Juliet Cohen

Detailed Information on Multiple System Atrophy

Multiple system atrophy affects about twice as many men as women.

MSA is also known as Shy-Drager syndrome. Multiple System Atrophy (MSA) is an adult-onset disease with features of Parkinsonism, autonomic dysfunction, urinary dysfunction and cerebellar ataxia. Patients with MSA have more widespread damage to the autonomic nervous system, the part of the nervous system that controls involuntary functions. The disorder is characterized by postural hypotension. 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.

MSA has been classified clinically into three types, the first of which primarily affects balance, coordination, and speech; a form which can parallel Parkinson’s disease because of slow movement and stiff muscles; and a mixed cerebellar and parkinsonian form. MSA results from degeneration of several parts of the brain and spinal cord. The basal ganglia (collections of nerve cells at the base of the cerebrum, deep within the brain), which help control voluntary muscle movements by balancing the actions of muscle groups that move the same muscles in opposite ways.

The cerebellum, which coordinates voluntary movements and helps maintain balance. Areas that manage the autonomic nervous system, which moderates involuntary body processes, such as how blood pressure changes in response to changes in posture. Nerve cells that encourage muscle action (motor neurons) in the cerebellum, basal ganglia, and spinal cord. There is no specific treatment for nerve degeneration in MSA. The goal of treatment is to control symptoms. Anticholinergic medications may be used to decrease early or mild tremors. Levodopa may improve movement and balance.

Dopamine and anticholinergic drugs may be prescribed to treat spasms. Orthostatic hypotension may be treated with flucortisone and other drugs that elevate blood pressure. Increased dietary fiber intake or use of laxatives may relieve constipation, and drugs or a penile implant may aid 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. Speech therapy is often useful to improve swallowing and communication.

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