Red flags for multiple system atrophy.
Identifieur interne : 002239 ( PubMed/Curation ); précédent : 002238; suivant : 002240Red flags for multiple system atrophy.
Auteurs : Martin Köllensperger [Autriche] ; Felix Geser ; Klaus Seppi ; Michaela Stampfer-Kountchev ; Martin Sawires ; Christoph Scherfler ; Sylvia Boesch ; Joerg Mueller ; Vasiliki Koukouni ; Niall Quinn ; Maria Teresa Pellecchia ; Paolo Barone ; Nicole Schimke ; Richard Dodel ; Wolfgang Oertel ; Erik Dupont ; Karen Stergaard ; Christine Daniels ; Günther Deuschl ; Tanya Gurevich ; Nir Giladi ; Miguel Coelho ; Cristina Sampaio ; Christer Nilsson ; H Kan Widner ; Francesca Del Sorbo ; Alberto Albanese ; Adriana Cardozo ; Eduardo Tolosa ; Michael Abele ; Thomas Klockgether ; Christoph Kamm ; Thomas Gasser ; Ruth Djaldetti ; Carlo Colosimo ; Giuseppe Meco ; Anette Schrag ; Werner Poewe ; Gregor K. WenningSource :
- Movement disorders : official journal of the Movement Disorder Society [ 1531-8257 ] ; 2008.
English descriptors
- KwdEn :
- Aged, Cerebellar Ataxia (diagnosis), Cohort Studies, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Multiple System Atrophy (classification), Multiple System Atrophy (diagnosis), Neurologic Examination (statistics & numerical data), Parkinson Disease (classification), Parkinson Disease (diagnosis), Parkinsonian Disorders (classification), Parkinsonian Disorders (diagnosis), Sensitivity and Specificity, Shy-Drager Syndrome (diagnosis).
- MESH :
- classification : Multiple System Atrophy, Parkinson Disease, Parkinsonian Disorders.
- diagnosis : Cerebellar Ataxia, Multiple System Atrophy, Parkinson Disease, Parkinsonian Disorders, Shy-Drager Syndrome.
- statistics & numerical data : Neurologic Examination.
- Aged, Cohort Studies, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Sensitivity and Specificity.
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.
DOI: 10.1002/mds.21992
PubMed: 18442131
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last="Nilsson">Christer Nilsson</name></author><author><name sortKey="Widner, H Kan" sort="Widner, H Kan" uniqKey="Widner H" first="H Kan" last="Widner">H Kan Widner</name></author><author><name sortKey="Sorbo, Francesca Del" sort="Sorbo, Francesca Del" uniqKey="Sorbo F" first="Francesca Del" last="Sorbo">Francesca Del Sorbo</name></author><author><name sortKey="Albanese, Alberto" sort="Albanese, Alberto" uniqKey="Albanese A" first="Alberto" last="Albanese">Alberto Albanese</name></author><author><name sortKey="Cardozo, Adriana" sort="Cardozo, Adriana" uniqKey="Cardozo A" first="Adriana" last="Cardozo">Adriana Cardozo</name></author><author><name sortKey="Tolosa, Eduardo" sort="Tolosa, Eduardo" uniqKey="Tolosa E" first="Eduardo" last="Tolosa">Eduardo Tolosa</name></author><author><name sortKey="Abele, Michael" sort="Abele, Michael" uniqKey="Abele M" first="Michael" last="Abele">Michael Abele</name></author><author><name sortKey="Klockgether, Thomas" sort="Klockgether, Thomas" uniqKey="Klockgether T" first="Thomas" last="Klockgether">Thomas Klockgether</name></author><author><name sortKey="Kamm, Christoph" sort="Kamm, Christoph" uniqKey="Kamm C" first="Christoph" last="Kamm">Christoph Kamm</name></author><author><name sortKey="Gasser, Thomas" sort="Gasser, Thomas" uniqKey="Gasser T" first="Thomas" last="Gasser">Thomas Gasser</name></author><author><name sortKey="Djaldetti, Ruth" sort="Djaldetti, Ruth" uniqKey="Djaldetti R" first="Ruth" last="Djaldetti">Ruth Djaldetti</name></author><author><name sortKey="Colosimo, Carlo" sort="Colosimo, Carlo" uniqKey="Colosimo C" first="Carlo" last="Colosimo">Carlo Colosimo</name></author><author><name sortKey="Meco, Giuseppe" sort="Meco, Giuseppe" uniqKey="Meco G" first="Giuseppe" last="Meco">Giuseppe Meco</name></author><author><name sortKey="Schrag, Anette" sort="Schrag, Anette" uniqKey="Schrag A" first="Anette" last="Schrag">Anette Schrag</name></author><author><name sortKey="Poewe, Werner" sort="Poewe, Werner" uniqKey="Poewe W" first="Werner" last="Poewe">Werner Poewe</name></author><author><name sortKey="Wenning, Gregor K" sort="Wenning, Gregor K" uniqKey="Wenning G" first="Gregor K" last="Wenning">Gregor K. Wenning</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2008">2008</date><idno type="doi">10.1002/mds.21992</idno><idno type="RBID">pubmed:18442131</idno><idno type="pmid">18442131</idno><idno type="wicri:Area/PubMed/Corpus">002239</idno><idno type="wicri:Area/PubMed/Curation">002239</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Red flags for multiple system atrophy.