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For the first visit(median,42 months after the onset of symptoms),the raters'sensitivity(median,56%;range,50%-69%)and positive predictive values (median,76%;range,61%-91%)for the clinical diagnosis of MSA were not optimal.For the last visit(74 months after the onset of symptoms),the raters'sensitivity(median,69%;range,56%-94%)and positive predictive values (median,80%;range,77%-92%)improved.Primary neurologists correctly identified 25%and 50%of the patients with MSA at the first and last visits,respectively.False-negative and-positive misdiagnosis frequently occurred in patients with Parkinson disease and progressive supranuclear palsy.Early severe autonomic failure,absence of cognitive impairment,early cerebellar symptoms,and early gait disturbances were identified as the best predictive features to diagnose MSA.The low sensitivity for the clinical diagnosis of MSA,particularly among neurologists who followed up these patients in the tertiary centers,suggests that this disorder is underdiagnosed.The misdiagnosis of MSA is usually due to its confusion with Parkinson disease or progressive supranuclear palsy,thus compromising the research on all 3 disorders. |
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