Tremor in Multiple System Atrophy – a review

Christine Kaindlstorfer; Roberta Granata; Gregor Karl Wenning

doi:10.5334/tohm.166

Figures & Tables

TABLE 1

Tremor in MSA

Study Design	Tremor Type (%)				Ref.
Study Design	Rest	Postural and Action	Cerebellar	Any	Ref.
Clinical, prospective, n = 100, 82% MSA-P, 18% MSA-C	29 (9 pill-rolling)	P: 47 (20 jerky)A: 20	15	66	4
Clinical, prospective, n = 24, 100% MSA-C	25	NR	NR	NR	24
Clinicopathological, n = 35, 86% MSA-P, 14% MSA-C	34 (11 pill-rolling)	P: 29A: 9	11	80	13
Clinicopathological, n = 203, 60% MSA-P, 28% MSA-C, 12% mixed	39 (8 pill-rolling)	P: 3 jerky	24	67(25 not specified)	10
Clinical, prospective, n = 11, 100% MSA-P	9 pill-rolling	NR	NR	NR	29
Clinical, prospective, n = 50, 70% MSA-P, 30% MSA-C	22–36 atypical (12 typical)*	P: 28–50A: 14–38	2–32*	50–62*	6
Clinical, prospective, NAMSA-SG, n = 84, MSA-P>MSA-C	39	P: 64	NR	NR	7
Clinical, retrospective, n = 49, 63% MSA-C, 37% MSA-P	33	NR	39	61	8
Clinical, retrospective, German Parkinson Net (KNP), n = 221, subtypes not specified	25	P: 28A: 29	NR	NR	25
Clinical, prospective, red-flag study, EMSA-SG, n = 57, 100% MSA-P	NR	P: 47 jerky	NR	NR	30
Clinical, retrospective, EMSA registry, n = 437, 68% MSA-P and 32% MSA-C	33	P: 54	NR	NR	5
Clinicopathological, n = 43, 12 MSA, 15 PSP, 8 PD and 8 healthy controls	33	NR	NR	NR	26
Clinical, prospective, n = 141, 62% MSA-P, 38% MSA-C	35–43%	56–67%	NR	NR	9

* At latest follow-up.

Abbreviations: A, action tremor; EMSA-SG, European Multiple System Atrophy Study Group; MSA, multiple system atrophy; MSA-C, multiple system atrophy cerebellar variant; MSA-P, multiple system atrophy parkinsonian variant; NAMSA-SG, North American Multiple System Atrophy Study Group; NR, not reported; P, postural tremor; PD, Parkinson’s disease; PSP, progressive supranuclear palsy.

TABLE 2

Tremor Rates in MSA-P and MSA-C

Tremor Type	MSA-P (%)	MSA-C (%)	References
Any	31–83	12–48	4, 8, 10, 11
Rest	32–44	17–26	4, 8, 24
Classic pill-rolling	9–10	6	4
Jerky/postural	47–55	22	4, 28, 30
Action	22	11	4
Intention	11–28	33–45	4, 8

[i] Abbreviations: MSA-C, multiple system atrophy cerebellar variant; MSA-P, multiple system atrophy parkinsonian variant.

TABLE 3

Evolution of MSA Tremor (Modified According to Tison et al 20026)

Tremor Type	Initial Visit (%)		Follow-up Visit (%)^*
MSA	PD	MSA	PD
Any^**	50	82	62	84
Unilateral	26	56	24	20
Asymmetrical	16	12	12	40
Classic pill-rolling	12	68	12	74
Atypical rest⁺	22	4	36	4
Postural	28	6	50	52
Action	14	6	38	16
Intention	2	0	32	12

* Mean follow-up time was 5.5 years after initial presentation.

** Including upper and lower limbs in terms of unilateral and asymmetric appearance and including postural, rest, action, and intention tremor.

+ Defined as fast, irregular, or myoclonic.

{ label (or @symbol) needed for fn[@id='TFN04t03'] } Abbreviations: MSA, multiple system atrophy; PD, Parkinson’s disease.