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Six "red flag" symptoms can strongly distinguish parkinsonian multiple system atrophy (MSA-P) from Parkinson's disease at diagnosis, according to this study. The list of red flag symptoms is used in addition to the Consensus criteria for MSA diagnosis (http://www.mdvu.org/emove/article.asp?ID=42). Fifty-seven patients with probable MSA-P according to Consensus criteria and 116 patients with PD were examined for presence or absence of 22 additional symptoms. All but Raynaud's phenomenon were significantly more common in MSA-P than PD. Thirteen were highly specific for MSA-P; factor analysis was performed to select a subset. Six symptoms were chosen: Early instability Rapid progression Abnormal postures Bulbar dysfunction Respiratory dysfunction Emotional incontinence When at least 2 of these 6 red-flag symptoms were present, the specificity was 98.3% and the sensitivity was 84.2% for a diagnosis of MSA-P. These criteria were then applied to 17 patients originally diagnosed with possible MSA, who progressed to probable MSA-P over 2 years of follow-up. "By applying these criteria.a diagnosis of probable MSA-P would have been possible in 13 (76.5%) already at baseline, on average 15.9 (+/- 7.0) months earlier than with the Consensus criteria alone," the authors report. Red flags for multiple system atrophy M Kollensperger, F Geser, K Seppi, et al., on behalf of the European MSA Study Group (EMSA-SG) Movement Disorders 2008;23:1093-1099 ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn