Table 1.
Form for registration of cases of MSA.
| Item | Option |
|---|---|
| Sex | 1. Male, 2. female |
| Age | |
| Symptoms at onset |
1. Ataxia |
| 2. Parkinsonism | |
| 3. Autonomic dysfunction | |
| Mode of onset | 1. Mild, 2. subacute, 3. acute |
| Progression | 1. Progressive, 2. arrested, 3. improved, 4. other |
| Neurological findings |
1. Walking capacity |
| 2. Gait abnormalities due to parkinsonism | |
| 3. Standing capacity, eyes open | |
| 4. Bent posture | |
| 5. Posture stability | |
| 6. Finger-to-nose test | |
| 7. Knee–tibia test | |
| 8. Tremor at rest | |
| 9. Rigidity | |
| 10. Finger taps | |
| 11. Rising from a chair | |
| Autonomic findings |
1. Head-up tilt test |
| 2. Syncope | |
| 3. Urinary disturbances | |
| 4. Urinary incontinence | |
| 5. Erectile dysfunction (male only) | |
| 6. Severe constipation | |
| Other neurological findings |
1. Dementia |
| 2. Hallucination (non-drug-induced) | |
| 3. Aphasia | |
| 4. Apraxia | |
| 5. Agnosia | |
| 6. Alien hand sign | |
| 7. Vertical supranuclear gaze palsy | |
| 8. Persistent Spontaneous Nystagmus | |
| 9. Dysphasia | |
| 10. Dysarthria | |
| 11. Respiratory failure | |
| 12.Tendon reflex | |
| 13. Babinski reflex | |
| 14. Other neurological findings | |
| Brain images with CT/MRI |
1. CT examination |
| 2. MRI examination | |
| 3. Cerebellar atrophy | |
| 4. Brain-stem atrophy | |
| 5. Hot-cross-bun sign | |
| 6. Striatal atrophy/signal abnormality | |
| 7. Enlargement of 3rd ventricle | |
| 8. Cerebral atrophy | |
| 9. Cerebral white-matter lesion | |
| ADL | 1. Eating |
| 2. Bathing | |
| 3. Hygiene | |
| 4. Dressing | |
| 5. Toileting | |
| 6. Walking (more than 50 m) | |
| 7. Climbing stairs | |
| Medication | 1. Taltirelin hydrate |
| 2. Protirelin tartrate hydrate | |
| 3. Levodopa | |
| 4. Dopamine receptor agonists | |
| 5. Amantadine hydrochloride | |
| 6. Anticholinergics | |
| 7. MAO-B inhibitors | |
| 8. Droxidopa | |
| Diagnosis | 1. SND 2. SDS 3. OPCA |