Do selective serotonin reuptake inhibitors improve survival in multiple system atrophy?

TY - JOUR

T1 - Do selective serotonin reuptake inhibitors improve survival in multiple system atrophy?

AU - Coon, Elizabeth

AU - Ahlskog, J. Eric

AU - Silber, Michael H.

AU - Fealey, Robert D.

AU - Benarroch, Eduardo E.

AU - Sandroni, Paola

AU - Mandrekar, Jayawant

AU - Low, Phillip Anson

AU - Singer, Wolfgang

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Introduction: Loss of brainstem serotonergic neurons in MSA patients is implicated in respiratory dysfunction including stridor and may increase the risk of sudden death. Augmenting serotonergic transmission through selective serotonergic reuptake inhibitors (SSRIs) has been proposed to improve stridor and prolong survival in multiple system atrophy (MSA). We sought to determine whether MSA patients on an SSRI during their disease course have improved survival compared to those not on an SSRI. Methods: Review of all MSA patients from 1998 to 2012 at Mayo Clinic, Rochester who completed autonomic function testing. Use of SSRI medications was obtained from patient-provided medication lists in the electronic medical record. Clinical symptoms were collected from patient histories; the presence of stridor was obtained from clinical histories and polysomnogram. Surviving patients were called to assess for stridor and SSRI use. Results: Of 685 MSA patients, 132 (19%) were on an SSRI. Median time from symptom onset to death was 7.5 years with no difference based on SSRI use (p = .957). Rates of stridor were similar in SSRI users and non-users based on patient report and polysomnography (p = .494 and p = .181, respectively). SSRI use was associated with parkinsonism (p = .027) and falls (p = .002). Stridor was similar in SSRI users and those not on an SSRI. Conclusions: There was no difference in survival in MSA patients on an SSRI. However, SSRI use was associated with higher rates of parkinsonism and falls.

AB - Introduction: Loss of brainstem serotonergic neurons in MSA patients is implicated in respiratory dysfunction including stridor and may increase the risk of sudden death. Augmenting serotonergic transmission through selective serotonergic reuptake inhibitors (SSRIs) has been proposed to improve stridor and prolong survival in multiple system atrophy (MSA). We sought to determine whether MSA patients on an SSRI during their disease course have improved survival compared to those not on an SSRI. Methods: Review of all MSA patients from 1998 to 2012 at Mayo Clinic, Rochester who completed autonomic function testing. Use of SSRI medications was obtained from patient-provided medication lists in the electronic medical record. Clinical symptoms were collected from patient histories; the presence of stridor was obtained from clinical histories and polysomnogram. Surviving patients were called to assess for stridor and SSRI use. Results: Of 685 MSA patients, 132 (19%) were on an SSRI. Median time from symptom onset to death was 7.5 years with no difference based on SSRI use (p = .957). Rates of stridor were similar in SSRI users and non-users based on patient report and polysomnography (p = .494 and p = .181, respectively). SSRI use was associated with parkinsonism (p = .027) and falls (p = .002). Stridor was similar in SSRI users and those not on an SSRI. Conclusions: There was no difference in survival in MSA patients on an SSRI. However, SSRI use was associated with higher rates of parkinsonism and falls.

KW - Autonomic

KW - Multiple system atrophy

KW - Parkinsonism

KW - SSRI

KW - Stridor

UR - http://www.scopus.com/inward/record.url?scp=85039443463&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85039443463&partnerID=8YFLogxK

U2 - 10.1016/j.parkreldis.2017.12.011

DO - 10.1016/j.parkreldis.2017.12.011

M3 - Article

C2 - 29254663

AN - SCOPUS:85039443463

JO - Parkinsonism and Related Disorders

JF - Parkinsonism and Related Disorders

SN - 1353-8020

ER -