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Laboratory-Supported Multiple System Atrophy beyond Autonomic Function Testing and Imaging: A Systematic Review by
Iva Stankovic1, Alessandra Fanciulli2, Vladimir S Kostic1
1Neurology Clinic, Clinical Center of Serbia, School of Medicine University of Belgrade Belgrade Serbia.
Movement Disorders Clinical Practice
|April 5, 2021
Summary
Diagnosing multiple system atrophy (MSA) can be improved with additional tests beyond neuroimaging and autonomic function tests (AFT). Further laboratory work-up may enhance accuracy for this progressive neurological disorder.
Area of Science:
- Neurology
- Clinical Diagnostics
- Biomarker Research
Background:
- Neuroimaging is currently used to aid in diagnosing possible multiple system atrophy (MSA).
- The second consensus criteria for MSA primarily include blood pressure changes upon standing, but other autonomic function tests (AFT) are also valuable for identifying widespread autonomic failure.
- There is a need for additional diagnostic tools to improve the accuracy of MSA diagnosis.
Purpose of the Study:
- To evaluate the usefulness of diagnostic tools beyond brain imaging and AFT.
- To enhance laboratory-supported diagnosis of MSA.
- To inform the upcoming revision of MSA diagnostic criteria.
Main Methods:
- A systematic review of original papers was conducted by the International Parkinson and Movement Disorders Society MSA Study Group (MoDiMSA).
- The review covered biomarkers, sleep studies, genetic, neuroendocrine, neurophysiological, and neuropsychological tests, including olfactory testing and levodopa challenge tests.
- Literature published before August 2019 was included.
Main Results:
- Levodopa responsiveness and olfaction evaluation are helpful for suspected MSA-parkinsonian subtype.
- Neuropsychological testing can exclude dementia at diagnosis.
- Screening for ataxia causes is useful for MSA-cerebellar subtype; stridor and REM sleep behavior disorder are useful for both subtypes.
- No additional tools are validated in large postmortem-confirmed MSA cohorts.
Conclusions:
- Additional laboratory investigations for possible MSA should be considered.
- These tests may optimize clinical diagnostic accuracy beyond current imaging and AFT.
- Further validation is needed for these supplementary diagnostic tools.