What is MSA? [Multiple Systems Atrophy meaning]

Diseases which look like Parkinson’s disease, but have additional features are called “Parkinson’s Plus” syndromes.

You can read more about Parkinson’s Plus Syndromes here.

Multiple System atrophy (MSA) is a Parkinson’s Plus syndrome.

In MSA, a component of our nervous system called the “Autonomic Nervous System” is also affected. This causes problems in body functions such as urination, maintaining blood pressure & cardiac rhythm.

What does the Autonomic Nervous System do?

The Autonomic Nervous System helps us do things that we don’t think about consciously. Thus, it helps us in:

  • Preventing a drop in blood pressure when we stand up from a chair or bed.
    BloodPressure
    The Autonomic Nervous System helps us maintain our Blood Pressure.
  • Maintaining heart rhythm
  • Having an erection
  • Sweating
  • Passing urine and stool

The following symptoms can be seen because of this system dysfunction:

  • A sudden drop in blood pressure can cause sudden dizziness, blurred vision, or loss of consciousness if you stand up abruptly.
    LosingConciousness
    In MSA, patients may feel lightheaded, have blurred visions, or experience loss of consciousness if they stand up suddenly.
  • Heart rhythm problems (these are uncommon).
  • Impotence
  • Reduced sweating
  • Loss of bladder or bowel control or severe constipation

Occasionally, trouble breathing or stridor may be seen. This is a significant problem. Stridor needs to be detected and treated immediately, especially if it occurs in sleep.

Types of MSA

There are 2 types of MSA.

The two types are MSA-P and MSA-C. Both types have the autonomic symptoms described above.

Here are the other differences between the two:

MSA-PMSA-C
More commonLess common
The P stands for ParkinsonismThe C stands for Cerebellum. This brain part helps with balance and coordination.
The 4 cardinal features of Parkinsonism are seen.

These are – slowness, tremor, stiffness & instability.

Out of these, slowness (also called bradykinesia) is most common in MSA-P

These patients appear uncoordinated and unsteady. This is called ATAXIA.

When they are walking, they are unsteady. Therefore they may sway from side-to-side. Onlookers may mistakenly think that they are drunk.

Coordination problems may make it difficult to drink water, write or button shirts.

Swallowing trouble is common.Swallowing trouble appears a bit later.

In the early stages, MSA-P is often misdiagnosed as Parkinson’s disease.

In the early stages, MSA-C patients may have a lot of investigations. This is because many diseases can cause similar symptoms. Click here to know more [External link: Practical Neurology – Khemani 2013].

Later, the autonomic symptoms (described above) become easily noticeable. So, in later stages the diagnosis of MSA becomes easier.

What Causes Multiple System Atrophy (MSA)?

MSA is caused by the accumulation of the same waste material as in Parkinson’s disease (synuclein).

We don’t know why the accumulation of synuclein causes Parkinson’s disease in some and Multiple System Atrophy in others.

What is the Treatment of Multiple System Atrophy (MSA)?

Like all Parkinson’s Plus syndromes, the mainstay treatment is Levodopa. As noted before, the patient’s response to Levodopa is unpredictable and sometimes may not be excellent.

Just like all Parkinson’s Plus syndromes, and Parkinson’s disease itself, many MSA symptoms are treatable. For example:

  • Drop in blood pressure: Maintaining a proper fluid balance and taking medications such as pyridostigmine, fludrocortisone, midodrine may be helpful.
  • Heart rhythm problems: We can control these with medications. In rare cases, a pacemaker may be needed.
    Pacemaker
    Very rarely, a pacemaker may be needed to make sure the heart beats regularly.
  • Impotence: There are many effective medications for impotence.
  • Bladder & bowel control: A mixture of behavioural changes, physical supports (diapers), and medications are usually helpful.
  • Stridor: Patients with stridor may need further evaluation with a sleep study. If there are severe breathing problems while sleeping, then a machine called CPAP can be used to keep the airway open.
    For critical problems, putting a small tube in the windpipe (tracheostomy) may be considered.

Click here to know more about Stridor in MSA [External Link: Cortelli 2019 in the journal Neurology].

