Distinguishing PD From Multiple System Atrophy

[Guest guest]

http://www.craniospinal.net/netpages/physicians/parkvsmsa.html

Distinguishing PD From Multiple System Atrophy

Preliminary Predictive Model Requires Validation

Recognizing a pattern of clinical features may help physicians

distinguish Parkinson's disease (PD) from multiple system atrophy (MSA),

according to

research published in the March issue of the Journal of Neurology,

Neurosurgery, and

Psychiatry. The investigators offer a preliminary predictive model to aid in

the distinction of

these similar-looking conditions.

" It is often difficult to distinguish clinically between MSA and [PD],

particularly early in the

disease, " write the authors, led by G.K. Wenning from the neurology

department of University

Hospital in Innsbruck, Austria. The authors point out that no systematic

studies have been

conducted to determine reasons for such poor diagnostic accuracy, and that

overlapping

clinical features probably contribute. " [A]s prognosis and treatment

response is different for

patients with MSA compared with PD, a correct diagnosis is important. ...

Our results suggest

that improving diagnostic accuracy of MSA requires pattern recognition

rather than defining

unique pathognomonic symptoms or signs. "

Thus, the authors set out to develop a predictive model to help

differentiate MSA from PD.

They examined data on 100 pathologically confirmed cases of PD and 38 cases

of MSA, in

brains collected by the Parkinson's Disease Society Brain Bank (PDSBB) in

London between

1987 and 1993. Statistical measures were used to determine diagnostic

utility of a diversity

of variables that included socio-demographic factors, clinical features,

drug side effects, and

other features, like presence of depression.

Researchers were able to determine that the following clinical features tend

to suggest a

diagnosis of MSA over PD: poor initial response to levodopa and absence of

psychiatric side

effects from antiparkinsonian drugs, recurrent falls, autonomic failure,

dysarthria and

dysphagia, and preserved cognitive function on bedside testing. Features

that failed to

distinguish the two diseases included symmetric onset, akinesia, tremor,

levodopa-induced

motor complications, and depression.

" Most good clinicians can distinguish the two disorders, ... but this

quantifies what people

have intuitively sensed, " Abraham Lieberman, MD, tells in an interview

seeking

independent assessment of the study. " Practically, it doesn't make a

difference because

there's no treatment for . ... Basically, what you do is put people on

sinemet [a

levodopa/carbidopa combination], and if they respond, they probably have

Parkinson's

disease. If they don't respond, they probably have something like . ...

I think in the

future it will be important, because the etiologies of these diseases are

probably different. ...

Five years from now, when we have treatments for and a means of trying

to prevent

the disease and slow it down, it'll be very important that we distinguish

one from the other. "

Lieberman is a professor of neurology at the University of Miami and medical

director of the

National Parkinson's Foundation.

The next step, write the authors, is to validate the model they have

developed with different

data sets. Furthermore, advances in neurodiagnostic methods may help ease

the difficulty in

distinguishing these two disorders.

[Guest guest]

Diseases may be classified according to the syptoms

associated with them, or they may be classified according

to the 'etiology' that is the underlying disease process.

My impression is that MSA, or at least some cases of

MSA may be classified as atypical Parkinson's or as

Parkinson's plus based on how the patient is affected.

However the cellular damage that is observed post-mortem is

different between Parknsons and MSA. Lewy bodies are found

in the brain tissues of Parkinson's patients, not so in MSA

patients. In that respect Parkinson's is similar to Alzheimers

or diffuse Lewy body disease though it is very very different

from those in terms of the symptoms.

There has been some encouraging work in immunotherapy, the

development of a vaccine that produces antibodies in the

immune system that destroys the Lewy bodies. A vaccine of

this sort has been show to prevent an Alzheimer's-like

disease in a strain of mice bred to develop the disease

and also to halt the progress of the disease when the

vaccine is admininistered later. Unlike stem cell therapy

this cure does nothing to repair the damage already done,

it does stop further damage from occurring.

That work might help both Alzheimers and Parkinsons

patients but would most likely not help MSA patients.

Stem cell therapy has the potential for helping all.

The post mortem clinical indicator used to identify MSA

is the presence of cytoplasmic inclusions in the glial

cells. However, inclusions of that sort are also observed

in some otherwise healthy brains so it is not clear how

they fit into the picture.

That there are two distictly different clinical indicators

for Parkinsons and MSA tells me that they are probably two

very different underlying diseases. But real researchers

who really do know their burros from their burrows, may view

that difference (the cellular differences) as superficial.

Or in other words what they believe is not so important as

why they believe it.

> i have read where researchers believe that MSA is atypical

parkinson's. any

> comments on that. casunlimited@a...

[Guest guest]

Please clarify the definition of the word SPORADIC.

Thought it meant not hereditary but in a post from Bill just now the term

sporadic or hereditary was used.

[Guest guest]

mooneyg@... wrote:

Are

any of these diseases genetically transferred?

There are some ataxias (movement disorders) which are genetically transferred.

