What Is Multiple System Atrophy (MSA)?
Multiple system atrophy, or MSA, is a rare neurological disorder
that impairs your body’s involuntary functions, including:
- heart rate
- bladder function
- blood pressure
This disorder has many similar symptoms to Parkinson’s
disease, such as impaired movement, poor balance, and muscle rigidity.
According to Orphanet, a consortium of about 40 countries that
collects information on rare diseases, MSA occurs in about five out of every
100,000 people. The Mayo Clinic states that MSA usually occurs between
50 and 60 years of age and tends to affect men more than women.
This progressive disorder is serious.
What Are the Symptoms of Multiple System Atrophy?
Because MSA causes progressive damage to the nervous system, it
can cause a wide range of symptoms, including changes in facial movement, such
- a mask-like appearance to the face
- an inability to close the mouth
- a reduced ability to change facial expressions
MSA can also cause a loss of fine motor skills, which can lead
to difficulty with:
- activities requiring small movements
MSA can cause difficulty with movement, such as:
- a loss of balance
- a change in walking pattern
- 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
- 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
- a loss of bladder and bowel control
- an inability to sweat
- blurred vision
- possible mild impairment of mental function
What Are the Causes of Multiple System Atrophy?
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
How Is Multiple System Atrophy Diagnosed?
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
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
What Complications Are Associated with Multiple System Atrophy?
Complications linked to MSA may include:
gradual loss of the ability to walk
gradual loss of the ability to care for yourself
performing routine activities
MSA can lead to long-term complications, like:
- sleep apnea
How Is Multiple System Atrophy Treated?
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.
To manage symptoms, your doctor may recommend the following:
may prescribe medications to increase your blood pressure and help prevent
dizziness when standing or sitting.
may prescribe medications to reduce balance and movement problems and stiffness.
The benefits of these may gradually decline as the illness progresses.
may need to insert a pacemaker to keep your heart beating at a slightly faster
pace. This can help increase your blood pressure.
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
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.
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
What Is the Long-Term Outlook for People with Multiple System Atrophy?
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.