2010 MSA Research Award

Prospective 5-year natural history study of probable multiple system atrophy (MSA) in 175 North American subjects

S. Gilman1, P.A. Low2, S. May3, C. Tanner4, M. Stern5, P. Sandroni2, S. Reich6, F. Marshall7, P. Novak8, J. Jankovic9, G. F. Wooten10, B. Racette11, D. Sletten2, C. Shults3
1University of Michigan, Ann Arbor, MI; 2Mayo Clinic, Rochester, MN; 3University of California, San Diego, CA; 4Parkinson’s Institute, Sunnyvale, CA; 5University of Pennsylvania, Philadelphia, PA; 6University of Maryland, Baltimore, MD; 7University of Rochester, Rochester, NY; 8Boston University, Boston, MA; 9Baylor College of Medicine, Houston, TX; 10University of Virginia, Charlottesville, VA; 11Washington University, St. Louis, MO

This study, funded by NINDS, comprised a study of 11 North American sites and used standardized methodology and strict entry criteria for MSA. The study, led by Dr. Sid Gilman at University of Michigan, explored the natural history of MSA. We focused on patients who fulfill strict criteria for the disorder and asked the question of whether patients with different types of MSA have different outlooks. Patients with MSA most commonly have parkinsonism as the main feature (MSA-P). Some have ataxia (unsteadiness) and other symptoms of cerebellar involvement (MSA-C). We found that the most common first symptom was autonomic involvement. We also found that the outlook from the first symptom was very bad, with an average time to death a little over 5 years. The type of MSA did not result in any significant difference in prognosis, estimated as time to death (outlook). Symptoms of involvement of different domains of autonomic function were also not different between types. One take-home message of the study is that, in treatment trials, we need to identify early cases of the condition and try to stop the condition from progressing.