Natural history of multiple system atrophy in the USA: a prospective cohort study.

Background: Multiple system atrophy is a rare, fatal neurodegenerative disorder with symptoms of autonomic failure plus parkinsonism, cerebellar ataxia, or both. We report results of the first prospective natural history study of multiple system atrophy in the USA, and the effects of phenotype and autonomic failure on prognosis.

Methods: We recruited participants with probable multiple system atrophy-of either the parkinsonism subtype (MSA-P) or the cerebellar ataxia subtype (MSA-C)-at 12 neurology centres in the USA specialising in movement or autonomic disorders.

Potential outcome measures and trial design issues for multiple system atrophy.

Multiple system atrophy (MSA) is a neurodegenerative disorder exhibiting a combination of parkinsonism, cerebellar ataxia, and autonomic failure. A disease-specific scale, the Unified Multiple System Atrophy Rating Scale (UMSARS), has been developed and validated to measure progression of MSA, but its use as an outcome measure for therapeutic trials has not been evaluated. On the basis of twelve months of follow-up from an observational study of 67 patients with probable MSA, we evaluated three disease-specific scores: Activities of Daily Living, Motor Examination, and a combined score from the UMSARS and two general health scores, the Physical Health and Mental Health scores of the SF-36 health survey, for their use as outcome measures in a therapeutic trial.

Pramipexole vs levodopa as initial treatment for Parkinson disease: a 4-year randomized controlled trial.

Background: The best way to initiate dopaminergic therapy for early Parkinson disease remains unclear.

Objective: To compare initial treatment with pramipexole vs levodopa in early Parkinson disease, followed by levodopa supplementation, with respect to the development of dopaminergic motor complications, other adverse events, and functional and quality-of-life outcomes.

Design: Multicenter, parallel-group, double-blind, randomized controlled trial.

Structure, odd lines and topological entropy of disorder of amorphous silicon.

A continuous random network model of amorphous silicon, subject to periodic boundary conditions, is partitioned into cells bounded by irreducible rings. An algorithm has been developed to find the cells and the rings that bound them. A thread can be imagined to pass through odd rings (rings containing an odd number of atoms) without passing through even rings.