Multiple System Atrophy

What is Multiple System Atrophy?

Multiple system atrophy (MSA) refers to three slowly progressive related disorders that affect the central and autonomic nervous systems. The disorders are characterised by their foremost symptoms: olivopontocerebellar atrophy (OPCA), which primarily affects balance, coordination, and speech; a parkinsonian form (striatonigral degeneration), which can resemble Parkinson's disease because of slow movement and stiff muscles; and a form with predominant autonomic nervous system involvement (formerly Shy-Drager syndrome, now called MSA with orthostatic hypotension). In all three forms of MSA, the patient can have orthostatic, or postural, hypotension-an excessive drop in blood pressure when the patient stands up, which causes dizziness or momentary blackouts. Other symptoms may include stiffness and rigidity, loss of balance and coordination, impaired speech, breathing and swallowing difficulties, blurred vision, male impotence, constipation, and urinary difficulties. Most patients develop dementia late in the course of the disease, which is usually diagnosed in persons over age 50. MSA is twice as common in men as in women.

Is there any treatment?

There is no specific treatment for nerve degeneration in MSA. Levodopa, used to treat rigidity and tremor in Parkinson's disease, may offer some help. However, striatonigral degeneration does not respond well to levodopa. Dopamine and anticholinergic drugs may be prescribed to treat spasms. Orthostatic hypotension may be treated with flucortisone and other drugs that raise blood pressure. Increased dietary fiber intake or use of laxatives may relieve constipation, and drugs or a penile implant may help with male impotence. A routine of stretching and exercise can help retain muscle strength and range of movement. An artificial feeding tube or breathing tube may be surgically inserted for management of swallowing and breathing difficulties.

What is the prognosis?

MSA is a progressive disorder and most patients have a life expectancy after diagnosis of about 10 years or less.
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