Symptomatic medication of 97 patients with multiple system atrophy parkinsonian subtype: An observational study

Background: Multiple system atrophy (MSA) is a sporadic, adult-onset and rapidly progressive neurodegenerative disorder. MSA clinically is characterized by prominent autonomic dysfunction with combinations of parkinsonism (MSA-P), cerebellar ataxia (MSA-C) and possible corticospinal signs. To date no disease-modifying treatment is available. Motor symptoms of certain patients with MSA-P, however, are somewhat responsive to dopaminergic medication. Objective: To present the analysis of symptomatic treatment options on 97 patients suffering from probable MSA-P. Methods: A retrospective survey was conducted on 97 patients from a specialized neurological acute care hospital, all meeting appropriate published criteria of probable MSA-P. We undertook a thorough analysis on patients' records regarding the dopaminergic drugs and amantadine. Results: Ten patients from our study cohort received no L-dopa, in the remaining 87 patients (89.69%) the mean L-dopa daily dose was 650.93 +/- 289.21 mg. Fifteen study patients received >= 1000 mg of L-dopa per day. For 31 MSA-P patients (31.96%) dopamine agonists were added as a second treatment option with pramipexole and ropinirole being the most frequently used. Further, two study patients received amantadine as an alternative medication. Conclusions: In the study the considerable proportion of MSA-P patients received high levels of dopaminergic medication chronically. Its efficacy on MSA is still uncertain and further studies with standardised clinical efficacy monitoring are highly welcome.