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Decision-making trends in therapeutic interventions for multiple system atrophy: a 24-year retrospective study
Katsuya Nishida1, Kento Sakashita1, Naonobu Futamura1
1Department of Neurology, National Hospital Organization Hyogo Chuo National Hospital, Hyogo, Japan.
Background:
Managing multiple system atrophy (MSA) is challenging. While invasive interventions for amyotrophic lateral sclerosis are well-studied, those for MSA remain less explored.
Objectives:
To explore factors influencing treatment choices and trends in advanced-stage MSA.
Methods:
A retrospective cohort study analyzed 128 MSA patients at Hyogo Chuo National Hospital, Japan, from 2000 to 2024, focusing on treatment period and age at onset.
Results:
Tracheostomy invasive ventilation (TIV) decreased after 2014 (26.9% vs. 9.2%; P = 0.023). TIV-treated patients remained similarly young before and after 2014 (age at onset 52.7 vs. 54.5 years; P = 0.659) and tracheostomy was chosen by younger patients after 2014 (58.3 vs. 51.5 years; P < 0.001). Conversely, enteral nutrition increased in older patients (57.4 vs. 62.9 years; P = 0.011).
Conclusions:
In Japanese MSA, preferences for invasive treatments shifted, with younger patients favoring TIV and tracheostomy, while older patients preferred less invasive options, emphasizing personalized care.
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