Evidence map›Paper›PMID 29254663›Full record

ArticleParkinsonism & related disorders2018

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

Elizabeth A Coon, J Eric Ahlskog, Michael H Silber, Robert D Fealey, Eduardo E Benarroch, Paola Sandroni, Jay N Mandrekar, Phillip A Low, Wolfgang Singer

Open access · greenAbstract read
In one paragraph

Article in Parkinsonism & related disorders, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
0.4field-weighted citation impact, top 34% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.

  1. A strategic approach of the management of sleep-disordered breathing in multiple system atrophy.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2025
    Pooled it
  2. Review
  3. Review
  4. Article
  5. Coenzyme Q10: Role in Less Common Age-Related Disorders.Antioxidants (Basel, Switzerland) · 2022
    Review
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Elizabeth A CoonDepartment of Neurology, Mayo Clinic, Rochester, MN, USA.
J Eric AhlskogDepartment of Neurology, Mayo Clinic, Rochester, MN, USA.
Michael H SilberDepartment of Neurology, Mayo Clinic, Rochester, MN, USA.
Robert D FealeyDepartment of Neurology, Mayo Clinic, Rochester, MN, USA.
Eduardo E BenarrochDepartment of Neurology, Mayo Clinic, Rochester, MN, USA.
Paola SandroniDepartment of Neurology, Mayo Clinic, Rochester, MN, USA.
Jay N MandrekarDepartment of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
Phillip A LowDepartment of Neurology, Mayo Clinic, Rochester, MN, USA.
Wolfgang SingerDepartment of Neurology, Mayo Clinic, Rochester, MN, USA. Electronic address: Singer.Wolfgang@mayo.edu.
Mayo Clinic in Arizona · USMayo Clinic in Florida · US

Funding

Mayo Clinic Center for Translational Science ActivitiesUL1TR000135 · NCATS · MAYO CLINIC ROCHESTER · PI KHOSLA, SUNDEEP · 2012 to 2015
$41.2M
Studies on Diagnosis, Pathophysiology, and Treatment of Autonomic Failure in MSAP01NS044233 · NINDS · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI LOW, PHILLIP A · 2003 to 2014
$12.4M
Training CoreU54NS065736 · NINDS · VANDERBILT UNIVERSITY MEDICAL CENTER · PI LOW, PHILLIP A · 2009 to 2018
$11.6M
Synucleinopathies – Novel Targets in Early Diagnosis, Pathophysiology, and Therapeutic ApproachR01NS092625 · NINDS · MAYO CLINIC ROCHESTER · PI SINGER, WOLFGANG, VEMURI, PRASHANTHI · 2015 to 2025
$6.6M
Differential Approach to the Postural Tachycardia SyndromeK23NS075141 · NINDS · MAYO CLINIC ROCHESTER · PI SINGER, WOLFGANG · 2012 to 2016
$872k
Phase 1 Study of Autologous Mesenchymal Stem Cell in Multiple System AtrophyR01FD004789 · FDA · MAYO CLINIC ROCHESTER · PI LOW, PHILLIP A · 2014 to 2016
$600k
FDA HHS R01 FD004789NCATS NIH HHS UL1 TR000135NINDS NIH HHS K23 NS075141NINDS NIH HHS P01 NS044233NINDS NIH HHS R01 NS092625NINDS NIH HHS U54 NS065736
6 · The paper itself

Abstract

introductionLoss 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.

methodsReview 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.

resultsOf 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.

conclusionsThere was no difference in survival in MSA patients on an SSRI. However, SSRI use was associated with higher rates of parkinsonism and falls.

Indexed as

Age of OnsetCohort StudiesElectronic Health RecordsFemaleHumansKaplan-Meier EstimateMaleMultiple System AtrophyPolysomnographyRespiratory SoundsSelective Serotonin Reuptake InhibitorsSelective Serotonin Reuptake InhibitorsAutonomicMultiple system atrophyParkinsonismSSRIStridor

Identifiers

PMID29254663
PMCPMC5826868
OpenAlexW2771601047

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.