MDS 2022 | MSA: challenges with early diagnosis
Carlo Colosimo, MD, FEAN, Santa Maria University Hospital, Terni, Italy, talks about the challenges associated with the diagnosis and treatment of multiple system atrophy (MSA), an atypical parkinsonian syndrome. MSA can be relatively similar clinically to Parkinson’s disease (PD), making the diagnosis challenging; however, because MSA tends to progress more rapidly than PD, an early and accurate diagnosis is essential to give patients the correct prognosis and counseling. An early MSA diagnosis is also important for including patients in clinical trials evaluating potential disease-modifying treatments. Recently, the Movement Disorders Society developed new criteria for the diagnosis of MSA with the aim of improving diagnostic accuracy, particularly in the early disease stages. This interview took place at the 2022 International Congress of Parkinson’s Disease and Movement Disorders in Madrid, Spain.
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Transcript (edited for clarity)
So MSA is one of the typical Parkinsonian disorders, so a disorder which can be relatively similar clinically to Parkinson’s disease at the beginning, which is much more frequent. But then the natural history, the evolution is quite different. And typically, the evolution and the natural history of MSA is much more severe than Parkinson’s. This is also because only a minority of people with the MSA will respond to antiparkinsonian agents...
So MSA is one of the typical Parkinsonian disorders, so a disorder which can be relatively similar clinically to Parkinson’s disease at the beginning, which is much more frequent. But then the natural history, the evolution is quite different. And typically, the evolution and the natural history of MSA is much more severe than Parkinson’s. This is also because only a minority of people with the MSA will respond to antiparkinsonian agents. So the issue of early recognition is already important because first, you have to give the right prognosis to a patient. You have to tell him, “Okay, you’ve got Parkinson’s disease, or you have got probably MSA, which is bad news.” But because we know from the beginning what is the natural history of MSA, then we can also try to put in place the right therapies. Even if they are symptomatic, even if they are palliative therapies is good to know what we are dealing with because then you can help the patient more.
And secondly, the issue of early diagnosis is also important because there have been a number of trials, and there will be more in the future I hope are possible. This is modifying agents for this condition. So, in this case, it’s really important to recruit patients as early as possible. And at the moment, this is not so easy because at the beginning, as I was saying before, it can be a little bit difficult to distinguish between MSA and some cases of Parkinson’s disease or MSA in some cases of sporadic cerebellar ataxia. So with the new criteria which were recently developed by the Movement Disorder Society, the idea is really to be as sensitive as possible in detecting early cases of MSA with the aim possibly in the future of recruiting this patient early on and possibly to have better results in terms of improving the disease trajectory.
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