The Clinical Study Of The Non-motor Syndromes Of Multiple System Atrophy

Background and Purposes: Multiple system atrophy (MSA) is a neurodegenerativedisorder that involves multiple functional anatomical parts of the central nervous system,and possesses characters of adult and insidious onset, sporadic in population and chronicprogression. Its clinical manifestations include different degrees of autonomic nervedysfunction, Parkinsonism, cerebellar ataxia, pyramidal and extrapyramidal signs, etc.Since differences of involvement of autonomic nervous system, pyramidal andextrapyramidal motor system at the early stages of the disorder, the clinical manifestationsare different. But with the development of the disease, the patients’ clinical manifestationsand pathological damage that occurred in multiple anatomical structures of the centralnervous system possess the similar characters in the end. Thus the disease is called MSA.Based on the motor symptoms, clinically it can be divided into two types:(1) MSA-P typein whom the main manifestations are Parkinsonism with the characters of rigidity andakinesia.(2) MSA-C type, main presentations are gait disturbance and cerebellar ataxia. Infact, a lot of patients with MSA start with non-motor symptoms such as the bladderdysfunction, sexual function decline, and orthostatic hypotension, etc. However, clinicallywe have overly focused on motor symptoms as the initial presentations for P type(Parkinson’s symptoms) and C type (cerebellar ataxia) of MSA, without paying enoughattention to non-motor symptoms (autonomic nerve dysfunction symptom and the otherinvoluntary movement symptoms) as the initial presentations for this disorder. As a result,the MSA patients whose early presentations are non-motor are easily misdiagnosed, andtheir diagnoses are even missed. In the present study, data of the onset symptoms of MSAhave been collected. The ratio of MSA whose initial symptom is motor or nonmotor andthe proportion of the latter in MSA have been analyzed. The present study can make a greatcontribution as reference for clinical research.Methods: From March2012to February2014,31cases of patients with MSA asinpatients and outpatients in department of neurology at our hospital have been collectedbased on detailed history, physical examinations, and onset of disease and specificmanifestations of motor symptoms or non-motor symptoms. Unifield multiple systematrophy rating scale (UMSARS) was adopted to evaluate the severity of illness.Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA)were adopted to evaluate the function of cognition while self-rating depression scale (SAS)and self-rating anxiety scale (SDS) were adopted to evaluate the function of emotion. Results: In this study, of total31cases,23cases (74%) started with non-motorsymptoms, with RBD (30%), urination disorder (22%), sexual dysfunction (22%), and OH(17%) being the most common initial nonmotor symptoms. Comparing with the patientswith MSA-P type (12/18,66.67%), for patients with MSA-C type (11/13,84.62%) initialnon-motor symptoms are more common.31patients with MSA all have the non-motorsymptoms. Among all the cases, the most common symptoms are rectal dysfunction (94%),urinary bladder dysfunction (90%, consisting of frequent urination64%, urinaryincontinence61%, nocturia increased55%and urgency48%), OH (65%), sleep apnea(61%), RBD (48%). Besides, some patients presented with different degrees of cognitivedysfunction (68%) and emotional disorders (anxiety90%, depression71%) as their initialsymptoms. For symptoms and incidences, there were no statistically significant differencebetween MSA-P type and MSA-C type of patients. The courses of disorder with non-motorinitial symptoms were longer than those with motor initial symptoms (P=0.01), while thereare no statistically significant differences in terms of age, duration of symptoms andUMSARS for the two groups.Conclusion: In the present study, we found that patients with MSA mainly possessthe non-motor symptoms that onset with ubiquitous autonomic dysfunction. Unnecessaryerrors often occur because of ignoring of the nonmotor symptoms. There is no statisticallysignificant difference in symptoms and incidence between patients with MSA-P type andpatients with MSA-C type, but the latter is more common type with non-motor initialsymptoms. The onset of non-motor symptoms in MSA is earlier than that of motorsymptoms. MSA patients with non-motor initial symptoms may have slow progression andrelatively good prognosis.