The Unified Multiple System Atrophy Rating Scale: Status, Critique, and Recommendations

Florian Krismer, Jose‐Alberto Palma, Giovanna Calandra‐Buonaura, Iva Stankovic, Luca Vignatelli, Anna‐Karin Berger, Cristian Falup‐Pecurariu, Alexandra Foubert‐Samier, Günter Höglinger, Horacio Kaufmann, Larry Kellerman, Han‐Joon Kim, Thomas Klockgether, Johannes Levin, Pablo Martinez‐Martin, Tiago A. Mestre, Maria Teresa Pellecchia, Susan Perlman, Irfan Qureshi, Olivier Rascol, Anette Schrag, Klaus Seppi, Huifang Shang, Glenn T. Stebbins, Gregor K. Wenning, Wolfgang Singer, Wassilios G. Meissner
Movement Disorders. 2022-09-08; 37(12): 2336-2341
DOI: 10.1002/mds.29215

Lire sur PubMed

Krismer F(1), Palma JA(2), Calandra-Buonaura G(3)(4), Stankovic I(5), Vignatelli L(3)(4), Berger AK(6), Falup-Pecurariu C(7), Foubert-Samier A(8), Höglinger G(9)(10), Kaufmann H(2), Kellerman L(11), Kim HJ(12), Klockgether T(13)(14), Levin J(9)(15)(16)(17), Martinez-Martin P(18), Mestre TA(19), Pellecchia MT(20), Perlman S(21), Qureshi I(22), Rascol O(23), Schrag A(24), Seppi K(1), Shang H(25), Stebbins GT(26), Wenning GK(1), Singer W(27), Meissner WG(8)(28)(29)(30).

Author information:
(1)Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
(2)Department of Neurology, New York University Grossman School of Medicine, New
York, New York, USA.
(3)Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna,
Bologna, Italy.
(4)IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
(5)Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University
of Belgrade, Beograd, Serbia.
(6)Clinical Science, Assessment and Innovation, Department of Clinical
Development, Lundbeck, Valby, Denmark.
(7)Department of Neurology, County Clinic Hospital, Faculty of Medicine,
Transylvania University, Brasov, Romania.
(8)CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc,
Bordeaux, France.
(9)German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
(10)Department of Neurology, Hannover Medical School, Hannover, Germany.
(11)Patient Advocacy Group, Multiple System Atrophy Coalition, McLean, Virginia,
(12)Department of Neurology and Movement Disorder Center, Seoul National
University Hospital, Seoul, South Korea.
(13)Department of Neurology, University Hospital Bonn, Bonn, Germany.
(14)German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
(15)Department of Neurology, Ludwig-Maximilians-Universität München, Munich,
(16)Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
(17)SME, MODAG GmbH, Wendelsheim, Germany.
(18)Center for Networked Biomedical Research in Neurodegenerative Diseases
(CIBERNED), Carlos III Institute of Health, Madrid, Spain.
(19)Parkinson’s Disease and Movement Disorders Center, Division of Neurology,
Department of Medicine, The Ottawa Hospital Research Institute, University of
Ottawa Brain and Mind Institute, Ottawa, Ontario, Canada.
(20)Department of Medicine, Surgery and Dentistry, Neuroscience Section,
University of Salerno, Salerno, Italy.
(21)Department of Neurology, David Geffen School of Medicine at UCLA, Los
Angeles, California, USA.
(22)Pharmaceutical Company, Biohaven Pharmaceuticals, New Haven, Connecticut,
(23)French Reference Center for MSA, CIC 1436, NS-Park/FCRIN network and
NeuroToul COEN Center, University Hospital of Toulouse, University of Toulouse 3
and INSERM, Toulouse, France.
(24)Department of Clinical Neurosciences, UCL Queen Square Institute of
Neurology, University College London, London, United Kingdom.
(25)Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare
Diseases Center, West China Hospital, Sichuan University, Chengdu, China.
(26)Department of Neurological Sciences, Rush University Medical Center,
Chicago, Illinois, USA.
(27)Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
(28)University of Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France.
(29)Department of Medicine, University of Otago, Christchurch, New Zealand.
(30)New Zealand Brain Research Institute, Christchurch, New Zealand.

The Unified Multiple System Atrophy (MSA) Rating Scale was developed to provide
a surrogate marker of disease severity and clinical progression in patients with
MSA. It is comprised of four subscales: UMSARS-I (12 items) rates
patient-reported functional disability; UMSARS-II (14 items) assesses motor
impairment based on a clinical examination; UMSARS-III records blood pressure
and heart rate in the supine and standing positions; and UMSARS-IV (1 item)
rates chore-based disability. Strengths of the UMSARS include its wide
acceptance in the field, the comprehensive coverage of motor symptoms and its
clinimetric properties (including reliability and validity). However, with its
increasing use, potential areas of improvement in the UMSARS have become
apparent. To address these limitations, a task force, involving clinicians,
researchers, patient groups, and industry representatives, has recently been
endorsed by the International Parkinson’s Disease and Movement Disorders
Society. The present viewpoint summarizes strengths and weaknesses of the UMSARS
and suggests a roadmap to develop an improved MSA clinical outcome assessment.


Auteurs Bordeaux Neurocampus