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Abnormalities on structural MRI associate with faster disease progression in multiple system atrophy
Florian Krismer1, Klaus Seppi2, Gregor K Wenning1
1Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
Background:
The rate of clinical progression in patients with multiple system atrophy (MSA) varies between individuals and predictors for disease progression remain undefined. While the MSA-rasagiline study found no difference in the rates of clinical progression for patients treated with rasagiline versus placebo, it included a large, prospective magnetic resonance imaging (MRI) substudy that can provide new information on the underlying disease progression in patients with early MSA.
Methods:
This post-hoc analysis compared the rate of clinical progression in patients with MSA-specific structural changes at baseline (MRI-positive group) versus the rate of progression in patients without evidence of such changes at baseline (MRI-negative group) using a repeated measures ANCOVA. Clinical progression was assessed using the Unified MSA Rating Scale (UMSARS) and Clinical Global Impression of Improvement (CGI-I).
Results:
Twenty-eight patients with early MSA of the parkinsonian subtype (MRI-positive n = 13; MRI-negative n = 15) who had complete baseline and follow-up UMSARS data were included in this analysis. Patients in the MRI-positive group had faster clinical progression from baseline to the end of the 48-week study compared with those in the MR-negative group as assessed by the UMSARS total (p = 0.028) and UMSARS motor (p = 0.008) scales. At week 48, MRI-positive patients also had a significantly worse health status vs. MRI-negative patients (p = 0.015).
Conclusions:
This is the first study to demonstrate that MSA-specific abnormalities on structural MRI might represent a variant of MSA-P that is associated with more rapid progression and an overall worse prognosis.
Insights
Structural MRI abnormalities predict faster disease progression in early Parkinsonian Multiple System Atrophy (MSA-P). Patients with MRI-positive findings showed worse outcomes, suggesting a more aggressive disease variant.
Area of Science:
- Neurology
- Radiology
- Neurodegenerative Diseases
Background:
- Predicting clinical progression in Multiple System Atrophy (MSA) is challenging.
- A previous study found no difference in progression with rasagiline treatment but included a valuable MRI substudy.
- This analysis leverages that MRI substudy to investigate early disease progression predictors.
Purpose of the Study:
- To determine if baseline structural MRI abnormalities predict clinical progression in early Parkinsonian MSA (MSA-P).
- To compare the rate of clinical progression between MRI-positive and MRI-negative patients.
Main Methods:
- Post-hoc analysis of a prospective MRI substudy in early MSA patients.
- Comparison of clinical progression using the Unified MSA Rating Scale (UMSARS) between MRI-positive and MRI-negative groups.
- Statistical analysis using repeated measures ANCOVA.
Main Results:
- MRI-positive patients (n=13) showed significantly faster progression on UMSARS total and motor scales compared to MRI-negative patients (n=15).
- At 48 weeks, MRI-positive patients reported significantly worse health status.
- The study included 28 early MSA-P patients with complete UMSARS data.
Conclusions:
- Baseline MSA-specific structural MRI abnormalities identify a subgroup of MSA-P with more rapid clinical progression.
- These findings suggest MRI-detectable abnormalities indicate a more severe variant of MSA-P.
- Structural MRI may serve as a prognostic biomarker in early MSA.
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