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Hi all-- Marcia Hutcheson asked about info on MSA, which nudged me to report on my trip to Baylor Med Center's Mvmt Dsrdr Clnc in Houston last week. Dr. Jankovic and his adjunct, Dr. Hanna, were quite thorough in their examination (I had gone there to get a second opinion on whether I had idiopathic PD or MSA as the first specialist said). Before we went, I gathered as much info as possible on MSA and the more I read the more I didn't feel I fit the profile--and the more I realized how incredibly hard it is to differentiate. But for those who want to study up, I'd first recommend asking John C to send you the long study reported in the archives by Jancovic and another (I've loaned out my copy to a support group friend so can't check the name); it details all the "look-alikes" and gives the main symptoms of each in easily read graphs and the relative percentage of occurrence for them. (John C, I hope your having fun but the leaves are reaching their peak here in OK; don't you miss them? just kidding) MSA encompasses three diseases: the original multiple systems atrophy (called Shy-Drager syndrome, a name losing favor) which is a progressive shutdown of the autonomic system (like Marcia's dad's inability to swallow or control body temp in extremities) especially blood pressure--orthostatic hypotension is main symptom; olivopontocerebellar degeneration (OPCB) which strikes the cerebellar functions; and striatonigral degeneration which has parkinsonism symptoms. MSA is often misdiagnosed as PD or progressive supranuclear palsy. These three types of MSA share the fact that the area of the brain affected is not the same as that in PD. I won't bore you, but their symptoms, especially SNG's, overlap PD's to large extent. MSA patients don't respond to L-dopa nearly as well as PWPs. I kept a diary after I was told I had MSA in July and realized Sinemet was helping me far more than I realized--or had indicated to my regular neuro and the first specialist. It had been held out to be something that would help me be almost as good as new at least for the first few years (Dr. Duvoisin, at a seminar I attended 3 mos. post diagnosis, was positively euphoric about it and lit into several doubting Thomases like myself who didn't think it was quite akin to sliced bread). Now I remembered all the list folks like Barb M. who can't take large doses of Sinemet either--we can't all be classified as "other." I think Dr. Jankovic realized that the symptoms I cared about most (soft voice and articulations among them) were not my worst but they were the ones Sinemet doesn't help as much as it does others. Bottom line: he said I had your garden variety PD, albeit with a few anomalies like diphasic distonia (sound familiar, Ida?). He started me on Mirapex, suggested I get another MRI to make sure the cyst hadn't reappeared and sent me on my way. But it was a revelation to learn how hard it is to tell the difference, and who knows? the dx could be wrong; I tried to be as accurate as possible and he seemed to be weighing heavily the one-sidedness of the PD and the visible signs of my walk etc. more than my recollections, so I trust he is right. I'd recommend him to anyone wanting a "definitive" answer--heaven knows he's seen enough of all kinds to be a good judge. Didn't mean to ramble--sorry. Kathy Kunz (62/3+, symp5) <[log in to unmask]> <[log in to unmask]>