</title><author><name sortKey="Kollensperger, Martin" sort="Kollensperger, Martin" uniqKey="Kollensperger M" first="Martin" last="Köllensperger">Martin Köllensperger</name><affiliation wicri:level="1"><nlm:affiliation>Section for Clinical Neurobiology, Department of Neurology, Innsbruck Medical University, Austria.</nlm:affiliation><country xml:lang="fr">Autriche</country><wicri:regionArea>Section for Clinical Neurobiology, Department of Neurology, Innsbruck Medical University</wicri:regionArea></affiliation></author><author><name sortKey="Geser, Felix" sort="Geser, Felix" uniqKey="Geser F" first="Felix" last="Geser">Felix Geser</name></author><author><name sortKey="Seppi, Klaus" sort="Seppi, Klaus" uniqKey="Seppi K" first="Klaus" last="Seppi">Klaus Seppi</name></author><author><name sortKey="Stampfer Kountchev, Michaela" sort="Stampfer Kountchev, Michaela" uniqKey="Stampfer Kountchev M" first="Michaela" last="Stampfer-Kountchev">Michaela Stampfer-Kountchev</name></author><author><name sortKey="Sawires, Martin" sort="Sawires, Martin" uniqKey="Sawires M" first="Martin" last="Sawires">Martin Sawires</name></author><author><name sortKey="Scherfler, Christoph" sort="Scherfler, Christoph" uniqKey="Scherfler C" first="Christoph" last="Scherfler">Christoph Scherfler</name></author><author><name sortKey="Boesch, Sylvia" sort="Boesch, Sylvia" uniqKey="Boesch S" first="Sylvia" last="Boesch">Sylvia Boesch</name></author><author><name sortKey="Mueller, Joerg" sort="Mueller, Joerg" uniqKey="Mueller J" first="Joerg" last="Mueller">Joerg Mueller</name></author><author><name sortKey="Koukouni, Vasiliki" sort="Koukouni, Vasiliki" uniqKey="Koukouni V" first="Vasiliki" last="Koukouni">Vasiliki Koukouni</name></author><author><name sortKey="Quinn, Niall" sort="Quinn, Niall" uniqKey="Quinn N" first="Niall" last="Quinn">Niall Quinn</name></author><author><name sortKey="Pellecchia, Maria Teresa" sort="Pellecchia, Maria Teresa" uniqKey="Pellecchia M" first="Maria Teresa" last="Pellecchia">Maria Teresa Pellecchia</name></author><author><name sortKey="Barone, Paolo" sort="Barone, Paolo" uniqKey="Barone P" first="Paolo" last="Barone">Paolo Barone</name></author><author><name sortKey="Schimke, Nicole" sort="Schimke, Nicole" uniqKey="Schimke N" first="Nicole" last="Schimke">Nicole Schimke</name></author><author><name sortKey="Dodel, Richard" sort="Dodel, Richard" uniqKey="Dodel R" first="Richard" last="Dodel">Richard Dodel</name></author><author><name sortKey="Oertel, Wolfgang" sort="Oertel, Wolfgang" uniqKey="Oertel W" first="Wolfgang" last="Oertel">Wolfgang Oertel</name></author><author><name sortKey="Dupont, Erik" sort="Dupont, Erik" uniqKey="Dupont E" first="Erik" last="Dupont">Erik Dupont</name></author><author><name sortKey=" Stergaard, Karen" sort=" Stergaard, Karen" uniqKey=" Stergaard K" first="Karen" last=" Stergaard">Karen Stergaard</name></author><author><name sortKey="Daniels, Christine" sort="Daniels, Christine" uniqKey="Daniels C" first="Christine" last="Daniels">Christine Daniels</name></author><author><name sortKey="Deuschl, Gunther" sort="Deuschl, Gunther" uniqKey="Deuschl G" first="Günther" last="Deuschl">Günther Deuschl</name></author><author><name sortKey="Gurevich, Tanya" sort="Gurevich, Tanya" uniqKey="Gurevich T" first="Tanya" last="Gurevich">Tanya Gurevich</name></author><author><name sortKey="Giladi, Nir" sort="Giladi, Nir" uniqKey="Giladi N" first="Nir" last="Giladi">Nir Giladi</name></author><author><name sortKey="Coelho, Miguel" sort="Coelho, Miguel" uniqKey="Coelho M" first="Miguel" last="Coelho">Miguel Coelho</name></author><author><name sortKey="Sampaio, Cristina" sort="Sampaio, Cristina" uniqKey="Sampaio C" first="Cristina" last="Sampaio">Cristina