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Nonmotor presentations of multiple system atrophy

Abstract

Multiple system atrophy (MSA) is a neurodegenerative disease characterized clinically by a combination of parkinsonian, cerebellar, autonomic and pyramidal features. Recent data show that the MSA clinical spectrum is wider than was originally thought, and may include various nonmotor symptoms that arise at disease onset. These symptoms include urinary disorders, erectile dysfunction in men, orthostatic hypotension, sleep disruption, stridor, and severe constipation. Neurologists and other specialists must be made aware that this relatively common neurodegenerative disease can manifest with nonmotor symptoms well before patients develop any overt motor disorder. The importance of recognizing such symptoms should not be underestimated, being crucial for understanding the disease prognosis, avoiding unnecessary tests and procedures, and planning any therapeutic intervention.

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Figure 1: Cardiovascular autonomic testing in a patient presenting with orthostatic intolerance.

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Acknowledgements

The author wishes to thank A. Berardelli, G. Fabbrini and C. Fieschi for allowing him to present data from patients under their care, S. Strano for providing the figure on tilt-table testing, and G. Wenning and T. Bak for useful suggestions about the clinicopathological correlations in this disease. Written consent was obtained from the patients whose cases are featured in Boxes 2–4.

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C. Colosimo is involved in a pharmacological trial of rasagiline in multiple system atrophy, sponsored by Teva Pharmaceutical Industries.

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Colosimo, C. Nonmotor presentations of multiple system atrophy. Nat Rev Neurol 7, 295–298 (2011). https://doi.org/10.1038/nrneurol.2011.5

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