation>Fédération de Neurologie, Epidémiologie et Biostatistiques Centre Hospitalo‐Universitaire de Bordeaux, Bordeaux, France</affiliation></author><author><persName><forename type="first">Farid</forename><surname>Yekhlef</surname><roleName type="degree">MD</roleName></persName><affiliation>Fédération de Neurologie, Epidémiologie et Biostatistiques Centre Hospitalo‐Universitaire de Bordeaux, Bordeaux, France</affiliation></author><author><persName><forename type="first">Virginie</forename><surname>Chrysostome</surname><roleName type="degree">MD</roleName></persName><affiliation>Fédération de Neurologie, Epidémiologie et Biostatistiques Centre Hospitalo‐Universitaire de Bordeaux, Bordeaux, France</affiliation></author><author><persName><forename type="first">Eric</forename><surname>Balestre</surname><roleName type="degree">Tec</roleName></persName><affiliation>Institut National de la Santé et de la Recherche Médicale U‐330, Epidémiologie et Biostatistiques Centre Hospitalo‐Universitaire de Bordeaux, Bordeaux, France</affiliation></author><author><persName><forename type="first">Niall P.</forename><surname>Quinn</surname><roleName type="degree">FRCP</roleName></persName><affiliation>Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom</affiliation></author><author><persName><forename type="first">Werner</forename><surname>Poewe</surname><roleName type="degree">MD</roleName></persName><affiliation>Klinik für Neurologie, University Hospital, Innsbruck, Austria</affiliation></author><author><persName><forename type="first">Gregor K.</forename><surname>Wenning</surname><roleName type="degree">MD, PhD</roleName></persName><affiliation>Klinik für Neurologie, University Hospital, Innsbruck, Austria</affiliation></author></analytic><monogr><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. 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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 α >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 (R2 = 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. © 2002 Movement Disorder Society</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>multiple system atrophy</term></item><item><term>Parkinson's disease</term></item><item><term>parkinsonism</term></item><item><term>severity</term></item><item><term>UPDRS‐III</term></item><item><term>internal consistency</term></item><item><term>factor analysis</term></item><item><term>dependency</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>Article category</head><item><term>Research Article</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2001-09-10">Received</change><change when="2001-12-10">Registration</change><change when="2002-07">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/1229E5C7D229E3791022ECCCACCBC9E6DC87648F/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>New York</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1531-8257</doi><issn type="print">0885-3185</issn><issn type="electronic">1531-8257</issn><idGroup><id type="product" value="MDS"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="MOVEMENT DISORDERS">Movement Disorders</title><title type="short">Mov. Disord.</title></titleGroup></publicationMeta><publicationMeta level="part" position="40"><doi origin="wiley" registered="yes">10.1002/mds.v17:4</doi><numberingGroup><numbering type="journalVolume" number="17">17</numbering><numbering type="journalIssue">4</numbering></numberingGroup><coverDate startDate="2002-07">July/August 2002</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="100" status="forIssue"><doi origin="wiley" registered="yes">10.1002/mds.10171</doi><idGroup><id type="unit" value="MDS10171"></id></idGroup><countGroup><count type="pageTotal" number="9"></count></countGroup><titleGroup><title type="articleCategory">Research Article</title><title type="tocHeading1">Research Articles</title></titleGroup><copyright ownership="thirdParty">Copyright © 2002 Movement Disorders Society</copyright><eventGroup><event type="manuscriptReceived" date="2001-09-10"></event><event type="manuscriptRevised" date="2001-11-30"></event><event type="manuscriptAccepted" date="2001-12-10"></event><event type="firstOnline" date="2002-04-10"></event><event type="publishedOnlineFinalForm" date="2002-07-22"></event><event type="publishedOnlineAcceptedOrEarlyUnpaginated" date="2002-04-10"></event><event type="xmlConverted" agent="Converter:JWSART34_TO_WML3G version:2.4.7 mode:FullText source:FullText result:FullText" date="2011-02-24"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-02-02"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-31"></event></eventGroup><numberingGroup><numbering type="pageFirst">701</numbering><numbering type="pageLast">709</numbering></numberingGroup><correspondenceTo>Service de Neurologie, Hôpital du Haut‐Lévêque, 33600 Pessac, France</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:MDS.MDS10171.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="0"></count><count type="tableTotal" number="3"></count><count type="referenceTotal" number="39"></count><count type="wordTotal" number="5263"></count></countGroup><titleGroup><title type="main" xml:lang="en">Parkinsonism in multiple system atrophy: Natural history, severity (UPDRS‐III), and disability assessment compared with Parkinson's disease</title><title type="short" xml:lang="en">Parkinsonism in MSA Compared with PD</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1" corresponding="yes"><personName><givenNames>François</givenNames><familyName>Tison</familyName><degrees>MD, PhD</degrees></personName><contactDetails><email normalForm="francois.tison@chu-bordeaux.fr">francois.tison@chu‐bordeaux.fr</email></contactDetails></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Farid</givenNames><familyName>Yekhlef</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Virginie</givenNames><familyName>Chrysostome</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Eric</givenNames><familyName>Balestre</familyName><degrees>Tec</degrees></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Niall P.</givenNames><familyName>Quinn</familyName><degrees>FRCP</degrees></personName></creator><creator xml:id="au6" creatorRole="author" affiliationRef="#af4"><personName><givenNames>Werner</givenNames><familyName>Poewe</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au7" creatorRole="author" affiliationRef="#af4"><personName><givenNames>Gregor K.