Annals of Indian Academy of Neurology
ORIGINAL ARTICLE
Year
: 2020  |  Volume : 23  |  Issue : 3  |  Page : 289--295

Parkinsonian and cerebellar phenotypes of probable MSA: An insight in to prognostic factors based on autonomic functions


Malligurki Raghurama Rukmani1, Ravi Yadav2, Binukumar Bhaskarapillai3, Pramod Kumar Pal2, Talakad N Sathyaprabha1 
1 Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
2 Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
3 Department of Biostatistics, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India

Correspondence Address:
Dr. Ravi Yadav
Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore - 560 029, Karnataka
India

Background: Multiple system atrophy is an adult-onset, sporadic, neurodegenerative disorder with parkinsonian (MSA-P) and cerebellar (MSA-C) subtypes. Objective: We aimed to elucidate differences in prognostic factors between MSA subtypes. Methods: The study population comprised 45 probable MSA patients (MSA-P = 22; MSA-C = 23) and 45 healthy controls. Clinical parameters, heart rate variability (HRV), and conventional cardiac autonomic function testing (AFT) were the study tools. Results: Mean age of onset of MSA was 54.7 ± 9 years for MSA-P and 51.9 ± 7 years for MSA-C subgroups. Median disease duration was 2 years in both subgroups. A greater percentage of MSA-P patients (45.5%) had beneficial response to levodopa (P < 0.01). Patients in both subgroups reported significant autonomic disturbances, such as postural symptoms, bladder disturbances, and erectile dysfunction. MSA-P patients had a trend for a greater number of falls and bladder disturbances than MSA-C patients (P = 0.05). Cardiac AFT showed that in MSA-P, 22.2% had definitive and 77.7% had severe autonomic dysfunction, whereas in MSA-C, 9.5% had early, 28.5% had definitive, and 57.1% had severe autonomic dysfunction. HRV analysis showed significant reduction in overall HRV, sympathetic activity, and parasympathetic activity in MSA patients as compared with controls (P < 0.0001). The sympathetic limb was more severely affected in MSA-P patients as compared with MSA-C patients (P < 0.05). Conclusion: Autonomic dysfunction and postural instability, negative prognostic markers, were relatively more common in the MSA-P than in the MSA-C patients. This implies that MSA-P patients have poorer prognosis as compared with MSA-C. Dopaminergic medications can be beneficial in MSA-P patients.


How to cite this article:
Rukmani MR, Yadav R, Bhaskarapillai B, Pal PK, Sathyaprabha TN. Parkinsonian and cerebellar phenotypes of probable MSA: An insight in to prognostic factors based on autonomic functions.Ann Indian Acad Neurol 2020;23:289-295


How to cite this URL:
Rukmani MR, Yadav R, Bhaskarapillai B, Pal PK, Sathyaprabha TN. Parkinsonian and cerebellar phenotypes of probable MSA: An insight in to prognostic factors based on autonomic functions. Ann Indian Acad Neurol [serial online] 2020 [cited 2022 May 22 ];23:289-295
Available from: https://www.annalsofian.org/article.asp?issn=0972-2327;year=2020;volume=23;issue=3;spage=289;epage=295;aulast=Rukmani;type=0