Diagnostic criteria for MSA (“second consensus statement”)

International experts on multiple system atrophy (MSA) have revised the diagnostic criteria.  The new criteria are called the “second consensus statement.”

You can find the second consensus statement online at no charge:

www.ncbi.nlm.nih.gov/pmc/articles/PMC2676993/

This paper includes the diagnostic criteria for MSA-P and MSA-C.  (Note that MSA-A no longer exists.)  The “P” stands for parkinsonism while the “C” stands for cerebellar.

One important table in the statement is table 4, which lists symptoms that do NOT support a diagnosis of MSA.  This list includes:

* classic pill-rolling rest tremor
* clinically significant neuropathy
* hallucinations not induced by drugs
* onset after age 75 years
* family history of ataxia or parkinsonism
* dementia (on DSM-IV)
* white matter lesions suggesting multiple sclerosis

Also, interestingly, the criteria for the diagnosis of probable MSA mentions “urinary incontinence.”  That symptom is described as “inability to control the release of urine from the bladder.”  In contrast, the criteria for the diagnosis of possible MSA mentions several possible urinary problems, including “otherwise unexplained urinary urgency, frequency or incomplete bladder emptying.”

The criteria for the diagnosis of probable MSA requires that there be a certain decrease in blood pressure:  “orthostatic decrease of blood pressure within 3 [minutes] of standing by at least 30 mm Hg systolic or 15 mm Hg diastolic.”  If that level of decrease isn’t seen, then the person might be diagnosed as having possible MSA.

I believe that those diagnosed with MSA should understand on what basis they’ve been given that diagnosis, and this helps to accomplish that understanding.