Definition

Multiple system atrophy (MSA) is a disorder of the nervous system.

MSA is sometimes called a Parkinson plus syndrome because many of the symptoms are similar. There are different types MSA based on symptoms. Once symptoms develop, the average life expectancy is 10 years or less.

Causes

The cause of MSA is unknown. Genetic factors may play a role in some families.

The symptoms are caused by degeneration of nerves throughout the brain and spinal cord. These nerves control automatic functions like balance and muscle coordination. The damage to the nerve may be caused by a buildup of a specific protein, but this is not a confirmed cause.

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Risk Factors

MSA tends to appear after 60 years of age.

Symptoms

Symptoms of MSA can vary greatly. Initial symptoms are similar to those of Parkinson's disease. These initial symptoms may also be determined by the type of MSA:

• Type MSA-A is associated with orthostatic hypotension. This is where blood pressure drops when moving from sitting to standing. It can lead to lightheadedness or fainting.
• Type MSA-P is associated with symptoms similar to initial Parkinson's symptoms such as:
  • Slow, stiff movements
  • Tremors
  • Clumsiness—loss of balance and coordination
  • Shuffling
• Type MSA-C is associated with:
  • Difficulty swallowing
  • Problems speaking and hoarseness
  • Trouble breathing due to tightness in throat
  • Difficulty coordinating muscle movement

As the disease progresses, symptoms will cross over types and become more severe. Many will develop muscle coordination problems and need walking aids. Other problems that may exist across type include:

• Problems with bladder and bowel control
• Erectile dysfunction
• Muscle tightening around a joint that prevents free movement
• Problems with posture, such as leaning to one side and forward head bend
• Trouble with sweating
• Inappropriate laughing or crying
• Excess yawning
• Vision problems
• Changes in writing

Diagnosis

You will be asked about your symptoms and medical history. An exam of the nervous system will also be done. You will likely be referred to a specialist.

Tests may include:

• Blood tests
• Testing of owel and bladder function

Images may be taken of your bodily structures. This can be done with an MRI scan.

Tests will also be done on your heart rate and blood pressure. These tests will help determine what is causing problems with your autonomic nervous system. Nerve impulses to your muscles may also be tested.

Treatment

There is no cure for MSA. Treatment will focus on managing the symptoms and supportive care. Talk with your doctor about the best plan for you. Options include the following:

Prevention

There are no known guidelines to prevent MSA since the cause is not clear.