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J Neurol Neurosurg Psychiatry. 2016 May;87(5):554-61. doi: 10.1136/jnnp-2014-309999. Epub 2015 May 14.

New insights into orthostatic hypotension in multiple system atrophy: a European multicentre cohort study.

Author information

1
Neurology Department, French Reference Center for MSA, University Hospital of Toulouse, Toulouse, France Unité INSERM U 1048 Eq 8, Toulouse, France.
2
Faculty of Mathematics, Paul Sabatier University, Toulouse, France.
3
Department of Clinical Pharmacology, Clinical Investigation Center CIC 1436, University Hospital of Toulouse, University of Toulouse 3 and INSERM, Toulouse, France Faculty of Medical Sciences, UCA-BIOMED-CONICET, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina.
4
DIBINEM Alma Mater Studiorum-Università di Bologna, Bologna, Italy IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
5
Neurology Department, French Reference Center for MSA, University Hospital of Toulouse, Toulouse, France EuroMov, Laboratoire Movement to Health (M2H), Pôle Sommeil et Neurologie Clinique Beau Soleil, University of Montpellier, Montpellier, France.
6
Dipartimento di Neurologia e Psichiatria, Sapienza Università di Roma, Roma, Italy.
7
Neurology Department, French Reference Center for MSA, University Hospital of Toulouse, Toulouse, France.
8
Department of Neurology, Medical University, Innsbruck, Austria.
9
Centre de référence atrophie multisystématisée, CHU de Bordeaux, Bordeaux, France Service de Neurologie, CHU de Bordeaux, Bordeaux, France Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.
10
Movement Disorders Unit, Department of Neurology, Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel.
11
Division of Neurobiology, Medical University, Innsbruck, Austria.
12
Neurology department, University Hospital Hautepierre, Strasbourg, France.
13
Department of Neurology, Medical University, Innsbruck, Austria Division of Neurobiology, Medical University, Innsbruck, Austria.
14
Neurology Department, French Reference Center for MSA, University Hospital of Toulouse, Toulouse, France Department of Clinical Pharmacology, Clinical Investigation Center CIC 1436, University Hospital of Toulouse, University of Toulouse 3 and INSERM, Toulouse, France.

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.

KEYWORDS:

AUTONOMIC; MOVEMENT DISORDERS; MULTISYSTEM ATROPHY

PMID:
25977316
DOI:
10.1136/jnnp-2014-309999
[Indexed for MEDLINE]

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