Clinical trials in MSA


Mission statement

The early clinical differential diagnosis of atypical parkinsonian disorders including MSA is still challenging and misdiagnosis is common. Hence, further research is required to improve the early clinical differential diagnosis. We have contributed to a better understanding of the significance of autonomic and non-motor symptoms in atypical parkinsonian disorders which will improve the diagnostic accuracy in the longer term. Our second major contribution to science is to improve the laboratory-supported differential diagnosis of parkinsonism. Since clinical symptoms are often overlapping in early disease stages, additional investigations are inevitable to improve diagnostic accuracy. We have a particular research interest in neuroimaging and have generated a record of accomplished and productive research in this field. For clinical trials and other academic research as well as patient counselling it is important to accurately monitor symptom severity and disease progression. We contributed to this field by developing, improving and validating rating scales in movement disorders. In particular, MSA-specific rating scales have been a major research focus. A detailed understanding of the natural disease course is an integral part for the planning of future interventional trials in atypical parkinsonian disorders. We substantially contributed to studies aiming to thoroughly characterize the evolution of symptoms and the progression of disease-specific rating scales in MSA.


Dr. Florian Krismer

Priv.Doz. Dr. KRISMER Florian PhD

Team Leader

Dr. FANCIULLI Alessandra PhD

Prof. Dr. SEPPI Klaus

Dr. SIDOROFF Victoria

Prof. Dr. STEFANOVA Nadia PhD

Research topics

Archer DB, Bricker JT, Chu WT, Burciu RG, Mccracken JL, Lai S, Coombes SA, Fang R, Corcos DM, Kurani AS, Mitchell T, Black ML, Herschel E, Simuni T, Parrish TB, Comella C, Xie T, Seppi K, Bohnen NI, Müller MLTM, Albin RL, Krismer F, Du G, Lewis MM, Huang X, Li H, Pasternak O, McFarland NR, Okun MS, Vaillancourt DE. Development and Validation of the Automated Imaging Differentiation in Parkinsonism (AID-P): A Multi-Site Machine Learning Study. The Lancet Digital Health; 2019;1(5):e222-e231.

Bajaj S, Krismer F, Palma JA, Wenning GK, Kaufmann H, Poewe W, Seppi K. Diffusion-weighted MRI distinguishes Parkinson disease from the parkinsonian variant of multiple system atrophy: A systematic review and meta-analysis. PLoS One. 2017;12(12):e0189897. doi: 10.1371/journal.pone.0189897.

Borm CDJM, Krismer F, Wenning GK, Seppi K, Poewe W, Pellecchia MT, Barone P, Johnsen EL, Østergaard K, Gurevich T, Djaldetti R, Sambati L, Cortelli P, Petrović I, Kostić VS, Brožová H, Růžička E, Marti MJ, Tolosa E, Canesi M, Post B, Nonnekes J, Bloem BR; European MSA Study Group (EMSA-SG). Axial motor clues to identify atypical parkinsonism: A multicentre European cohort study. Parkinsonism Relat Disord. 2018;56:33-40. doi: 10.1016/j.parkreldis.2018.06.015.

Krismer F, Pinter B, Mueller C, Mahlknecht P, Nocker M, Reiter E, Djamshidian-Tehrani A, Boesch SM, Wenning GK, Scherfler C, Poewe W, Seppi K. Sniffing the diagnosis: Olfactory testing in neurodegenerative parkinsonism. Parkinsonism Relat Disord. 2017;35:36-41. doi: 10.1016/j.parkreldis.2016.11.010.

Krismer F, Seppi K, Göbel G, Steiger R, Zucal I, Boesch S, Gizewski ER, Wenning GK, Poewe W, Scherfler C. Morphometric MRI profiles of multiple system atrophy variants and implications for differential diagnosis. Mov Disord. 2019;34(7):1041-1048. doi: 10.1002/mds.27669.

Krismer F, Seppi K, Tison F, et al. The unified Multiple System Atrophy rating scale: Intrarater reliability. Movement Disorders 2012;27(13):1683-5

Krismer F, Susanne Duerr, Martina Minnerop, et al. MSA-QoL: Ein spezifisches Bewertungsinstrument zur Erfassung der Lebensqualität bei Patienten mit Multisystematrophie - Validierung der deutschsprachigen Übersetzung. Nervenarzt 2013;84(6):709-14

Krismer F, Seppi K, Wenning GK, Abler V, Papapetropoulos S, Poewe W. Minimally clinically important decline in the parkinsonian variant of multiple system atrophy. Mov Disord. 2016;31(10):1577-1581. doi: 10.1002/mds.26743.

Krismer F, Seppi K, Wenning GK, Papapetropoulos S, Abler V, Goebel G, Schocke M, Poewe W. Abnormalities on structural MRI associate with faster disease progression in multiple system atrophy. Parkinsonism Relat Disord. 2019;58:23-27. doi: 10.1016/j.parkreldis.2018.08.004.

Krismer F, Seppi K, Wenning GK, Abler V, Papapetropoulos S, Poewe W. Minimally clinically important decline in the parkinsonian variant of multiple system atrophy. Mov Disord. 2016;31(10):1577-1581. doi: 10.1002/mds.26743.

Mahlknecht P, Pechlaner R, Boesveldt S, Volc D, Pinter B, Reiter E, Müller C, Krismer F, Berendse HW, van Hilten JJ, Wuschitz A, Schimetta W, Högl B, Djamshidian A, Nocker M, Göbel G, Gasperi A, Kiechl S, Willeit J, Poewe W, Seppi K. Optimizing odor identification testing as quick and accurate diagnostic tool for Parkinson's disease. Mov Disord. 2016;31(9):1408-13. doi: 10.1002/mds.26637.

Ofori E, Krismer F, Burciu RG, Pasternak O, McCracken JL, Lewis MM, Du G, McFarland NR, Okun MS, Poewe W, Mueller C, Gizewski ER, Schocke M, Kremser C, Li H, Huang X, Seppi K, Vaillancourt DE. Free water improves detection of changes in the substantia nigra in parkinsonism: A multisite study. Mov Disord. 2017;32(10):1457-1464. doi: 10.1002/mds.27100.

Palma JA, Vernetti PM, Perez MA, Krismer F, Seppi K, Fanciulli A, Singer W, Low P, Biaggioni I, Norcliffe-Kaufmann L, Pellecchia MT, Martí MJ, Kim HJ, Merello M, Stankovic I, Poewe W, Betensky R, Wenning G, Kaufmann H. Limitations of the Unified Multiple System Atrophy Rating Scale as outcome measure for clinical trials and a roadmap for improvement. Clin Auton Res. 2021;31(2):157-164. doi: 10.1007/s10286-021-00782-w. Epub 2021 Feb 7. PMID: 33554315; PMCID: PMC7868077.

Pavy-Le Traon A, Piedvache A, Perez-Lloret S, Calandra-Buonaura G, Cochen-De Cock V, Colosimo C, Cortelli P, Debs R, Duerr S, Fanciulli A, Foubert-Samier A, Gerdelat A, Gurevich T, Krismer F, Poewe W,

Tison F, Tranchant C, Wenning G, Rascol O, Meissner WG; European MSA Study Group. New insights into orthostatic hypotension in multiple system atrophy: a European multicentre cohort study. J Neurol Neurosurg Psychiatry 2016;87(5):554-61. doi: 10.1136/jnnp-2014-309999.

Wenning GK, Geser F, Krismer F, et al. The Natural History of Multiple System Atrophy: A Prospective Study by the European MSA Study Group (EMSA-SG). Lancet Neurology 2013;12(3):264-74.