</givenNames><familyName>Wenning</familyName><degrees>MD, PhD</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="FR" type="organization"><unparsedAffiliation>Fédération de Neurologie, Epidémiologie et Biostatistiques Centre Hospitalo‐Universitaire de Bordeaux, Bordeaux, France</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="FR" type="organization"><unparsedAffiliation>Institut National de la Santé et de la Recherche Médicale U‐330, Epidémiologie et Biostatistiques Centre Hospitalo‐Universitaire de Bordeaux, Bordeaux, France</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="GB" type="organization"><unparsedAffiliation>Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom</unparsedAffiliation></affiliation><affiliation xml:id="af4" countryCode="AT" type="organization"><unparsedAffiliation>Klinik für Neurologie, University Hospital, Innsbruck, Austria</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">multiple system atrophy</keyword><keyword xml:id="kwd2">Parkinson's disease</keyword><keyword xml:id="kwd3">parkinsonism</keyword><keyword xml:id="kwd4">severity</keyword><keyword xml:id="kwd5">UPDRS‐III</keyword><keyword xml:id="kwd6">internal consistency</keyword><keyword xml:id="kwd7">factor analysis</keyword><keyword xml:id="kwd8">dependency</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>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 (<i>P</i> = 0.0001) higher in MSA. The internal consistency of the UPDRS‐III was fair in MSA patients (Cronbach's α >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 (<i>R</i><sup>2</sup> = 0.70, <i>P</i> = 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. © 2002 Movement Disorder Society</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><!--Version 0.6 générée le 4-12-2015--><mods version="3.6"><titleInfo lang="en"><title>Parkinsonism in multiple system atrophy: Natural history, severity (UPDRS‐III), and disability assessment compared with Parkinson's disease</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Parkinsonism in MSA Compared with PD</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Parkinsonism in multiple system atrophy: Natural history, severity (UPDRS‐III), and disability assessment compared with Parkinson's disease</title></titleInfo><name type="personal"><namePart type="given">François</namePart><namePart type="family">Tison</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Fédération de Neurologie, Epidémiologie et Biostatistiques Centre Hospitalo‐Universitaire de Bordeaux, Bordeaux, France</affiliation><description>Correspondence: Service de Neurologie, Hôpital du Haut‐Lévêque, 33600 Pessac, France</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Farid</namePart><namePart type="family">Yekhlef</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Fédération de Neurologie, Epidémiologie et Biostatistiques Centre Hospitalo‐Universitaire de Bordeaux, Bordeaux, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Virginie</namePart><namePart type="family">Chrysostome</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Fédération de Neurologie, Epidémiologie et Biostatistiques Centre Hospitalo‐Universitaire de Bordeaux, Bordeaux, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Eric</namePart><namePart type="family">Balestre</namePart><namePart type="termsOfAddress">Tec</namePart><affiliation>Institut National de la Santé et de la Recherche Médicale U‐330, Epidémiologie et Biostatistiques Centre Hospitalo‐Universitaire de Bordeaux, Bordeaux, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Niall P.</namePart><namePart type="family">Quinn</namePart><namePart type="termsOfAddress">FRCP</namePart><affiliation>Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Werner</namePart><namePart type="family">Poewe</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Klinik für Neurologie, University Hospital, Innsbruck, Austria</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Gregor K.</namePart><namePart type="family">Wenning</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Klinik für Neurologie, University Hospital, Innsbruck, Austria</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre authority="originalCategForm">article</genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">New York</placeTerm></place><dateIssued encoding="w3cdtf">2002-07</dateIssued><dateCaptured encoding="w3cdtf">2001-09-10</dateCaptured><dateValid encoding="w3cdtf">2001-12-10</dateValid><copyrightDate encoding="w3cdtf">2002</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="tables">3</extent><extent unit="references">39</extent><extent unit="words">5263</extent></physicalDescription><abstract lang="en">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 α >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 (R2 = 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. © 2002 Movement Disorder Society</abstract><subject lang="en"><genre>Keywords</genre><topic>multiple system atrophy</topic><topic>Parkinson's disease</topic><topic>parkinsonism</topic><topic>severity</topic><topic>UPDRS‐III</topic><topic>internal consistency</topic><topic>factor analysis</topic><topic>dependency</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title></titleInfo><titleInfo type="abbreviated"><title>Mov. Disord.</title></titleInfo><subject><genre>article category</genre><topic>Research Article</topic></subject><identifier type="ISSN">0885-3185</identifier><identifier type="eISSN">1531-8257</identifier><identifier type="DOI">10.1002/(ISSN)1531-8257</identifier><identifier type="PublisherID">MDS</identifier><part><date>2002</date><detail type="volume"><caption>vol.</caption><number>17</number></detail><detail type="issue"><caption>no.</caption><number>4</number></detail><extent unit="pages"><start>701</start><end>709</end><total>9</total></extent></part></relatedItem><identifier type="istex">1229E5C7D229E3791022ECCCACCBC9E6DC87648F</identifier><identifier type="DOI">10.1002/mds.10171</identifier><identifier type="ArticleID">MDS10171</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2002 Movement Disorders Society</accessCondition><recordInfo><recordOrigin>Wiley Subscription Services, Inc., A Wiley Company</recordOrigin><recordContentSource>WILEY</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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