# Decision‐making trends in therapeutic interventions for multiple system atrophy: a 24‐year retrospective study

## TL;DR

This study examines how treatment choices for multiple system atrophy in Japan changed over 24 years, showing a shift in preferences based on patient age.

## Contribution

The study reveals changing trends in invasive treatment preferences for MSA patients, highlighting the importance of age-based personalized care.

## Key findings

- Tracheostomy invasive ventilation decreased after 2014, especially among younger patients.
- Older patients increasingly opted for enteral nutrition over invasive procedures.
- Age at onset remained consistent for TIV-treated patients before and after 2014.

## Abstract

Managing multiple system atrophy (MSA) is challenging. While invasive interventions for amyotrophic lateral sclerosis are well‐studied, those for MSA remain less explored.

To explore factors influencing treatment choices and trends in advanced‐stage MSA.

A retrospective cohort study analyzed 128 MSA patients at Hyogo Chuo National Hospital, Japan, from 2000 to 2024, focusing on treatment period and age at onset.

Tracheostomy invasive ventilation (TIV) decreased after 2014 (26.9% vs. 9.2%; P = 0.023). TIV‐treated patients remained similarly young before and after 2014 (age at onset 52.7 vs. 54.5 years; P = 0.659) and tracheostomy was chosen by younger patients after 2014 (58.3 vs. 51.5 years; P < 0.001). Conversely, enteral nutrition increased in older patients (57.4 vs. 62.9 years; P = 0.011).

In Japanese MSA, preferences for invasive treatments shifted, with younger patients favoring TIV and tracheostomy, while older patients preferred less invasive options, emphasizing personalized care.