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Multiple system atrophy (MSA) - Degenerative neurological disorder

Initial presentation

Multiple system atrophy is a term for a degenerative type of neurological disorder which is often abbreviated to MSA. It is commonly related to the processes of degeneration which occurs in the specific areas of the brain and the nerve cells. As this degeneration takes place it causes numerous different problems inside the human body concerning the balance and the movement along with certain autonomic controls such as the blood pressure regulation or bladder control. It is a quite peculiar fact that there are no known causes of this medical condition and it cannot be related to any specific types of risk factors. Most people do not know that the multiple system atrophy commonly affects men much more than it does affect women. As far as age groups are concerned, people who are in their late fifties or early sixties seem to be affected by the condition more than those from other age groups. The most common symptom and the actual first sign of the multiple system atrophy is the so called akinetic rigid syndrome. This is a term used for the slowness of the initiation of movement which is very similar to Parkinson’s disease. There are also certain other common medical problems which may be associated with multiple system atrophy and those usually involve problems with balance, inability to achieve or sustain an erection and various problems with the bladder including inability to pass urine, incomplete bladder emptying, frequency and urgency.  The combination of unsteady walking, poor coordination, slow movement, tremor, muscle rigidity and autonomic dysfunction is commonly experienced by most people who suffer from multiple system atrophy.

Symptoms as disease progresses

As the disease slowly progresses, there are three main groups of symptoms which dominate above the others. The first group of symptoms is referred to as Parkinsonism which is characterized by writing which becomes spidery and small, along with stiff and slow movement. The second group is referred to as cerebral dysfunction and it is characterized by difficulty coordinating balance and movement. The third group of symptoms is called autonomic dysfunction and it is characterized by a vast array of different types of impaired automatic body functions. These may include REM behavior disorder, sleep apnea, inspirator stridor during sleep, abnormal breathing during sleep, trouble regulating body temperature due to abnormal sweating, dry skin, dry mouth, vocal cord paralysis, constipation, impotence urinary retention, urinary incontinence, fainting upon standing up, dizziness upon standing up, orthostatic hypotension, postural hypotension and various other sorts of sleep disorders. There are also certain rare cases which have included other symptoms such as double vision and significant cognitive impairment.

 Diagnosis and Treatment

The process of diagnosis is quite challenging because there are no particular tests which can be used to confirm the condition in a patient. This is mainly due to the fact that most symptoms usually occur with several other medical conditions, so it is quite hard to pinpoint the exact case of multiple system atrophy. The only way to confirm the multiple system atrophy is to find the evidence of abundant amounts of glial cytoplasmic inclusions in the central nervous system. For now, there is no cure for the multiple system atrophy, so all different treatment methods available are aimed mainly at alleviating the symptoms of the condition. One needs proper care from a neurologist specialized in different types of movement disorders. Those who suffer from this dreadful medical condition need to take fludrocortisones because they often suffer from drops in blood pressure upon standing up. This increases the risks of fainting and injuries from falling. This type of medicament is actually a synthetic type of mineralocorticoid. An alpha agonist known by the name of midodrine is also often used in the treatment of multiple system atrophy. There are also other non drug treatment options available such as pressure stockings, generous intake of fluids, increased intake of salt in the diet, salt tablets, and the head up tilt. It is of extreme importance to avoid dehydration, alcohol, hot weather and all other triggers of low blood pressure. Certain scientific studies have shown that the medication commonly used for the treatment of Parkinson’s disease called levodopa can be of certain help in some cases of multiple system atrophy as well.


Rehabilitation is an essential part of the treatment for all those who suffer from multiple system atrophy, especially those who have problems with speech, daily tasks, movement and walking. This requires management by different professionals which should include speech therapists, occupational therapists, physiotherapists, physiatrists and others. The contractures are prevented and the mobility is increased by utilizing physiotherapy. There are also certain mobility aids which need to be used in some cases.


Unfortunately, there is no remission from the multiple system atrophy, and it progresses much more quickly than the Parkinson’s disease.

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