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Abnormalities of white and grey matter in early multiple system atrophy: comparison of parkinsonian and cerebellar variants

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Abstract

Objective

Multiple system atrophy (MSA) is a neurodegenerative disorder with progressive motor and autonomic dysfunction. There is a paucity of information on the early neurostructural changes in MSA, especially its subtypes, MSA-P (patients with predominant parkinsonism) and MSA-C (patients with predominant cerebellar signs). This study investigates the abnormalities of grey matter (GM) and white matter (WM) in early MSA and its subtypes using multi-modal voxel-based analysis.

Materials and methods

Twenty-six patients with MSA with duration of symptoms ≤ 2.5 years (mean duration: 1.6 ±0.9 years) were assessed clinically and with 3T MRI. Voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) were performed to identify the structural changes in MSA and its subtypes. The GM changes and diffusion parameters of WM tracts were correlated with the clinical scores. The results were compared with MRI of 25 age- and gender-matched healthy controls.

Results

The early structural changes in MSA included GM loss of the cerebellum and subcallosal gyrus with widespread involvement of supratentorial and infratentorial WM fibres. In MSA-C, GM loss was limited to the cerebellum with WM changes predominantly affecting the infratentorial WM and association tracts. In contrast, MSA-P did not demonstrate any GM loss and the WM involvement was mainly supratentorial. There was no significant correlation between structural changes and clinical severity score.

Conclusion

In early MSA, WM microstructure was more affected than GM. These changes were greater in MSA-C than in MSA-P, suggesting variable deterioration in the subtypes of MSA.

Key Points

• Structural changes in early multiple system atrophy were evaluated using multi-modal neuroimaging.

• White matter was more affected than grey matter in early MSA.

• Clinical variables did not correlate with early structural changes.

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Fig. 1
Fig. 2

Abbreviations

CC:

Corpus callosum

DTI:

Diffusion tensor imaging

EMSA-SG:

European multiple system atrophy study group

FA:

Fractional anisotropy

GM:

Grey matter

IC:

Internal capsule

ICP:

Inferior cerebellar peduncle

IFOF:

Inferior fronto-occipital fasciculus

MCP:

Middle cerebellar peduncle

MD:

Mean diffusivity

MRI:

Magnetic resonance imaging

MSA-C:

Cerebellar ataxia predominant multiple system atrophy

MSA-P:

Parkinsonism predominant multiple system atrophy

MSA:

Multiple system atrophy

NAMSA-SG:

North American multiple system atrophy study group

SLF:

Superior longitudinal fasciculus

UMSARS:

Unified multiple system atrophy rating scale

VBM:

Voxel-based morphometry

WM:

White matter

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Author notes

  1. Santosh Kumar Dash and Albert Stezin contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, Karnataka, 560029, India

    Santosh Kumar Dash, Lija George, Nitish L Kamble, M Netravathi, Ravi Yadav & Pramod Kumar Pal

  2. Department of Clinical Neuroscience and Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, Karnataka, 560029, India

    Albert Stezin

  3. Symbiosis Institute of Technology, Symbiosis International University, Lavale, Pune, India

    Tejashree Takalkar & Madhura Ingalhalikar

  4. Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, Karnataka, 560029, India

    Keshav J. Kumar

  5. Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, Karnataka, 560029, India

    Jitender Saini

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  1. Santosh Kumar Dash
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Correspondence to Pramod Kumar Pal.

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The scientific guarantor of this publication is Dr. Pramod Kumar Pal.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Statistics and biometry

No complex statistical methods were necessary for this paper.

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Methodology

• prospective

• case-control study

• performed at one institution

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Dash, S.K., Stezin, A., Takalkar, T. et al. Abnormalities of white and grey matter in early multiple system atrophy: comparison of parkinsonian and cerebellar variants. Eur Radiol 29, 716–724 (2019). https://doi.org/10.1007/s00330-018-5594-9

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  • DOI: https://doi.org/10.1007/s00330-018-5594-9

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