Symptomatic medication of 97 patients with multiple system atrophy parkinsonian subtype: An observational study

Background

Multiple system atrophy (MSA) is a sporadic, adult-onset and rapidly progressive neurodegenerative disorder. MSA clinically is characterized by prominent autonomic dysfunction with combinations of parkinsonism (MSA-P), cerebellar ataxia (MSA-C) and possible corticospinal signs. To date no disease-modifying treatment is available. Motor symptoms of certain patients with MSA-P, however, are somewhat responsive to dopaminergic medication.

Objective

To present the analysis of symptomatic treatment options on 97 patients suffering from probable MSA-P.

Methods

A retrospective survey was conducted on 97 patients from a specialized neurological acute care hospital, all meeting appropriate published criteria of probable MSA-P. We undertook a thorough analysis on patients’ records regarding the dopaminergic drugs and amantadine.

Results

Ten patients from our study cohort received no L-dopa, in the remaining 87 patients (89.69%) the mean L-dopa daily dose was 650.93 ± 289.21 mg. Fifteen study patients received ≥1000 mg of L-dopa per day. For 31 MSA-P patients (31.96%) dopamine agonists were added as a second treatment option with pramipexole and ropinirole being the most frequently used. Further, two study patients received amantadine as an alternative medication.

Conclusions

In the study the considerable proportion of MSA-P patients received high levels of dopaminergic medication chronically. Its efficacy on MSA is still uncertain and further studies with standardised clinical efficacy monitoring are highly welcome.