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.
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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.
- Maintaining heart rhythm
- Having an erection
- 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.
- Heart rhythm problems (these are uncommon).
- 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:
|More common||Less common|
|The P stands for Parkinsonism||The 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.
- 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 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.