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

Elizabeth Coon, J. Eric Ahlskog, Michael H. Silber, Robert D. Fealey, Eduardo E. Benarroch, Paola Sandroni, Jayawant Mandrekar, Phillip Anson Low, Wolfgang Singer

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalParkinsonism and Related Disorders
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Multiple System Atrophy
Serotonin Uptake Inhibitors
Respiratory Sounds
Survival
Parkinsonian Disorders
Serotonergic Neurons
Polysomnography
Electronic Health Records
Sudden Death
Brain Stem

Keywords

  • Autonomic
  • Multiple system atrophy
  • Parkinsonism
  • SSRI
  • Stridor

ASJC Scopus subject areas

  • Neurology
  • Geriatrics and Gerontology
  • Clinical Neurology

Cite this

Do selective serotonin reuptake inhibitors improve survival in multiple system atrophy? / Coon, Elizabeth; Ahlskog, J. Eric; Silber, Michael H.; Fealey, Robert D.; Benarroch, Eduardo E.; Sandroni, Paola; Mandrekar, Jayawant; Low, Phillip Anson; Singer, Wolfgang.

In: Parkinsonism and Related Disorders, 01.01.2017.

Research output: Contribution to journalArticle

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AU - Ahlskog, J. Eric

AU - Silber, Michael H.

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AU - Benarroch, Eduardo E.

AU - Sandroni, Paola

AU - Mandrekar, Jayawant

AU - Low, Phillip Anson

AU - Singer, Wolfgang

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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.

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