Sampaio</name></author><author><name sortKey="Nilsson, Christer" sort="Nilsson, Christer" uniqKey="Nilsson C" first="Christer" last="Nilsson">Christer Nilsson</name></author><author><name sortKey="Widner, H Kan" sort="Widner, H Kan" uniqKey="Widner H" first="H Kan" last="Widner">H Kan Widner</name></author><author><name sortKey="Sorbo, Francesca Del" sort="Sorbo, Francesca Del" uniqKey="Sorbo F" first="Francesca Del" last="Sorbo">Francesca Del Sorbo</name></author><author><name sortKey="Albanese, Alberto" sort="Albanese, Alberto" uniqKey="Albanese A" first="Alberto" last="Albanese">Alberto Albanese</name></author><author><name sortKey="Cardozo, Adriana" sort="Cardozo, Adriana" uniqKey="Cardozo A" first="Adriana" last="Cardozo">Adriana Cardozo</name></author><author><name sortKey="Tolosa, Eduardo" sort="Tolosa, Eduardo" uniqKey="Tolosa E" first="Eduardo" last="Tolosa">Eduardo Tolosa</name></author><author><name sortKey="Abele, Michael" sort="Abele, Michael" uniqKey="Abele M" first="Michael" last="Abele">Michael Abele</name></author><author><name sortKey="Klockgether, Thomas" sort="Klockgether, Thomas" uniqKey="Klockgether T" first="Thomas" last="Klockgether">Thomas Klockgether</name></author><author><name sortKey="Kamm, Christoph" sort="Kamm, Christoph" uniqKey="Kamm C" first="Christoph" last="Kamm">Christoph Kamm</name></author><author><name sortKey="Gasser, Thomas" sort="Gasser, Thomas" uniqKey="Gasser T" first="Thomas" last="Gasser">Thomas Gasser</name></author><author><name sortKey="Djaldetti, Ruth" sort="Djaldetti, Ruth" uniqKey="Djaldetti R" first="Ruth" last="Djaldetti">Ruth Djaldetti</name></author><author><name sortKey="Colosimo, Carlo" sort="Colosimo, Carlo" uniqKey="Colosimo C" first="Carlo" last="Colosimo">Carlo Colosimo</name></author><author><name sortKey="Meco, Giuseppe" sort="Meco, Giuseppe" uniqKey="Meco G" first="Giuseppe" last="Meco">Giuseppe Meco</name></author><author><name sortKey="Schrag, Anette" sort="Schrag, Anette" uniqKey="Schrag A" first="Anette" last="Schrag">Anette Schrag</name></author><author><name sortKey="Poewe, Werner" sort="Poewe, Werner" uniqKey="Poewe W" first="Werner" last="Poewe">Werner Poewe</name></author><author><name sortKey="Wenning, Gregor K" sort="Wenning, Gregor K" uniqKey="Wenning G" first="Gregor K" last="Wenning">Gregor K. Wenning</name></author></analytic><series><title level="j">Movement disorders : official journal of the Movement Disorder Society</title><idno type="eISSN">1531-8257</idno><imprint><date when="2008" type="published">2008</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Cerebellar Ataxia (diagnosis)</term><term>Cohort Studies</term><term>Diagnosis, Differential</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Multiple System Atrophy (classification)</term><term>Multiple System Atrophy (diagnosis)</term><term>Neurologic Examination (statistics & numerical data)</term><term>Parkinson Disease (classification)</term><term>Parkinson Disease (diagnosis)</term><term>Parkinsonian Disorders (classification)</term><term>Parkinsonian Disorders (diagnosis)</term><term>Sensitivity and Specificity</term><term>Shy-Drager Syndrome (diagnosis)</term></keywords><keywords scheme="MESH" qualifier="classification" xml:lang="en"><term>Multiple System Atrophy</term><term>Parkinson Disease</term><term>Parkinsonian Disorders</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Cerebellar Ataxia</term><term>Multiple System Atrophy</term><term>Parkinson Disease</term><term>Parkinsonian Disorders</term><term>Shy-Drager Syndrome</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Neurologic Examination</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Cohort Studies</term><term>Diagnosis, Differential</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Sensitivity and Specificity</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><pubmed><MedlineCitation Owner="NLM" Status="MEDLINE"><PMID Version="1">18442131</PMID><DateCreated><Year>2008</Year><Month>07</Month><Day>10</Day></DateCreated><DateCompleted><Year>2008</Year><Month>10</Month><Day>20</Day></DateCompleted><DateRevised><Year>2009</Year><Month>03</Month><Day>03</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1531-8257</ISSN><JournalIssue CitedMedium="Internet"><Volume>23</Volume><Issue>8</Issue><PubDate><Year>2008</Year><Month>Jun</Month><Day>15</Day></PubDate></JournalIssue><Title>Movement disorders : official journal of the Movement Disorder Society</Title><ISOAbbreviation>Mov. Disord.