{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T21:28:03Z","timestamp":1766179683046,"version":"build-2065373602"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2002,5,21]],"date-time":"2002-05-21T00:00:00Z","timestamp":1021939200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Movement Disorders"],"published-print":{"date-parts":[[2002,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The clonidine\u2013growth hormone test (CGHT) has been proposed as a means of differentiating multiple system atrophy (MSA) from idiopathic Parkinson's disease (PD). However, it is controversial whether the CGHT is valid. We sought to confirm the validity of the CGHT and to compare the diagnostic accuracy of the CGHT with that of external anal sphincter electromyelography (Sph\u2010EMG) for MSA. We performed the CGHT and the Sph\u2010EMG on 21 PD patients, 23 patients with probable MSA of parkinsonian type (MSA\u2010p), and 22 patients with probable MSA of cerebellar type (MSA\u2010c). We compared the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of CGHT, Sph\u2010EMG, and a combination of the two tests. We also evaluated the correlations of Unified Parkinson's Disease Rating Scale (UPDRS) scores with the results of the two tests. There was no significant difference between the UPDRS scores for the PD and MSA\u2010p groups. Serum growth hormone concentrations after clonidine significantly increased in PD (mean increase \u00b1 SEM, 4.19 \u00b1 0.92 ng\/ml; <jats:italic>P<\/jats:italic> &lt; 0.0001), but remained unchanged in both MSA\u2010p (0.83 \u00b1 0.61 ng\/ml) and MSA\u2010c (1.45 \u00b1 0.58 ng\/ml). The growth hormone responses to clonidine in MSA\u2010p were significantly different from those in PD (<jats:italic>P<\/jats:italic> &lt; 0.05). Abnormal, denervated Sph\u2010EMG was observed in 95.7% of MSA\u2010p, 86.4% of MSA\u2010c, and 33.3% of PD patients. Compared to Sph\u2010EMG, the CGHT was less sensitive but more specific in both MSA\u2010p and MSA\u2010c. The result of neither test correlated with the severity of parkinsonism. Interestingly, combining the results of the CGHT and Sph\u2010EMG markedly increased the specificity (85.7% in the CGHT and 66.7% in Sph\u2010EMG vs. 95.2% in the combination study) and the PPV in both MSA\u2010p (85.7% and 75.9% vs. 94.4%) and MSA\u2010c (82.4% and 73.1% vs. 91.7%). We confirm that the CGHT can distinguish MSA\u2010p from PD. Its sensitivity is lower and its specificity higher than Sph\u2010EMG. Compared to either test alone, combined testing with the CGHT and Sph\u2010EMG increased specificity and PPV, thereby enhancing accuracy in the diagnosis of MSA. \u00a9 2002 Movement Disorder Society<\/jats:p>","DOI":"10.1002\/mds.10225","type":"journal-article","created":{"date-parts":[[2002,12,4]],"date-time":"2002-12-04T09:20:29Z","timestamp":1038993629000},"page":"1242-1247","source":"Crossref","is-referenced-by-count":20,"title":["Diagnosing multiple system atrophy with greater accuracy: Combined analysis of the clonidine\u2013growth hormone test and external anal sphincter electromyography"],"prefix":"10.1002","volume":"17","author":[{"given":"Eun Ah","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B. Joon","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Won Yong","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2002,5,21]]},"reference":[{"key":"e_1_2_5_2_2","series-title":"Movement disorders","first-page":"262","author":"Quinn N","year":"1994"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/117.4.835"},{"key":"e_1_2_5_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870120611"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/1531-8257(199905)14:3<430::AID-MDS1007>3.0.CO;2-S"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/1531-8257(200011)15:6<1158::AID-MDS1015>3.0.CO;2-0"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.65.1.65"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.54.3.697"},{"key":"e_1_2_5_9_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.53.5.1020"},{"key":"e_1_2_5_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)35246-1"},{"key":"e_1_2_5_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.58.5.618"},{"key":"e_1_2_5_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.60.4.460"},{"key":"e_1_2_5_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(199711)20:11<1396::AID-MUS7>3.0.CO;2-5"},{"key":"e_1_2_5_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/0022-510X(86)90130-9"},{"key":"e_1_2_5_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.1989.tb06043.x"},{"key":"e_1_2_5_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870100504"},{"key":"e_1_2_5_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s004150070158"},{"key":"e_1_2_5_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(92)92355-J"},{"key":"e_1_2_5_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)10168-9"},{"key":"e_1_2_5_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)00147-6"},{"key":"e_1_2_5_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s004150070072"},{"key":"e_1_2_5_22_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.55.3.181"},{"key":"e_1_2_5_23_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.46.5.1470"},{"key":"e_1_2_5_24_2","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/clinchem\/39.4.561","article-title":"Receiver\u2212operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine","volume":"39","author":"Zweig MH","year":"1993","journal-title":"Clin Chem"},{"key":"e_1_2_5_25_2","first-page":"13","article-title":"The use of relative operating characteristic (ROC) curves in test performance evaluation","volume":"110","author":"Beck JR","year":"1986","journal-title":"Arch Pathol Lab Med"},{"key":"e_1_2_5_26_2","first-page":"314","volume-title":"Fundamentals of biostatistics","author":"Rosner B","year":"1995"},{"key":"e_1_2_5_27_2","doi-asserted-by":"publisher","DOI":"10.1159\/000123062"},{"key":"e_1_2_5_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870120203"},{"key":"e_1_2_5_29_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(199709)20:9<1167::AID-MUS12>3.0.CO;2-Q"},{"key":"e_1_2_5_30_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.47.6.637"}],"container-title":["Movement Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fmds.10225","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mds.10225","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T14:24:38Z","timestamp":1760970278000},"score":1,"resource":{"primary":{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/10.1002\/mds.10225"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2002,5,21]]},"references-count":29,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2002,11]]}},"alternative-id":["10.1002\/mds.10225"],"URL":"https:\/\/doi.org\/10.1002\/mds.10225","archive":["Portico"],"relation":{},"ISSN":["0885-3185","1531-8257"],"issn-type":[{"type":"print","value":"0885-3185"},{"type":"electronic","value":"1531-8257"}],"subject":[],"published":{"date-parts":[[2002,5,21]]}}}