Abstract Details

Title Differentiation of Autonomic Dysfunction in Multiple System Atrophy Sub types and Idiopathic Parkinson’s Disease

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-043

Objective This study aimed to describe autonomic dysfunction in Multiple System Atrophy (MSA) patients and compare this with Idiopathic Parkinson’s disease (IPD) patients and healthy controls.

Background

MSA is a neurodegenerative extrapyramidal syndrome with autonomic dysfunction forming the cornerstone of diagnosis. It is of two sub types, MSA-cerebellar type (MSA-C) and MSA-parkinsonism (MSA-P) type. There is limited data on differences in autonomic features between the two subtypes.

Design/Methods We conducted an observational cross-sectional study in a tertiary care center in India which enrolled forty eight MSA-P, fifty two MSA-C, fifty IPD patients and fifty healthy controls. A self-administered questionnaire (SCOPA-Aut) was filled by participants. All participants underwent cardiovascular autonomic testing including deep breathing tests (change in heart rate, E:I ratio), Valsalva ratio, hand-grip, cold pressor and postural tests (change in systolic blood pressure, 30: 15 ratio). Disease status was assessed by Unified MSA Rating Scale, Hoehn and Yahr stage and Unified Parkinson's Disease Rating scale part III.

Results We studied MSA-P (48 participants; age 63.6 ± 9.7 years; UMSARS 45± 16.5), MSA-C (50 participants; 58 ± 8.1 years; UMSARS 44± 12.8), IPD (50 participants; 57.6±6.7 years) and healthy controls (50 participants; 58±8.0 years). SCOPA-Aut revealed that MSA patients scored poorly versus control in gastrointestinal, urinary, cardiovascular and sexual autonomic domains and from IPD in gastrointestinal, urinary and cardiovascular domains. MSA subtypes did not differ in symptomatology or autonomic function. Between MSA and IPD, change in heart rate on standing and deep breathing, and rise in diastolic blood pressure with cold pressor test were significantly different.

Conclusions MSA patients report autonomic dysfunction frequently although the two subtypes do not differ. In gastrointestinal, urinary and cardiovascular domains, these are more severe compared to IPD. Heart rate variability and cold pressor testing distinguishes IPD and MSA. This may enable clinicians to differentiate patients with MSA from IPD.

Authors/Disclosures
Divyani Garg, MD, FRCP (All India Institute of Medical Sciences, New Delhi) PRESENTER	Dr. Garg has nothing to disclose.
Achal K. Srivastava, MD, FAAN (AIIMS)	Dr. Srivastava has nothing to disclose.
	No disclosure on file
	No disclosure on file
Michael Stalder (SiteRX)	No disclosure on file
	No disclosure on file
Deepti Vibha, MD (All India Institute of Medical Sciences)	Dr. Vibha has nothing to disclose.
	No disclosure on file
Kameshwar Prasad, MD (Rajendra Institute of Medical Sciences, Ranchi)	The institution of Prof. Prasad has received research support from Government of India Departments of Health Research and Biotechnology.

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