 

Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

Call 022-4897-1800

Send Message


NeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar IconNeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar

near LIC, Dr Balabhai Nanavati hospital, near LIC, Swami Vivekananda Road, LIC Colony, Vile Parle

4.6 87 reviews

  • Avatar Paras Prabhu ★★★★★ 6 months ago
    Out patient is epileptic from about 10 years and her seizure gotten worse during the past year with the frequency of about 3-4 times a week.So we consulted … More Dr. Kharkar. He tried a few medicines, and within 1.5-2 months now the patient is feeling very well now. There are no seizures for 14 days currently.Dr. tried to keep medicines as minimum as possible. He also tried to keep the cost of the treatment minimum.When some of the medicines started showing side-effects, he was quick to switch the medicines to the better options.Overall I think we are getting a best of the available treatments. We thank you very much Dr. Kharkar.
  • Avatar Dr Shobha Sankhe ★★★★★ a month ago
    Dr Kharkar is gem of a doctor with tremendous patience, empathy, genuine concern for his patients .He guides them very methodically & scientifically … More for their neurological ill healthOur epilepsy patient is extremely happy with his treatment , Patient feels better by just visiting him too!May his selfless service to humanity flourish to reach all the needy patients!!
  • Avatar shrruti khanna ★★★★★ a month ago
    I consulted Dr Sidharth for my sister who has become very hyper and aggressive and we could not understand the issue. Keeping in mind she is someone with … More special needs Dr Sidharth was extremely understanding of the situation and did not put her through unnecessary investigation and avoided a very long stay at the hospital. He was infact more keen on her returning home to her natural environment. We highly appreciate Dr Sidharth for his effort and for looking into the matter with utmost care. It was a very difficult decision for my family to get my sister admitted but we are glad we did it under his care.Thankyou Doc.
  • Avatar Prashant Purohit ★★★★★ a month ago
    my name is prashant purohit. I m become completely bed ridden from last 9 months and was unable to walk. I couldnt find out the cause even after visiting … More many doctors and many hospital in Ahmedabad nd jodhpur.started losing hope. A good friend of mine suggested to visit a neurologist. After searching a lot, I came to know about Dr. Siddharth Kharkar and took his appointment in Nanavati Hospital. He examined and said that he suffered from \u201cPKD(PAROXYSMAL KNESIGENIC DYSKNESIA\u201c. He assured us to reverse this in 5 days time. And indeed this happened. I started recovering miraculously. today I am fully well fit I m walking as normal . Many Many thanks to Dr. Siddharth Kharkhar sir for giving me a new life.
  • Avatar Sanjay Pradhan ★★★★★ 7 months ago
    Dr. Kharkar is truly exceptional. He is extremely knowledgeable. But simultaneously, he is extremely patient and kind - taking the time and care to respond … More to all the questions. It is rare to come across a doctor who is not in a hurry to get on to the next patient, but instead, focuses on the one in front with full attention, expertise and compassion. A great experience.
  • Avatar N N ★★★★★ 8 months ago
    We visited Dr. Kharkhar for treatment regarding my mum - who is a multi-stroke patient and has aphasia. Certain medications were creating complications … More with her condition and Dr. Kharkhar was able to help mitigate the issue. We found him and his approach to be incredibly compassionate, considerate, individualized and patient-friendly. He advice is astute, up-to-date and empathetic. His treatment always comes from a deeply human place and is about seeing how to help the patient and their caregivers feel more at ease. Something that is quite rare and refreshing within the medical community.We feel that he genuinely cares about the patients that he is treating and is always kind and respectful in his communication. Moreover, his admin team is very efficient and prompt and it's a pleasure to deal with them.Would highly recommend Dr Kharkhar himself - though we must say our experience with Nanavati hospital itself has been less than ideal.Hope this helps.
  • Avatar Manish Ranjan ★★★★★ 8 months ago
    I have been visiting Dr Kharkar for treatment of my father. He is a very friendly doctor. He listens to our concerns with lot of patience. He also explains … More the issue in much greater details. He has really been of great help. My father is much better now.
  • Avatar Pinakin Shah ★★★★★ 6 months ago
    One of the best Dr. Gives complete attention and time to listen to patient's history, issues. Explains various options of treatment with pros and … More cons.
  • Avatar Lawrence Castellino ★★★★★ 8 months ago
    Exceptional experience with an expert,Dr. Kharkar is a knowledge house. It is rare nowadays to find doctors with patience, knowledge, and a flair for … More handling patient’s questions, besides Dr. Kharkar’s bedside manners are exemplary. I am privileged to be treated by such an amazing soul. I have told him and will repeat it here that “I am advancing my move back to India although I am a US Citizen, because I know I am in good hands and will be well taken care of. Thanks Dr. Kharkar for your selfless service!
  • Avatar Hemant Kansara ★★★★★ 10 months ago
    Great doctor!! Really appreciate.The doctor diagnosed to my sister correctly and start treatment, she has good improvement after taking medicine prescribed … More by doctor as no epilepsy attake. We have good experience with the doctor. Thank you

Leave a Comment

India Today Magazine - 2021Noted as one of the best Neurologist in Mumbai

Good Neurologist in Mumbai