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April 28, 2020; 94 (17) Article

Progression and prognosis in multiple system atrophy presenting with REM behavior disorder

View ORCID ProfileGiulia Giannini, Vincenzo Mastrangelo, Federica Provini, Andrea Droghini, Annagrazia Cecere, Giorgio Barletta, Francesco Mignani, Pietro Guaraldi, Pietro Cortelli, Giovanna Calandra-Buonaura
First published March 31, 2020, DOI: https://doi.org/10.1212/WNL.0000000000009372
Giulia Giannini
From IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G., F.P., A.C., G.B., F.M., P.G., P.C., G.C.-B.), UOC Clinica Neurologica Rete Metropolitana NEUROMET; Department of Biomedical and NeuroMotor Sciences (DiBiNeM) (G.G., V.M., F.P., A.D., G.B., P.C., G.C.-B.), Alma Mater Studiorum–University of Bologna; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
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  • ORCID record for Giulia Giannini
Vincenzo Mastrangelo
From IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G., F.P., A.C., G.B., F.M., P.G., P.C., G.C.-B.), UOC Clinica Neurologica Rete Metropolitana NEUROMET; Department of Biomedical and NeuroMotor Sciences (DiBiNeM) (G.G., V.M., F.P., A.D., G.B., P.C., G.C.-B.), Alma Mater Studiorum–University of Bologna; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
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Federica Provini
From IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G., F.P., A.C., G.B., F.M., P.G., P.C., G.C.-B.), UOC Clinica Neurologica Rete Metropolitana NEUROMET; Department of Biomedical and NeuroMotor Sciences (DiBiNeM) (G.G., V.M., F.P., A.D., G.B., P.C., G.C.-B.), Alma Mater Studiorum–University of Bologna; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
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Andrea Droghini
From IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G., F.P., A.C., G.B., F.M., P.G., P.C., G.C.-B.), UOC Clinica Neurologica Rete Metropolitana NEUROMET; Department of Biomedical and NeuroMotor Sciences (DiBiNeM) (G.G., V.M., F.P., A.D., G.B., P.C., G.C.-B.), Alma Mater Studiorum–University of Bologna; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
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Annagrazia Cecere
From IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G., F.P., A.C., G.B., F.M., P.G., P.C., G.C.-B.), UOC Clinica Neurologica Rete Metropolitana NEUROMET; Department of Biomedical and NeuroMotor Sciences (DiBiNeM) (G.G., V.M., F.P., A.D., G.B., P.C., G.C.-B.), Alma Mater Studiorum–University of Bologna; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
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Giorgio Barletta
From IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G., F.P., A.C., G.B., F.M., P.G., P.C., G.C.-B.), UOC Clinica Neurologica Rete Metropolitana NEUROMET; Department of Biomedical and NeuroMotor Sciences (DiBiNeM) (G.G., V.M., F.P., A.D., G.B., P.C., G.C.-B.), Alma Mater Studiorum–University of Bologna; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
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Francesco Mignani
From IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G., F.P., A.C., G.B., F.M., P.G., P.C., G.C.-B.), UOC Clinica Neurologica Rete Metropolitana NEUROMET; Department of Biomedical and NeuroMotor Sciences (DiBiNeM) (G.G., V.M., F.P., A.D., G.B., P.C., G.C.-B.), Alma Mater Studiorum–University of Bologna; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
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Pietro Guaraldi
From IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G., F.P., A.C., G.B., F.M., P.G., P.C., G.C.-B.), UOC Clinica Neurologica Rete Metropolitana NEUROMET; Department of Biomedical and NeuroMotor Sciences (DiBiNeM) (G.G., V.M., F.P., A.D., G.B., P.C., G.C.-B.), Alma Mater Studiorum–University of Bologna; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
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Pietro Cortelli
From IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G., F.P., A.C., G.B., F.M., P.G., P.C., G.C.-B.), UOC Clinica Neurologica Rete Metropolitana NEUROMET; Department of Biomedical and NeuroMotor Sciences (DiBiNeM) (G.G., V.M., F.P., A.D., G.B., P.C., G.C.-B.), Alma Mater Studiorum–University of Bologna; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
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Giovanna Calandra-Buonaura
From IRCCS Istituto delle Scienze Neurologiche di Bologna (G.G., F.P., A.C., G.B., F.M., P.G., P.C., G.C.-B.), UOC Clinica Neurologica Rete Metropolitana NEUROMET; Department of Biomedical and NeuroMotor Sciences (DiBiNeM) (G.G., V.M., F.P., A.D., G.B., P.C., G.C.-B.), Alma Mater Studiorum–University of Bologna; and Neurology Outpatient Clinic, Department of Primary Care (P.G.), Local Health Authority of Modena, Italy.
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Progression and prognosis in multiple system atrophy presenting with REM behavior disorder
Giulia Giannini, Vincenzo Mastrangelo, Federica Provini, Andrea Droghini, Annagrazia Cecere, Giorgio Barletta, Francesco Mignani, Pietro Guaraldi, Pietro Cortelli, Giovanna Calandra-Buonaura
Neurology Apr 2020, 94 (17) e1828-e1834; DOI: 10.1212/WNL.0000000000009372

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Abstract

Objectives To investigate (1) the prevalence of REM sleep behavior disorder (RBD) as mode of disease onset in a cohort of patients with multiple system atrophy (MSA) and (2) disease progression and prognosis in patients with MSA with RBD predating (pre-RBD) and following (post-RBD) disease onset.

Methods We retrospectively identified all patients with a clinical diagnosis of MSA evaluated at least once a year during the disease course. Type of onset was defined by the first reported motor or autonomic symptom/sign related to MSA. The occurrence of symptoms/signs and milestone of disease progression, and their latency from disease onset, were collected. Survival data were calculated. RBD was confirmed by video-polysomnography.

Results Of a total of 158 patients, pre-RBD represented the mode of disease onset in 27% of patients, preceding disease onset according to the international criteria with a median of 3 (2–5) years. Comparing pre-RBD and post-RBD patients, the first group showed an increased prevalence of autonomic onset of disease, a reduced prevalence of parkinsonism, an earlier onset of stridor, pyramidal signs, symptomatic orthostatic hypotension, urinary dysfunction, severe dysphagia, and wheelchair dependency. The risk of death was higher in patients with pre-RBD.

Conclusions In our MSA cohort, RBD represented the most frequent mode of disease presentation. A more rapid progression of disease was observed in the pre-RBD group. These findings suggested a careful assessment of sleep disorders to early recognize RBD and a closer follow-up of autonomic dysfunction and stridor in patients with pre-RBD.

Glossary

CI=
confidence interval;
DiBiNeM=
Department of Biomedical and Neuromotor Sciences;
IQR=
interquartile range;
MSA=
multiple system atrophy;
MSA-C=
cerebellar multiple system atrophy;
MSA-P=
parkinsonian multiple system atrophy;
OH=
orthostatic hypotension;
RBD=
REM sleep behavior disorder;
VPSG=
video polysomnography

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • ↵* These authors contributed equally to this work.

  • Received July 29, 2019.
  • Accepted in final form November 14, 2019.
  • © 2020 American Academy of Neurology
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