Multiple System Atrophies (MSA)

Because MSA causes progressive damage to the nervous system, it can cause a wide range of symptoms, including changes in facial movement, such as:

• a mask-like appearance to the face
• an inability to close the mouth
• staring
• a reduced ability to change facial expressions

MSA can also cause a loss of fine motor skills, which can lead to difficulty with:

• eating
• reading
• writing
• activities requiring small movements

MSA can cause difficulty with movement, such as:

• a loss of balance
• a change in walking pattern
• shuffling
• difficulty beginning to walk
• the freezing of movement

MSA can cause 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

MSA can cause changes in speech and voice, including:

• difficulty speaking
• monotone speech
• slow or slurred speech
• speaking at a 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
• impotence
• a loss of bladder and bowel control
• an inability to sweat
• blurred vision
• possible mild impairment of mental function

There’s no known cause for MSA. Some current researchers are evaluating the possibility of a genetic aspect of the disease. Other researchers are investigating the involvement of an environmental toxin.

MSA causes certain areas of the brain to shrink, including:

• the cerebellum, which is the area of the brain responsible for motor control and coordination
• the basal ganglia, which is the area of the brain involved with movement
• the brain stem, which is the area of the brain that sends motor control signals to the rest of the body

Microscopic analysis of damaged brain tissue from people with MSA reveals an abnormally high level of a protein known as alpha-synuclein, suggesting that excessive production of this protein may be directly linked to the condition.

There’s no specific test for MSA, but your neurologist may make a diagnosis based on:

• your medical history
• the symptoms you’re experiencing
• a 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. Your doctor may need to perform a variety of tests to make a diagnosis. The primary symptoms often related to MSA are early signs of urogenital dysfunction, such as a loss of bladder control and erectile dysfunction.

Your doctor may measure your blood pressure when standing and lying down, and examine your eyes, your nerves, and your muscles to help them determine if you have MSA.

Further tests may include an MRI of the head and a determination of plasma norepinephrine hormone levels in your blood. Your urine may also be tested.

Complications linked to MSA may include:

• a gradual loss of the ability to walk
• a gradual loss of the ability to care for yourself
• difficulty performing routine activities
• injuries from falls

MSA can lead to long-term complications, like:

• dementia
• confusion
• depression
• sleep apnea

Unfortunately, there’s no cure for MSA. Your doctor will help you manage the disorder by providing treatment that reduces symptoms as much as possible while maintaining maximum body function. Certain medications used to treat MSA can lead to side effects.

Managing Symptoms

To manage symptoms, your doctor may recommend the following:

• They may prescribe medications to increase your blood pressure and help prevent dizziness when standing or sitting.
• They may prescribe medications to reduce balance and movement problems and stiffness. The benefits of these may gradually decline as the illness progresses.
• They may need to insert a pacemaker to keep your heart beating at a slightly faster pace. This can help increase your blood pressure.
• They may provide medication 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’re experiencing difficulty swallowing, your doctor may recommend that you eat softer foods. If swallowing or breathing become difficult, your doctor may recommend surgically inserting a feeding or breathing tube to make these activities easier. In the later stages of MSA, your doctor may recommend a feeding tube that goes directly to your stomach.

Physical Therapy

Through gentle exercise and repeated motion, physical therapy may help you maintain muscle strength and motor skills for as long as possible while MSA progresses. Speech-language therapy may also help you to maintain speech.

Currently, there’s no cure for MSA. For a majority of people, life expectancy is seven to nine years from diagnosis. Some people with the disease live for up to 18 years after being diagnosed.

Research on this rare disease is ongoing, and therapies that work for other neurodegenerative disease may prove to be effective for this disease as well.