</ISOAbbreviation></Journal><ArticleTitle>Red flags for multiple system atrophy.</ArticleTitle><Pagination><MedlinePgn>1093-9</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1002/mds.21992</ELocationID><Abstract><AbstractText>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.</AbstractText><CopyrightInformation>(c) 2008 Movement Disorder Society</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Köllensperger</LastName><ForeName>Martin</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Section for Clinical Neurobiology, Department of Neurology, Innsbruck Medical University, Austria.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Geser</LastName><ForeName>Felix</ForeName><Initials>F</Initials></Author><Author ValidYN="Y"><LastName>Seppi</LastName><ForeName>Klaus</ForeName><Initials>K</Initials></Author><Author ValidYN="Y"><LastName>Stampfer-Kountchev</LastName><ForeName>Michaela</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>Sawires</LastName><ForeName>Martin</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>Scherfler</LastName><ForeName>Christoph</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Boesch</LastName><ForeName>Sylvia</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Mueller</LastName><ForeName>Joerg</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Koukouni</LastName><ForeName>Vasiliki</ForeName><Initials>V</Initials></Author><Author ValidYN="Y"><LastName>Quinn</LastName><ForeName>Niall</ForeName><Initials>N</Initials></Author><Author ValidYN="Y"><LastName>Pellecchia</LastName><ForeName>Maria Teresa</ForeName><Initials>MT</Initials></Author><Author ValidYN="Y"><LastName>Barone</LastName><ForeName>Paolo</ForeName><Initials>P</Initials></Author><Author ValidYN="Y"><LastName>Schimke</LastName><ForeName>Nicole</ForeName><Initials>N</Initials></Author><Author ValidYN="Y"><LastName>Dodel</LastName><ForeName>Richard</ForeName><Initials>R</Initials></Author><Author ValidYN="Y"><LastName>Oertel</LastName><ForeName>Wolfgang</ForeName><Initials>W</Initials></Author><Author ValidYN="Y"><LastName>Dupont</LastName><ForeName>Erik</ForeName><Initials>E</Initials></Author><Author ValidYN="Y"><LastName>Østergaard</LastName><ForeName>Karen</ForeName><Initials>K</Initials></Author><Author ValidYN="Y"><LastName>Daniels</LastName><ForeName>Christine</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Deuschl</LastName><ForeName>Günther</ForeName><Initials>G</Initials></Author><Author ValidYN="Y"><LastName>Gurevich</LastName><ForeName>Tanya</ForeName><Initials>T</Initials></Author><Author ValidYN="Y"><LastName>Giladi</LastName><ForeName>Nir</ForeName><Initials>N</Initials></Author><Author ValidYN="Y"><LastName>Coelho</LastName><ForeName>Miguel</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>Sampaio</LastName><ForeName>Cristina</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Nilsson</LastName><ForeName>Christer</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Widner</LastName><ForeName>Håkan</ForeName><Initials>H</Initials></Author><Author ValidYN="Y"><LastName>Sorbo</LastName><ForeName>Francesca Del</ForeName><Initials>FD</Initials></Author><Author ValidYN="Y"><LastName>Albanese</LastName><ForeName>Alberto</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Cardozo</LastName><ForeName>Adriana</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Tolosa</LastName><ForeName>Eduardo</ForeName><Initials>E</Initials></Author><Author ValidYN="Y"><LastName>Abele</LastName><ForeName>Michael</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>Klockgether</LastName><ForeName>Thomas</ForeName><Initials>T</Initials></Author><Author ValidYN="Y"><LastName>Kamm</LastName><ForeName>Christoph</ForeName><Initials>C</Initials></Author><Author 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