PT  - JOURNAL ARTICLE
AU  - A Pavy-Le Traon
AU  - A Piedvache
AU  - S Perez-Lloret
AU  - G Calandra-Buonaura
AU  - V Cochen-De Cock
AU  - C Colosimo
AU  - P Cortelli
AU  - R Debs
AU  - S Duerr
AU  - A Fanciulli
AU  - A Foubert-Samier
AU  - A Gerdelat
AU  - T Gurevich
AU  - F Krismer
AU  - W Poewe
AU  - F Tison
AU  - C Tranchant
AU  - G Wenning
AU  - O Rascol
AU  - WG Meissner
TI  - New insights into orthostatic hypotension in multiple system atrophy: a European multicentre cohort study
AID  - 10.1136/jnnp-2014-309999
DP  - 2016 May 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 554--561
VI  - 87
IP  - 5
4099  - http://jnnp.bmj.com/content/87/5/554.short
4100  - http://jnnp.bmj.com/content/87/5/554.full
SO  - J Neurol Neurosurg Psychiatry2016 May 01; 87
AB  - 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.