Receiver operating characteristic analysis of sphincter electromyography and post-void residuals for multiple system atrophy

      Background: Although, it is usually difficult to differentiate multiple system atrophy (MSA) from Parkinson’s disease (PD), we have previously reported that post-void residuals and sphincter electromyography were useful for differentiation 1), 2). However, we did not know which is more appropriate in differentiating MSA from PD. Aims: We aimed to perform receiver operating characteristic analysis to determine the ability of sphincter electromyography (mean duration) and post-void residuals (free flow study and pressure-flow study) for distinguishing multiple system atrophy from Parkinson’s disease. Methods: We retrospectively reviewed 241 case records where both urodynamic study and sphincter electromyography were performed in patients with multiple system atrophy (n = 147) and Parkinson's disease (n = 94). We performed receiver operating characteristic analysis of the data sets. Results: The area under the curve (AUC) used to differentiate multiple system atrophy from Parkinson’s disease was 0.79 in post-void residuals during pressure flow study, 0.73 in post-void residuals during free-flow study and 0.69 in mean duration of sphincter electromyography, respectively; these values were statistically significant. Conclusion: The present results suggested that post-void residuals were more appropriate than mean duration of sphincter electromyography in differentiating MSA from PD. In particular, the AUC in post-void residuals under pressure flow study was larger than that of under free-flow study. 1) Yamamoto T, Sakakibara R, Uchiyama T, Yamaguchi C, Ohno S, Nomura F, Yanagisawa M, Hattori T, Kuwabara S. Time-dependent changes and gender differences in urinary dysfunction in patients with multiple system atrophy. Neurourol Urodyn. 2014 Jun;33(5):516-23. 2) Yamamoto T, Sakakibara R, Uchiyama T, Yamaguchi C, Nomura F, Ito T, Yanagisawa M, Yano M, Awa Y, Yamanishi T, Hattori T, Kuwabara S. Receiver operating characteristic analysis of sphincter electromyography for parkinsonian syndrome. Neurourol Urodyn. 2012 Sep;31(7):1128-34.
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