eprintid: 10099251
rev_number: 16
eprint_status: archive
userid: 608
dir: disk0/10/09/92/51
datestamp: 2020-06-02 09:32:30
lastmod: 2021-11-02 23:28:55
status_changed: 2020-06-02 09:32:30
type: article
metadata_visibility: show
creators_name: Chelban, V
creators_name: Catereniuc, D
creators_name: Aftene, D
creators_name: Gasnas, A
creators_name: Vichayanrat, E
creators_name: Iodice, V
creators_name: Groppa, S
creators_name: Houlden, H
title: An update on MSA: premotor and non-motor features open a window of opportunities for early diagnosis and intervention
ispublished: inpress
subjects: UCH
divisions: UCL
divisions: B02
divisions: C07
divisions: D07
divisions: F85
keywords: MSA, Multiple system atrophy, Non-motor features, Premotor phase
note: © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).
abstract: In this review, we describe the wide clinical spectrum of features that can be seen in multiple system atrophy (MSA) with a focus on the premotor phase and the non-motor symptoms providing an up-to-date overview of the current understanding in this fast-growing field. First, we highlight the non-motor features at disease onset when MSA can be indistinguishable from pure autonomic failure or other chronic neurodegenerative conditions. We describe the progression of clinical features to aid the diagnosis of MSA early in the disease course. We go on to describe the levels of diagnostic certainty and we discuss MSA subtypes that do not fit into the current diagnostic criteria, highlighting the complexity of the disease as well as the need for revised diagnostic tools. Second, we describe the pathology, clinical description, and investigations of cardiovascular autonomic failure, urogenital and sexual dysfunction, orthostatic hypotension, and respiratory and REM-sleep behavior disorders, which may precede the motor presentation by months or years. Their presence at presentation, even in the absence of ataxia and parkinsonism, should be regarded as highly suggestive of the premotor phase of MSA. Finally, we discuss how the recognition of the broader spectrum of clinical features of MSA and especially the non-motor features at disease onset represent a window of opportunity for disease-modifying interventions.
date: 2020-05-20
date_type: published
official_url: https://doi.org/10.1007/s00415-020-09881-6
oa_status: green
full_text_type: pub
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 1786825
doi: 10.1007/s00415-020-09881-6
pii: 10.1007/s00415-020-09881-6
lyricists_name: Chelban, Viorica
lyricists_name: Houlden, Henry
lyricists_id: VCHEL09
lyricists_id: HJHOU44
actors_name: Kalinowski, Damian
actors_id: DKALI47
actors_role: owner
full_text_status: public
publication: Journal of Neurology
event_location: Germany
citation:        Chelban, V;    Catereniuc, D;    Aftene, D;    Gasnas, A;    Vichayanrat, E;    Iodice, V;    Groppa, S;           Chelban, V;  Catereniuc, D;  Aftene, D;  Gasnas, A;  Vichayanrat, E;  Iodice, V;  Groppa, S;  Houlden, H;   - view fewer <#>    (2020)    An update on MSA: premotor and non-motor features open a window of opportunities for early diagnosis and intervention.                   Journal of Neurology        10.1007/s00415-020-09881-6 <https://doi.org/10.1007/s00415-020-09881-6>.    (In press).    Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10099251/1/Chelban_An%20update%20on%20MSA.%20Premotor%20and%20non-motor%20features%20open%20a%20window%20of%20opportunities%20for%20early%20diagnosis%20and%20intervention_AOP.pdf