Initial Diagnoses and Prodromal Symptoms in Multiple System Atrophy: Results from the MSA Trust Survey

Abstract

Introduction Multiple system atrophy (MSA) is a rapidly progressive, debilitating neurodegenerative disease with characteristic features often emerging with disease progression. Patients with different presentations are often initially diagnosed with Parkinson's disease (PD), Ataxia, or other disorders. Study Objectives To explore the rate of reported initial diagnoses, early symptomatology differences and progression in differing initial diagnoses. This is the largest UK MSA survey ever conducted detailing MSA patient experiences. Materials/Methods We analysed 284 patient responses collected from the 2018 MSA trust survey both online and by post. Results were analysed statistically using Excel crosstabulations. Results 36% of survey responders reported initially diagnosis of PD, 31% with MSA, 12% with Ataxia and 9% with atypical Parkinson's. Initial diagnosis of PD was associated with increased reported symptoms of pain and sleep disturbance compared to initial diagnosis of MSA (p<0.05), but had similar rates of reported early autonomic symptoms and difficulty moving. Patients with initial diagnosis of PD reported reduced dependence and lower quality of life despite also having had a shorter duration of difficulty moving than those with an initial diagnosis of MSA (p<0.05). Conclusions Initial diagnosis of PD in patients with MSA is associated with earlier symptoms of pain and sleep disturbances as well as well faster progression to disability. The rate of reported initial diagnosis of MSA in this cohort was higher than expected.