Multiple System Atrophy (MSA) is a group of related syndromes that make up a rare progressive neurological disorder presenting with similar symptoms to Parkinson’s disease. The condition is marked by a combination of symptoms affecting movement, blood pressure, and other body functions; hence the label Multiple System Atrophy.
MSA was the name for disorders once known individually as Striato Nigral Degeneration (SND), Sporadic Olivo Ponto Cerebellar Atrophy (OPCA), and the Shy-Drager Syndrome. Following a consensus conference in 1998, new diagnostic criteria were adapted. It was then recommended that patients be designated as having MSA- C if cerebellar features predominate and MSA-P if Parkinsonian features predominate, instead of using the earlier terms of SND and OPCA respectively,. The term Shy- Drager syndrome was found to no longer be useful as autonomic failure is invariably present.
Key Features
MSA is characterized by symptoms of autonomic nervous system failure; such as lightheadedness, blurred vision or fainting spells due to a fall in blood pressure when standing (orthostatic hypotension), constipation, erectile failure in men, urinary retention and or loss of bowel/bladder control. However, autonomic dysfunction may not always be the presenting feature of MSA. Patients with MSA may also present with in coordination or difficulties with balance (called cerebellar ataxia) or early bulbar and swallowing difficulty.
These symptoms maybe combined with tremor, slowed movements, rigidity, slurred speech, swallowing difficulties and loss of muscle coordination.
Some people with people with MSA may also experience depression and/or anxiety and may develop a dementia.
MSA affects both men and women, primarily in their 50’s, although it has been seen to affect people younger and older than this as well. Progressive in its nature, the condition may progress swiftly or slowly. Most importantly however, every individual may experience a different pattern of signs and symptoms as is the case with Parkinson’s and other movement disorders.
Diagnosing MSA
The diagnosis of MSA is complicated due to the similarities in the nature of its initial symptoms with those of Parkinson’s. However its hallmark of symptoms related autonomic nervous system failure distinguishes it from Parkinson’s and other similar conditions.
Thus it is imperative that the diagnosis be made by a specialist, usually a Neurologist. Since there are no specific tests for the disease, a period of observation is often needed before making such a diagnosis.
Causes of MSA
There is no known cause of MSA. Extensive research in this area is underway, however no proven cause has yet been established.
Treatment for MSA
Currently, there is no specific treatment for MSA. However, anti-parkinsonian drugs such as Levodopa, used to treat rigidity may offer some help. Orthostatic hypotension may be treated with fludro cortisone and other drugs that raise blood pressure.
A routine of stretching and exercise can help retain muscle strength and range of movement. Thus People with MSA, as is the case with Parkinson’s, may benefit from working with a multi disciplinary team that could include Physiotherapists, Speech Therapists, Dieticians, Continence Nurses, Occupational Therapists.
Increased dietary fiber intake or use of laxatives may relieve constipation, and drugs or a penile implant may help with male impotence. An artificial feeding tube or breathing tube may be surgically inserted for management of swallowing and breathing difficulties.
The diagnosis of MSA has significant impact not only on the person but also those close to the person with MSA. Progressive disability results in an increasing need for care and support for the person. Such a loss of independence can also be unsettling and challenging for the individual.
Caregivers and families too may feel stressed, frustrated and chronically tired, thus making the condition harder to cope.
Support services for both the person with MSA and their caregivers is vital to uphold the quality of care, encourage communication and a positive attitude towards ones treatment and care, and also maintain the pleasurable nature of the relationship.