ASYMMETRY OF SYMPTOMS AND SIGNS IN MULTIPLE SYSTEM ATROPHY

It has been widely recognized that some of the symptoms and signs of multiple system atrophy (MSA) emerge with laterality, but only a few studies have evaluated this issue comprehensively. Small-scale case reports that have been published thus far suggest that laterality in MSA is a rather rare finding. In order to examine the prevalence and characteristics of laterality in symptoms and signs in MSA, we retrospectively investigated the records of 155 MSA patients. Among all the patients, 39% had episodes that suggested the presence of laterality in their illness history. The MSA with predominant parkinsonism (MSA-P) patients presented with more episodes of laterality than the MSA with cerebellar features (MSA-C) patients. Among the episodes, laterality was more frequent in parkinsonism than for the cerebellar symptoms.Interestingly, these symptoms were more prevalent at the left side of the body. Laterality in the cerebellar signs was present in 63% of the MSA-C patients and laterality in parkinsonism was exhibited by 64% of the MSA-P patients. Interestingly, cerebellar signs, parkinsonism, and Horner's sign were all observed predominantly at the left side. Thus, we concluded that a significant number of MSA patients present with laterality in both symptoms and signs and that more interestingly, these are predominantly observed at the left side.