Red flags for multiple system atrophy

Martin Köllensperger, Felix Geser, Klaus Seppi, Michaela Stampfer-Kountchev, Martin Sawires, Christoph Scherfler, Sylvia Boesch, Joerg Mueller, Vasiliki Koukouni, Niall Quinn, Maria Teresa Pellecchia, Paolo Barone, Nicole Schimke, Richard Dodel, Wolfgang Oertel, Erik Dupont, Karen Østergaard, Christine Daniels, Günther Deuschl, Tanya GurevichNir Giladi, Miguel Coelho, Cristina Sampaio, Christer Nilsson, Håkan Widner, Francesca Del Sorbo, Alberto Albanese, Adriana Cardozo, Eduardo Tolosa, Michael Abele, Thomas Klockgether, Christoph Kamm, Thomas Gasser, Ruth Djaldetti, Carlo Colosimo, Giuseppe Meco, Anette Schrag, Werner Poewe, Gregor K. Wenning

Research output: Contribution to journalArticlepeer-review


The clinical diagnosis of multiple system atrophy (MSA) is fraught with difficulty and there are no pathognomonic features to discriminate the parkinsonian variant (MSA-P) from Parkinson's disease (PD). Besides the poor response to levodopa, and the additional presence of pyramidal or cerebellar signs (ataxia) or autonomic failure as major diagnostic criteria, certain other clinical features known as "red flags" or warning signs may raise the clinical suspicion of MSA. To study the diagnostic role of these features in MSA-P versus PD patients, a standardized red flag check list (RFCL) developed by the European MSA Study Group (EMSA-SG) was administered to 57 patients with probable MSA-P and 116 patients with probable PD diagnosed according to established criteria. Those red flags with a specifity over 95% were selected for further analysis. Factor analysis was applied to reduce the number of red flags. The resulting set was then applied to 17 patients with possible MSA-P who on follow-up fulfilled criteria of probable MSA-P. Red flags were grouped into related categories. With two or more of six red flag categories present specificity was 98.3% and sensitivity was 84.2% in our cohort. When applying these criteria to patients with possible MSA-P, 76.5% of them would have been correctly diagnosed as probable MSA-P 15.9 (±7.0) months earlier than with the Consensus criteria alone. We propose a combination of two out of six red flag categories as additional diagnostic criteria for probable MSA-P.

Original languageEnglish
Pages (from-to)1093-1099
Number of pages7
JournalMovement Disorders
Issue number8
Publication statusPublished - Jun 15 2008


  • Diagnosis
  • Multiple system atrophy
  • Red flags
  • Warning signs

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology


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