1. Progression and prognosis in multiple system atrophy presenting with REM behavior disorder
- Author
-
Annagrazia Cecere, Federica Provini, Giorgio Barletta, Pietro Guaraldi, Giulia Giannini, Andrea Droghini, Francesco Mignani, Giovanna Calandra-Buonaura, Vincenzo Mastrangelo, Pietro Cortelli, Giannini G., Mastrangelo V., Provini F., Droghini A., Cecere A., Barletta G., Mignani F., Guaraldi P., Cortelli P., and Calandra Buonaura G.
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Stridor ,REM Sleep Behavior Disorder ,Disease ,REM sleep behavior disorder ,03 medical and health sciences ,Orthostatic vital signs ,0302 clinical medicine ,Atrophy ,Prevalence ,medicine ,Humans ,Aged ,Retrospective Studies ,030214 geriatrics ,business.industry ,Parkinsonism ,Retrospective cohort study ,Middle Aged ,Multiple System Atrophy ,Prognosis ,medicine.disease ,Disease Presentation ,Disease Progression ,Female ,Neurology (clinical) ,Multiple system atrophy Autonomic diseases Cohort studies Natural history studies (prognosis) REM sleep behaviour disorder ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
ObjectivesTo investigate (1) the prevalence of REM sleep behavior disorder (RBD) as mode of disease onset in a cohort of patients with multiple system atrophy (MSA) and (2) disease progression and prognosis in patients with MSA with RBD predating (pre-RBD) and following (post-RBD) disease onset.MethodsWe retrospectively identified all patients with a clinical diagnosis of MSA evaluated at least once a year during the disease course. Type of onset was defined by the first reported motor or autonomic symptom/sign related to MSA. The occurrence of symptoms/signs and milestone of disease progression, and their latency from disease onset, were collected. Survival data were calculated. RBD was confirmed by video-polysomnography.ResultsOf a total of 158 patients, pre-RBD represented the mode of disease onset in 27% of patients, preceding disease onset according to the international criteria with a median of 3 (2–5) years. Comparing pre-RBD and post-RBD patients, the first group showed an increased prevalence of autonomic onset of disease, a reduced prevalence of parkinsonism, an earlier onset of stridor, pyramidal signs, symptomatic orthostatic hypotension, urinary dysfunction, severe dysphagia, and wheelchair dependency. The risk of death was higher in patients with pre-RBD.ConclusionsIn our MSA cohort, RBD represented the most frequent mode of disease presentation. A more rapid progression of disease was observed in the pre-RBD group. These findings suggested a careful assessment of sleep disorders to early recognize RBD and a closer follow-up of autonomic dysfunction and stridor in patients with pre-RBD.
- Published
- 2020