Photo Credit: Kateryna Kon

The following is a summary of “Current Landscape of Clinical Diagnosis in Multiple System Atrophy: A 15-Year Analysis From 2008 to 2022,” published in the November 2024 issue of Neurology by Sekiya et al.     

Researchers conducted a retrospective study to assess temporal changes in the positive predictive value (PPV) of multiple system atrophy (MSA) diagnosis.  

They analyzed clinical diagnoses for patients with MSA from the Mayo Clinic Brain Bank (2008-2022); PPV was compared between 2 periods (2008-2017 and 2018-2022) and successively with a 4-year moving average. Brain magnetic resonance imaging (MRI) usage and PPV for subtypes (MSA with parkinsonism [MSA-P] and MSA with cerebellar involvement [MSA-C]) were also assessed.  

The results showed 321 patients, 136 women, age at death 68 ± 9 years with clinical diagnoses of MSA. Of these, 225 were pathologically confirmed as MSA, resulting in an overall PPV of 70%. The remaining 30% had alternative pathological diagnoses, including Lewy body disease (18%), progressive supranuclear palsy (4%), cerebrovascular disease (1%), corticobasal degeneration (1%), and others (6%). The PPV improved from 63% in 2008-2017 to 78% in 2018-2022 (OR 2.0 [1.2-3.5], P=0.005). Linear analysis also demonstrated increased PPV over time (r = 0.66 [0.14-0.89], P=0.02). Brain MRI scans were more frequently performed in 2018-2022 compared with 2008-2017 (91% vs. 80%; OR 2.4 [1.2-5.0], P=0.012). The PPV was higher in patients who underwent brain MRI than those who did not (73% vs. 52%; OR 2.5 [1.3-4.9], P=0.0057). The PPV for MSA-C was similar in both periods (87% in 2008-2017 and 93% in 2018-2022), while the PPV for MSA-P improved from 59% in 2008-2017 to 72% in 2018-2022 (OR 1.8 [1.0-3.2], P=0.04).  

They concluded that the PPV for diagnosing MSA has improved, likely due to increased use of brain MRI, although challenges remain in achieving accurate clinical diagnoses.  

Source: neurology.org/doi/10.1212/WNL.0000000000210021