20th July 2023

Multiple System Atrophy (MSA)

A rare neurodegenerative disorder caused by neuronal loss in multiple areas of the brain manifesting as ataxia and Parkinsonism. An important feature is autonomic dysfunction causing postural hypotension and autonomic symptoms.

There are 2 main types; MSA-P (Parkinson’s features) and MSA-C (Cerebellar features); the type depends on which symptoms are predominant at diagnosis. MSA-P is more common, and the symptoms include rigidity, bradykinesia, tremors, posture and balance difficulties. MSA-C includes ataxia, dysarthria, visual disturbances and dysphagia. Symptoms of autonomic dysfunction can overlap in both types and can manifest as postural hypotension, urinary retention/incontinence, sleep disorders, erectile dysfunction, and emotional dysregulation. Autonomic dysfunction tends to present earlier than in Parkinson’s disease. MSA is caused by inclusion bodies containing alpha-synuclein leading to cell loss and reactive changes to glial cells in the CNS. A pathological diagnosis can only be made at autopsy. Management is mainly through an MDT approach, e.g. physios to help with contractures. Postural hypotension can respond to synthetic mineralocorticosteroids such as fludrocortisone. In contrast to Parkinson’s, medications such as levodopa are not found to work as well, and it tends to have a more rapid disease progression, with life expectancy from symptom onset being 6-9 years.