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Research paper
New insights into orthostatic hypotension in multiple system atrophy: a European multicentre cohort study
  1. A Pavy-Le Traon1,2,
  2. A Piedvache3,
  3. S Perez-Lloret4,5,
  4. G Calandra-Buonaura6,7,
  5. V Cochen-De Cock1,8,
  6. C Colosimo9,
  7. P Cortelli6,7,
  8. R Debs1,
  9. S Duerr10,
  10. A Fanciulli10,
  11. A Foubert-Samier11,12,13,
  12. A Gerdelat1,
  13. T Gurevich14,
  14. F Krismer10,
  15. W Poewe15,
  16. F Tison11,12,13,
  17. C Tranchant16,
  18. G Wenning10,15,
  19. O Rascol1,4,
  20. WG Meissner11,12,13
  21. on behalf of the European MSA Study Group
  1. 1Neurology Department, French Reference Center for MSA, University Hospital of Toulouse, Toulouse, France
  2. 2Unité INSERM U 1048 Eq 8, Toulouse, France
  3. 3Faculty of Mathematics, Paul Sabatier University, Toulouse, France
  4. 4Department of Clinical Pharmacology, Clinical Investigation Center CIC 1436, University Hospital of Toulouse, University of Toulouse 3 and INSERM, Toulouse, France
  5. 5Faculty of Medical Sciences, UCA-BIOMED-CONICET, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
  6. 6DIBINEM Alma Mater Studiorum—Università di Bologna, Bologna, Italy
  7. 7IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
  8. 8EuroMov, Laboratoire Movement to Health (M2H), Pôle Sommeil et Neurologie Clinique Beau Soleil, University of Montpellier, Montpellier, France
  9. 9Dipartimento di Neurologia e Psichiatria, Sapienza Università di Roma, Roma, Italy
  10. 10Department of Neurology, Medical University, Innsbruck, Austria
  11. 11Centre de référence atrophie multisystématisée, CHU de Bordeaux, Bordeaux, France
  12. 12Service de Neurologie, CHU de Bordeaux, Bordeaux, France
  13. 13Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
  14. 14Movement Disorders Unit, Department of Neurology, Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
  15. 15Division of Neurobiology, Medical University, Innsbruck, Austria
  16. 16Neurology department, University Hospital Hautepierre, Strasbourg, France
  1. Correspondence to Anne Pavy-Le Traon, MSA Reference Center, Department of Neurology, University Hospital of Toulouse, Hospital Pierre-Paul Riquet, Place du Dr Baylac, Toulouse 31900, France; pavy-letraon.a{at}chu-toulouse.fr

Abstract

Objectives Orthostatic hypotension (OH) is a key feature of multiple system atrophy (MSA), a fatal progressive neurodegenerative disorder associated with autonomic failure, parkinsonism and ataxia. This study aims (1) to determine the clinical spectrum of OH in a large European cohort of patients with MSA and (2) to investigate whether a prolonged postural challenge increases the sensitivity to detect OH in MSA.

Methods Assessment of OH during a 10 min orthostatic test in 349 patients with MSA from seven centres of the European MSA-Study Group (age: 63.6±8.8 years; disease duration: 4.2±2.6 years). Assessment of a possible relationship between OH and MSA subtype (P with predominant parkinsonism or C with predominant cerebellar ataxia), Unified MSA Rating Scale (UMSARS) scores and drug intake.

Results 187 patients (54%) had moderate (>20 mm Hg (systolic blood pressure (SBP)) and/or >10 mm Hg (diastolic blood pressure (DBP)) or severe OH (>30 mm Hg (SBP) and/or >15 mm Hg (DBP)) within 3 min and 250 patients (72%) within 10 min. OH magnitude was significantly associated with disease severity (UMSARS I, II and IV), orthostatic symptoms (UMSARS I) and supine hypertension. OH severity was not associated with MSA subtype. Drug intake did not differ according to OH magnitude except for antihypertensive drugs being less frequently, and antihypotensive drugs more frequently, prescribed in severe OH.

Conclusions This is the largest study of OH in patients with MSA. Our data suggest that the sensitivity to pick up OH increases substantially by a prolonged 10 min orthostatic challenge. These results will help to improve OH management and the design of future clinical trials.

  • MULTISYSTEM ATROPHY
  • AUTONOMIC
  • MOVEMENT DISORDERS

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