Multiple system atrophy (MSA) is a rare condition that causes symptoms similar to
Shy-Drager syndrome; Neurologic orthostatic hypotension; Shy-McGee-Drager syndrome; Parkinson’s plus syndrome; MSA-P; MSA-C
Causes, incidence, and risk factors
The cause is unknown. MSA develops gradually and is most often diagnosed in men older than 60.
MSA damages the nervous system. Symptoms can include:
- Face changes
- “Mask” appearance to face
- May be unable to close mouth
- Reduced ability to show facial expressions
- Difficulty chewing or swallowing (occasionally)
- Disrupted sleep patterns (especially during rapid eye movement (REM) sleep late at night)
Dizzinessor faintingwhen standing up or after standing still
- Frequent falls
- Loss of control over bowels or bladder
- Loss of fine motor skills
- Difficulty eating
- Difficulty with any activity that requires small movements
- Writing that is small and hard to read
- Loss of sweating in any part of the body
- Mild decline in mental function
Movement difficulties Loss of balance
Walking pattern (gait) changes
Muscle achesand pains (myalgia) Muscle rigidity
- Difficulty bending arms or legs
- Nausea and problems with digestion
- Posture difficulties: may be unstable, stooped, or slumped over
- Slow movements
- Difficulty beginning to walk or starting any voluntary movement
- Freezing of movement when the movement is stopped, unable to start moving again
- Small steps followed by the need to run to keep balance
- May become severe enough to interfere with activities
- May be worse when tired, excited, or stressed
- May occur at rest or at any time
- May occur with any action, such as holding a cup or other eating utensils
- Finger-thumb rubbing (pill rolling tremor)
- Vision changes, decreased or
- Voice and speech changes
- Difficulty speaking
- Slow speaking
- Voice is low volume
Other symptoms that may occur with this disease:
Confusion Dementia Depression
- Sleep-related breathing difficulties, especially
sleep apneaor a blockage in the air passage that leads to a harsh vibrating sound
Signs and tests
Your doctor or nurse will examine you, and check your eyes, nerves, and muscles.
Your blood pressure will be taken while you are lying down and standing up.
There are no specific tests to confirm this disease. A neurologist can make the diagnosis based on:
History of symptoms
Physical examination results
Ruling out other causes of symptoms
Testing to help confirm the diagnosis may include:
MRI of head
- Urine examination for norepinephrine breakdown products (
There is no cure for MSA. There is no known way to prevent the disease from getting worse. The goal of treatment is to control symptoms.
Anticholinergic medications may be used to reduce early or mild tremors. Levodopa may improve movement and balance.
Carbidopa is usually added to Levodopa to reduce its side effects and make it work better. However, for people with MSA the response to medications may be disappointing. Many people respond poorly to treatment with anticholinergics or Levodopa.
Medications that may be used to treat low blood pressure include:
A pacemaker that is programmed to stimulate the heart to beat at a rapid rate (faster than 100 beats per minute) may increase blood pressure for some people.
Constipation can be treated with a high-fiber diet and laxatives. Medicines are available to treat impotence.
The outcome is poor. Loss of mental and physical functions slowly get worse. Early death is likely. Patients typically live 7 to 9 years after diagnosis.
- Progressive loss of ability to walk or care for self
- Difficulty performing daily activities
- Injuries from falls/fainting
- Side effects of medications
Calling your health care provider
Call your health care provider if you develop symptoms of this disorder.
Call your health care provider if you have been diagnosed with MSA and your symptoms return or get worse. Also call if new symptoms appear, including possible side effects of medications:
- Changes in alertness/behavior/mood
- Delusional behavior
- Involuntary movements
- Loss of mental functioning
- Severe confusion or disorientation
Contact your health care provider if you have a family member with this disorder and his or her condition deteriorates to the point that you are unable to care for the person at home.