Multiple system atrophy (MSA)

Multiple system atrophy (MSA), also referred to as Shy-Drager Syndrome, is a neurological condition causing motor and autonomic symptoms due to its impact on the autonomic nervous system. These symptoms include balance problems, tremors, muscle weakness and significant impact on the legs.

Though there isn't a cure for this condition yet, early detection and proper treatment can aid in easing symptoms and enhancing the well-being of those affected.

If you or someone you know encounters any of the signs linked with multiple system atrophy, it's imperative to seek medical attention.

What is multiple system atrophy?

Multiple system atrophy stands as a rare and progressive neurological disorder that affects various bodily systems. Picture it akin to a glitch in the body's operating system, causing disturbances in movement, balance and involuntary functions such as blood pressure and bladder control.

In contrast to other neurodegenerative ailments like Parkinson's disease or multiple sclerosis (MS), multiple system atrophy doesn't singularly target one area of the brain or nervous system. Instead, it impacts multiple systems at the same time.

For instance, Parkinson's disease predominantly affects movement, displaying symptoms like tremors, stiffness and slowed movement. Conversely, multiple sclerosis primarily targets the central nervous system, inducing damage to the protective layer of nerve fibers (myelin sheath), resulting in an array of symptoms like fatigue, muscle weakness and vision issues.

Types of multiple system atrophy

MSA comes in two main types: MSA-C and MSA-P. Think of them as two different versions of the same problem.

• MSA-C: Primarily affects cerebellar functions (the "C" stands for cerebellar), leading to problems with coordination, balance and speech. This type may not have as many movement-related symptoms initially, but it can still cause significant difficulties in daily life.
• MSA-P: Primarily affects movement (the "P" stands for parkinsonism), leading to symptoms like Parkinson's disease, such as muscle stiffness, tremors and difficulty with coordination and balance.

What are the symptoms of MSA?

Multiple system atrophy can manifest a range of symptoms affecting movement and bodily functions, causing trouble in multiple areas simultaneously.

Multiple system atrophy symptoms may include:

• Changes in sweat production
• Color changes in hands and feet caused by pooling of blood
• Constipation
• Difficulty controlling emotions, such as laughing or crying inappropriately
• Dizziness, feeling lightheaded or fainting
• Impaired body temperature control, often causing cold hands or feet
• Impotence in men
• Heat intolerance due to reduced sweating
• Loss of bladder or bowel control (incontinence)
• Loss of libido
• Low blood pressure
• Sleep disorders
• Urinary and bowel dysfunction

While these are general symptoms, each type of multiple system atrophy also presents its own set of symptoms.

MSA-C symptoms

• Blurred or double vision
• Difficulty focusing your eyes
• Difficulty swallowing
• Impaired ability to walk and keep your balance
• Loss of muscle coordination (ataxia)
• Slurred speech or soft speaking

MSA-P symptoms

• Balance and posture problems
• Difficulty bending your arms and legs
• Muscle stiffness
• Slow movement
• Tremors in your arms and legs

How does MSA affect the legs?

Multiple system atrophy is a rare neurodegenerative disorder that primarily affects the autonomic nervous system and movement control.

While MSA primarily affects the autonomic nervous system, it can also lead to significant motor symptoms that affect the legs, which includes:

• Balance and coordination: Problems with balance and coordination are common with multiple system atrophy, making it difficult to maintain an upright posture. This instability can affect the legs, leading to difficulties with walking and increasing the risk of falls.
• Gait abnormalities: Changes in gait, including a shuffling or hesitant walk, reduced stride length and difficulty initiating movement are common with multiple system atrophy.
• Muscle weakness: As the disease progresses, muscle weakness may develop in the legs. This weakness can contribute to difficulties with walking, climbing stairs and performing other activities that require leg strength.
• Orthostatic hypotension: Multiple system atrophy often results in orthostatic hypotension, a drop in blood pressure upon standing up. Symptoms include dizziness, lightheadedness, and fainting, which can affect the legs' ability to support the body when standing.
• Parkinsonian symptoms: Multiple system atrophy often starts with symptoms, such as slowness of movement, rigidity and tremors. These symptoms often affect the legs, causing stiffness and difficulty with movement.

MSA causes and risk factors

The occurrence of multiple system atrophy involves various factors contributing to its onset. Scientists believe that it arises from a blend of genetic predispositions, environmental influences and other risk elements.

Although the precise cause of MSA remains unknown, significant progress has been made through research.

Genetics play a pivotal role in the development of multiple system atrophy. Specific genetic variations may heighten an individual's vulnerability to the disease, yet they typically interact with other factors to trigger MSA onset.

These genetic factors disrupt the functioning of proteins within cells, fostering abnormal protein accumulation in the brain — a defining characteristic of multiple system atrophy.

Several factors may escalate an individual's risk of developing MSA. Notably, age is a significant risk factor with the condition typically manifesting in adulthood, typically around ages 50-60.

Men also have a higher susceptibility to multiple system atrophy compared to women. Having a history of certain neurological conditions, such as Parkinson's disease, is another risk factor.

Diagnosing multiple system atrophy

Diagnosing multiple system atrophy can be challenging, as many of its symptoms overlap with those of other conditions like Parkinson's disease or corticobasal degeneration.

To diagnosis MSA, your doctor will perform a physical examination and order digital imaging tests such as MRI or CT scans.

Furthermore Your doctor may also administer a tilt table test to assess blood pressure irregularities. Tests on automatic functions may also be ordered, including:

• Evaluation of bowel and bladder function
• Assessment of electrical signals of the heart through an electrocardiogram (ECG or EKG)
• Sweat test to examine areas where your body sweats
• A sleep study

Due to the complexities involved in diagnosing multiple system atrophy, many people may remain undiagnosed.

Multiple system atrophy treatment options

There’s no cure for multiple system atrophy. There’s also no treatment to slow or stop its progression. The primary goal of treatment revolves around managing symptoms and making sure you're comfortable.

Medications may play a pivotal role in your treatment, especially for controlling blood pressure fluctuations. They may also help alleviate symptoms to those of Parkinson's disease, such as tremors, slow movement or impaired balance.

If you experience bladder issues, your doctor may prescribe medications to manage your functions or opt for catheter placement in the advanced stages of MSA progression.

In addition to medications, physical therapy, occupational therapy and speech therapy are commonly used to improve daily functioning and sustain independence. These therapies aim to address mobility issues, muscle weakness, communication difficulties and swallowing impairments.