A neurological disorder that worsens over time and negatively affects your body’s autonomic functions (such as motor control and blood pressure) is called multiple system atrophy (MSA). It is also known as Shy-Drager syndrome, olivopontocerebellar atrophy, or striatonigral degeneration. MSA has many symptoms similar to those of Parkinson’s disease including slow movement, muscle stiffness, poor balance, and others.
Healthcare providers usually prescribe medicines and lifestyle changes to treat this condition. Unfortunately, there is no way to cure MSA but with treatment, you can reduce the symptoms and improve your quality of life. In most cases, MSA progresses gradually leading to death.
Symptoms
This condition can impact different body parts. Commonly, the symptoms appear in adulthood, often between 50-60 years old. In any case, the symptoms are different among people because it depends on the type of MSA you experience. These include Parkinsonian and cerebellar.
Parkinsonian Type
Approximately all diagnosed MSA are Parkinsonian and symptoms are very similar to Parkinson’s disease. Examples include:
- Posture and balance problems
- Soft voice
- Tremors
- Bradykinesia (slow movement)
- Difficulty bending legs and arms
- Rigid muscles
Cerebellar Type
In such cases, the primary symptom is muscle coordination problems (ataxia) but people can experience other symptoms. For example:
- Visual problems (including double or blurred vision, difficulty focusing, and others)
- Speech changes (including slurred speech)
- Swallowing or chewing problems (dysphagia)
- Dysarthria (slow or low-volume speech)
- Problems with coordination and movement (including unsteady gait and loss of balance)
Furthermore, the main symptom of MSA is autonomic failure, which provokes different body function problems. For example:
- Postural (orthostatic) hypotension – This is a form of hypotension that causes dizziness, lightheadedness, and fainting (sometimes) when standing up from lying down or sitting.
- Urinary and bowel dysfunction – It usually leads to constipation and loss of bladder or bowel control (incontinence).
- Sweat production changes – These include reduced sweat production, heat intolerance, and impaired body temperature control.
- Sleep disorders – It leads to agitated sleep (caused by “acting out” dreams) and abnormal breathing during nighttime.
- Sexual dysfunction – Including reduced sex drive and impotence (men lose the ability to get and maintain an erection).
- Cardiovascular problems such as changes in hands and feet color due to pooling of blood.
- Psychiatric issues including mood swings
If you experience any of the symptoms listed above, immediately get medical help.
Causes
However, experts do not know the exact cause of multiple system atrophy. Some researchers suggest that some genetics and certain environmental toxins could play a role. But more research is needed.
This condition provokes damage and shrinkage of certain brain parts (including the cerebellum, basal ganglia, and brainstem). Thus, it leads to different body function problems.
Some doctors analyzed damaged brain tissue from people with MSA under a microscope and identified that nerve cells (neurons) have an increased level of protein (alpha-synuclein). Other healthcare specialists think that alpha-synuclein buildup provokes MSA.
Complications
Once MSA progresses it may interact with daily routine. Check below some potential MSA complications:
- Trouble breathing while sleeping
- Poor balance or fainting can lead to falls and provoke injuries
- Progressive immobility
- Paralysis of the vocal cord which leads usually to shortness of breath and slurred speech
- Swallowing problems
- Inability to take care of yourself
The life expectancy in people with MSA is approximately 10 years depending on how fast the disease progresses. Mostly, death happens due to breathing problems, infections, or pulmonary embolus (blood clots in the lungs).
Diagnosis
Sometimes, it is difficult to diagnose MSA because symptoms are similar to other health conditions (including Parkinson’s disease). The diagnosis usually involves autonomic tests, physical examination, and imaging studies. Because it is challenging to diagnose MSA, many people do not get properly diagnosed.
If physicians suspect you have MSA they will ask you about symptoms and medical history and you may need to do a blood test. They can also order you to do some brain imaging scans (such as MRI) to determine whether you have MSA or not. Check below other tests used to diagnose MSA:
Tilt Table Test
Physicians usually perform this test to identify if a person has blood pressure issues. This test involves a motorized table that straps you in place. Thereafter, physicians will move the table as your body will be positioned at a 70-degree angle.
Autonomic Functions Tests
Healthcare providers may order you some tests to determine the body’s involuntary function. For example:
- Measurement of the blood pressure while lying down or standing
- Sweat test to identify the body regions that sweat
- Bladder and bowel function tests
- Electrocardiogram to measure the electrical signals of the heart
An evaluation in the sleep laboratory is required if you experience sleeping problems including interrupted breathing or snoring. This is how the doctors diagnose sleep disorders (such as sleep apnea).
Treatment
However, it is not possible to cure MSA but with proper treatment, you can reduce the symptoms and improve the quality of life. Check below some treatment options prescribed usually by doctors:
- Medicines to elevate your blood pressure – This category of medications can help to increase blood pressure helping the body to retain more salt and water. These medicines include Pyridostigmine, Midodrine, and Droxidopa (usually used in the treatment of orthostatic hypotension).
- Medicines to lessen Parkinson’s disease symptoms – Doctors may prescribe a combination of medicines such as Levodopa and Carbidopa to reduce symptoms such as stiffness, balance problems, and others. However, many people with MSA do not respond to these medications.
- Erectile Dysfunction (ED) medicines – These include Sildenafil, Tadalafil, Vardenafil, and others.
- Managing swallowing problems – It is advised to eat softer foods in case you have swallowing problems. In severe cases, doctors advise a surgically inserted feeding or breathing tube.
- Bladder control medicines – People who experience bladder control issues may need medications. However, in severe cases, physicians may recommend a soft tube (catheter) that will help you to drain the bladder.
- Therapy – To maintain motor and muscle capacity, you may need a physical therapist. It usually is prescribed by doctors in the advanced stages of MSA.
Frequently Asked Questions
What is the most effective medicine for MSA?
The Parkinson’s medicine Levodopa is usually the most effective medication that helps the patients get rid of symptoms. However, it is not used alone but in combination with other treatment options including speech therapy, physical therapy, and others.
What is the life expectancy for people with multiple system atrophy?
Approximately 90% of 3-year survival rate from onset then 54% of 6-year survival rate. Discuss with your doctor for more details.
Is it possible to cure MSA?
This condition cannot be cured and with early diagnosis and proper treatment, you can get rid of symptoms and improve the quality of life. In case you have additional questions, ask your healthcare provider.
