Objective: To perform gait analysis on patients with multiple system atrophy (MSA) and assess whether the obtained data could be used as neurophysiological biomarkers.

Background: We had earlier reported that gait parameters, which were measured by two sets of triaxial accelerometers secured to the lower and upper back of each patient, were useful as objective indicators of spinocerebellar degeneration (SCD). Here, we performed gait analysis on patients with MSA, which develops faster than SCD.

Method: We analyzed acceleration signals through 6 minutes of walking each in 19 MSA patients; six of them were also reanalyzed 3 months after the first analysis. We then extracted the average and coefficient of variation of the motion trajectory amplitude. With reference to our previous research, the data of medial-lateral (ML) and vertical (VT) from the upper back and anterior-posterior (AP) from the lower back were used for evaluation. We observed for a possible correlation with the walk distance, the Scale for the Assessment and Rating of Ataxia (SARA), and the unified MSA rating scale (UMSARS).

Results: Patients in this study included 9 men and 10 women, with an average age of 63.3 years. The walk distance was significantly correlated with both UMSARS Part II (R=-0.8108, p<0.0001) and the gait score of SARA (R=-0.5428, p=0.0163). The average amplitude (AV) of ML, which was previously demonstrated to be a physiological biomarker for cerebellar ataxia, was found to be significantly correlated with the limb ataxia score of SARA (R=0.5744, p=0.0101), while the AV of VT also significantly correlated with the walk distance (R=0.8942, p<0.0001) and UMSARS Part II (R=-0.6997, p=0.0009). The walk distance of the parkinsonism-type MSA was significantly shorter than that of the cerebellar-type MSA (p=0.003). There was no significant correlation in the scores from 3 months after the first analysis due to the sample size being too small for statistical analysis.

Conclusion: UMSARS Part II and the walk distance were significantly correlated with the AV of VT, and thus, it may be a parameter that reflects the disease severity of MSA. Correspondingly, the AV of ML was significantly correlated with the limb ataxia score of SARA, and thus, it may be a parameter that reflects the severity of ataxia with MSA. Further cases and continuous evaluation would be required to confirm the statistically significant parameters that reflect the disease severity of MSA.

References: Shirai S, et al. Quantitative evaluation of gait ataxia by accelerometers. J Neurol Sci 2015; 358: 253-8

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MDS Abstracts - https://www.mdsabstracts.org/abstract/quantitative-evaluation-of-gait-ataxia-of-multiple-system-atrophy-patients/