Search

Objectives A pre-possible multiple system atrophy (MSA) phase, that is, the period between symptom onset and satisfying the second consensus diagnostic criteria for possible or probable MSA, may exist. The aim of the study was to identify the pre-possible MSA phase and to pursue the earlier diagnosis of MSA. Materials & methods We reviewed 52 patients with a clinical diagnosis of MSA and 430 patients showing any signs of parkinsonism, sporadic cerebellar ataxia, or autonomic failure with other clinical diagnoses. Results The pre-possible MSA phase was noted in 35 patients with a clinical diagnosis of MSA and 13 patients with other clinical diagnoses. During this phase, 16 patients presented with autonomic features first, while they presented later in 32 patients. Between these patients, there was no significant difference regarding parkinsonian, cerebellar features, levodopa response, or Babinski sign with hyperreflexia. Comparisons by autonomic features or autonomic function tests could not be performed due to the small number of patients. "Atrophy on magnetic resonance imaging of the putamen, middle cerebellar peduncle, pons, or cerebellum" and "new or increased snoring" showed high positive predictive values for MSA. Conclusion A pre-possible MSA phase exists. Improved earlier diagnosis of MSA depends on the sensitivity and positive predictive value of autonomic features or autonomic function tests and on the sensitivity of "atrophy on magnetic resonance imaging of the putamen, middle cerebellar peduncle, pons, or cerebellum" and "new or increased snoring" during the pre-possible MSA phase.

Osaki Y, Morita Y, Kuwahara T, Miyano I, Doi Y. Prevalence of Parkinson’s disease and atypical parkinsonian syndromes in a rural Japanese district. Acta Neurol Scand: 2011: 124: 182–187. © 2010 John Wiley & Sons A/S. Objectives – To investigate the prevalence of Parkinson’s disease (PD) and atypical parkinsonian syndromes (APS) in a rural Japanese district. Method – Collaboration with the medical institutions, the long-term care insurance system facilities, and the public health office. Results – The crude prevalence rates were 175 per 100 000 (95% CI: 143–206) for PD, 18 (8–28) for progressive supranuclear palsy, 17 (7–26) for multiple system atrophy (MSA), and 9 (2–16) for corticobasal degeneration. The age-adjusted prevalence rates were 109 per 100 000 (88–134), 10 (2–17), 13 (4–21), and 6 (0–12), for each condition. There was a preponderance of women with PD and of men with APS. Nine of the 116 PD patients and 7 of the 29 APS patients were newly diagnosed in this study. Conclusions – There are high prevalence rates for PD and APS and suboptimal recognition of APS. This is the first epidemiological prevalence study of MSA from Japan.

Osaki Y, Koga M, Matsubayashi K, Yuki N. Asymmetric pharyngeal–cervical–brachial weakness associated with anti-GT1a IgG antibody. Acta Neurol Scand 2002: 106: 234–235. © Blackwell Munksgaard 2002. We report a case of markedly asymmetric pharyngeal–cervical–brachial weakness. Acute progression of symptoms, albuminocytologic dissociation in cerebrospinal fluid, electrophysiologic evidence of demyelination and elevation of IgG anti-GT1a antibody titer paralleled the clinical course, support the diagnosis of Guillain–Barre syndrome. Guillain–Barre syndrome should be considered in the differential diagnosis of cranial neuropathy, even in cases where there is marked asymmetry.