Some of the OPCA forms are and even some PD is attributed to gene problems.

However, MSA is not by definition. Only the sporatic type of OPCA

is considered hereditary at this point. To our knowledge there have

never been two people in the same family with MSA.

Take care, Bill and Charlotte

[Guest guest]

Errr I guess this is where I ask a question.....

My father has been diagnosed with MSA. My garndfather died over 30

years ago with symptoms alsmost exactly the same as my Dad. Are there

questions I should be asking my doctor?

I have just come back from a weeks holiday with my Mum and Dad and my

daughter. Boy was it great but hard work! It was like taking three

toddlers mind you not just the one.

Becky (UK)

: Werre

Sent: 04 September 2001 15:16

To: shydrager

Subject: Re: Distinguishing PD From Multiple System Atrophy

mooneyg@... wrote:

Are any of these diseases genetically transferred?

There are some ataxias (movement disorders) which are genetically

transferred. Some of the OPCA forms are and even some PD is attributed

to gene problems. However, MSA is not by definition. Only the sporatic

type of OPCA is considered hereditary at this point. To our knowledge

there have never been two people in the same family with MSA.

Take care, Bill and Charlotte

If you do not wish to belong to shydrager, you may

unsubscribe by sending a blank email to

shydrager-unsubscribe

[Guest guest]

Sporadic means NON-hereditary.

Bill meant to say that there are both non-hereditary(sporadic) and

hereditary forms of OPCA. The non-hereditary(sporadic) form of OPCA is

considered to be Multiple System Atrophy.

The hereditary forms of OPCA are known as Spinocerebellar Ataxia (SCA).

Genetic tests are available for SCA-1, SCA-2, SCA-3, SCA-6 and SCA-8.

Research is progressing on SCA and more genes are being found every year

so more testing will be become available.

Regards,

Pam

Bvpond44@... wrote:

>

> Please clarify the definition of the word SPORADIC.

>

> Thought it meant not hereditary but in a post from Bill just now the

> term

> sporadic or hereditary was used.

>

> If you do not wish to belong to shydrager, you may

> unsubscribe by sending a blank email to

>

> shydrager-unsubscribe

>

>

[Guest guest]

Hi Becky,

I would make sure your father's doctors are aware of the family

history. If they were unaware of this when they diagnosed him it might

cause them to rethink the diagnosis.

Regards,

Pam

Becky wrote:

>

> Errr I guess this is where I ask a question.....

>

> My father has been diagnosed with MSA. My garndfather died over 30

> years ago with symptoms alsmost exactly the same as my Dad. Are there

> questions I should be asking my doctor?

>

> I have just come back from a weeks holiday with my Mum and Dad and my

> daughter. Boy was it great but hard work! It was like taking three

> toddlers mind you not just the one.

>

> Becky (UK)

>

>

>

> : Werre

> Sent: 04 September 2001 15:16

> To: shydrager

> Subject: Re: Distinguishing PD From Multiple System Atrophy

>

>

>

> mooneyg@... wrote:

>

> Are any of these diseases genetically transferred?

>

> There are some ataxias (movement disorders) which are genetically

> transferred. Some of the OPCA forms are and even some PD is attributed

> to gene problems. However, MSA is not by definition. Only the sporatic

> type of OPCA is considered hereditary at this point. To our knowledge

> there have never been two people in the same family with MSA.

>

> Take care, Bill and Charlotte

> If you do not wish to belong to shydrager, you may

> unsubscribe by sending a blank email to

>

> shydrager-unsubscribe

>

>

[Guest guest]

Becky,

The genes for many hereditary ataxias are known and a DNA check for those

genes is a simple blood test (which takes longer to analyze). With my

insurance most of it would be covered. Ask your doctor about it.

Take care, Bill and Charlotte

=============================

Becky wrote:

> Errr I guess this is where I ask a question.....

>

> My father has been diagnosed with MSA. My garndfather died over 30

> years ago with symptoms alsmost exactly the same as my Dad. Are there

> questions I should be asking my doctor?

>

> I have just come back from a weeks holiday with my Mum and Dad and my

> daughter. Boy was it great but hard work! It was like taking three

> toddlers mind you not just the one.

>

> Becky (UK)

>

>

>

> : Werre

> Sent: 04 September 2001 15:16

> To: shydrager

> Subject: Re: Distinguishing PD From Multiple System Atrophy

>

>

>

> mooneyg@... wrote:

>

> Are any of these diseases genetically transferred?

>

> There are some ataxias (movement disorders) which are genetically

> transferred. Some of the OPCA forms are and even some PD is attributed

> to gene problems. However, MSA is not by definition. Only the sporatic

> type of OPCA is considered hereditary at this point. To our knowledge

> there have never been two people in the same family with MSA.

>

> Take care, Bill and Charlotte

> If you do not wish to belong to shydrager, you may

> unsubscribe by sending a blank email to

>

> shydrager-unsubscribe

>

>