The Clinical Features Of Multiple System Atrophy And Its Differentiation From Parkinson's Disease

Objective To analyze the clinical features and auxiliary examinations of different subtypes of MSA,and summarize the crucial points in differentiating MSA from PD.Methods Based on Gilman diagnostic criteria,thirty subjects diagnosed as probable MSA during 2002.12 to 2007.12 in the hospital were studied retrospecftively about their clinical features.14 MSA-P cases and 26 PD cases are included. Their clinical features and main examinations are compared.Results In all the 30 patients,22 of them(73.3%)complained of motor disturbance as an initial symptom.93.3%patients were affected for above three systems,autonomic failure were present widespread and urinary systems were most frequently.MRI show atrophy in pons and cerebellum for 19 MSA cases.The mean age of onset for patients with MSA is 52.3±4.6 years compared with 63.4±5.7 years for PD(P＜0.05),initial rigidity has been seen more often among the MSA than the PD(57.2%vs19.2%, P＜0.05);the patients with PD presents more frequently with initial tremor(80.8%vs21.4%,P＜0.05),the initial symptoms mainly involve the single lateral limb for patients with PD,but it is not significant(76.9% vs57.2%,P＞0.05),a poor initial levodopa response was more common in the MSA group than in the PD group(71.4%vs19.2%,P＜0.05),sexual disturbance and dysphasia occurred more frequently in MSA than PD(respectively 64.3%VS30.8%,50.0%VS11.5%,P＜0.05),42.9% of MSA patients exhibited the cerebral symptoms and 64.3%of them had pyramidal symptoms.These symptoms were never seen in the PD patients.Conclusion MSA is a chronic and progressive disease with multiple systems affected.For MSA and PD,the clinical symptoms combined with auxiliary examination can provide useful evidence for differential diagnosis.