Multiple system atrophy (MSA) is a rare neurological disorder. According to Orphanet, a consortium of about 40 countries that collects information about rare diseases, MSA occurs about five times per 100,000 people (Orphanet, 2012).
MSA affects the body’s involuntary functions, including heart rate, digestion, bladder function, and blood pressure. This disorder has many similar symptoms to Parkinson’s disease, such as impaired movement, poor balance, and muscle rigidity.
According to the Mayo Clinic, MSA usually occurs between 50 and 60 years of age and tends to affect men more than women (Mayo). This progressive disorder is very serious and, sadly, patients diagnosed with MSA will likely die from related complications in about seven to nine years from their diagnosis.
At this time there is no known cause for MSA. According to the Mayo Clinic, some researchers are currently evaluating the possibility of a genetic aspect of the disease, while others are investigating the involvement of an environmental toxin (Mayo).
MSA causes certain areas of the brain to shrink; these areas include:
- cerebellum: the area of the brain responsible for motor control
- basal ganglia: the area of the brain involved with movement
- brain stem: the area of the brain that sends motor-control signals to the rest of the body
Microscopic analysis of damaged brain tissue from MSA sufferers has revealed an abnormally high level of a protein known as alpha-synuclein; this suggests that excessive production of this protein may be directly linked to the condition.
Because MSA causes progressive damage to the nervous system, it can cause a wide range of symptoms, including:
Changes in facial movement:
- a mask-like appearance to the face
- inability to close the mouth
- reduced ability to change facial expressions
Loss of fine motor skills, which can lead to:
- difficulty eating
- difficulty reading and writing
- difficulty with activities requiring small movements
Movement difficulties, such as:
- loss of balance
- change in walking pattern
- difficulty beginning to walk
- freezing of movement
Tremors, which can:
- interfere with activities
- worsen when stressed, excited, or tired
- occur suddenly during an action such as holding a cup
- include uncontrollable finger and thumb rubbing
Changes in speech and voice, including:
- difficulty speaking
- speaking in monotone
- slow or slurred speech
- speaking in low or high volume
Other symptoms of MSA include:
- occasional difficulty chewing or swallowing
- disrupted sleep patterns
- muscle stiffness in the arms or legs
- muscle aches
- problems with posture
- digestive problems accompanied by nausea
- fainting when standing
- frequent falls
- loss of bladder and bowel control
- inability to sweat
- blurred vision
- mild impairment to mental function (possible)
MSA can lead to more long-term complications, like:
- sleep apnea
There is no specific test for MSA, but your neurologist may make a diagnosis based on:
- your medical history
- the symptoms you are presenting
- your physical examination
- eliminating other causes of your symptoms
MSA is difficult to diagnose and is particularly difficult to differentiate from Parkinson’s disease and atypical Parkinsonian disorders. A variety of tests may be performed in order to narrow the diagnosis. Often the primary symptoms related to MSA are early signs of urogenital dysfunction, such as loss of bladder control and erectile dysfunction (EMSA-SG).
To help determine if you are suffering from MSA, your physician may perform the following examinations:
- a measurement of your blood pressure when standing and lying down
- eye examination
- examination of nerves and muscles
Further tests may include:
- MRI of the head
- plasma norepinephrine levels
- urine sample
Unfortunately there is no cure for MSA. Your doctor will help you to manage the disorder by providing treatment to reduce symptoms as much as possible while maintaining maximum body function.
To manage symptoms, your doctor may recommend:
- Medications to increase blood pressure may help prevent dizziness when standing or sitting.
- Medications to reduce symptoms similar to Parkinson’s disease. Some anti-Parkinson’s medications may be used to reduce balance and movement problems as well as stiffness. The benefits of these medications may gradually decline as the illness progresses.
- A pacemaker may help to keep your heart beating at a slightly faster pace, which can also help increase your blood pressure.
- Impotence medication may be prescribed to manage erectile dysfunction.
Bladder Care and Control
During the early stages of incontinence, your doctor may prescribe medications to help you control problems. During later stages, your doctor may recommend the insertion of a permanent catheter to allow you to pass urine comfortably.
Managing Breathing and Swallowing
If you are experiencing difficulty while swallowing, your doctor may recommend that you eat softer foods. If swallowing and/or breathing become very difficult, he or she may recommend a surgically inserted feeding or breathing tube to make these activities easier. In the later stages of MSA, your doctor may recommend a feeding tube that is surgically inserted directly to your stomach.
Through gentle exercise and repeated motion, physical therapy may help you maintain muscle strength and motor skills for as long as possible as MSA progresses. Speech-language therapy may also help you to maintain speech.
Complications linked to MSA may include:
- gradual loss of ability to walk
- gradual loss of ability to care for self
- difficulty performing routine activities
- injuries from falls
- side effects from medications
Unfortunately, the long-term prognosis of MSA is poor. The disorder becomes progressively worse. The average length of life from diagnosis to death is seven to nine years.