Multiple system atrophy (MSA): Topographic distribution of the α-synuclein-associated pathological changes

To study the topographic distribution of the pathology in multiple system atrophy (MSA). Pattern analysis was carried out using α-synuclein immunohistochemistry in 10 MSA cases. The glial cytoplasmic inclusions (GCI) were distributed randomly or in large clusters. The neuronal inclusions (NI) and abnormal neurons were distributed in regular clusters. Clusters of the NI and abnormal neurons were spatially correlated whereas the GCI were not spatially correlated with either the NI or the abnormal neurons. The data suggest that the GCI represent the primary change in MSA and the neuronal pathology develops secondary to the glial pathology.