What is MSA?

MSA is a neurological disorder of brain in which multiple brain areas are affected by a degenerative process leading to shrinking or atrophy. As parts of brain are involved in different functions, sometimes they are described as multiple systems, like the cortical system (e.g., motor control), the extrapyramidal system (e.g., balance and movements), or the cerebellar system (e.g., gait and dexterity). These parts are all interconnected and influence each other. In MSA, more than one of these systems are affected resulting in a variety of symptoms. In comparison, in Parkinson disease, one of these systems is affected.

 

What is the cause of MSA?

It is considered a degenerative disorder, implying that brain cells die or degenerate. This happens due to collection of an abnormal form of a protein called alpha synuclein in brain cells. Same protein is involved to cause Parkinson disease but in MSA, it is accumulated all over the brain, especially in many of its deep areas. Exact reason for its abnormal form, or why it is accumulated is unknown. Imaging with MRI may reveal significant shrinking of the affected areas of brain.

 

What are the symptoms of MSA?

Symptoms vary in different patients depending upon which brain system is more involved or involved first. Following list of symptoms and findings provides an outline of problems in MSA:

1. Extrapyramidal (or Parkinson) type: Rigidity, gait disorder, tremor, decreased movements.
2. Cerebellar type: Abnormal gait, abnormal speech, abnormal eye movements, tremor, loss of dexterity.
3. Autonomic type: Dizziness, low blood pressure, arrythmias, urinary retention or incontinence, lack of sweating, erectile dysfunction.
4. Cortical type: Dementia, usually of frontotemporal type, aphasia.
5. Other: REM sleep behavior disorder, central sleep apnea, laryngeal stridor (high pitched sound from larynx due to blockage caused by vocal cord spasm), axial dystonia (spasm of trunk muscles)

 

Are there different types of MSA

Neurologists may divide MSA in different types based upon which system, as described above, is more affected or affected first.

 

How quickly MSA progresses?

In comparison to Parkinson disease or Alzheimer dementia, it is a relatively quickly progressive condition. Many patients are severely disabled or using a wheelchair in 5 years. 

 

Is MSA a terminal illness?

Patients usually do not die directly from MSA, they succumb to one of its complications. Complications of MSA include falls and related injuries, aspiration, pressure sores, cardiac or lung failure, other infections such as UTI, or choking.

 

What conditions may look like MSA?

Conditions to consider are all conditions with Parkinson like symptoms, spinocerebellar ataxia, paraneoplastic syndrome, multiple strokes, vasculitis, Fragile X tremor-ataxia syndrome, multiple sclerosis, etc.

 

How is MSA treated?

There is no specific medicine or measure available to slow down, stop, or reverse the abnormal process of MSA. Medicines and many measures are used based upon symptoms.

1. Parkinson symptoms: With medicines used for Parkinson disease (Please read the section on Parkinson disease for more detail)
2. Low blood pressure: With meds and other measures (please read the section on orthostatic hypotension for more detail)
3. Sleep disorders: Medicines like gabapentin, dopaminergic drugs, etc.
4. Behavioral: Mood stabilizers, SSRI (small dose), antipsychotics (small dose)
5. Stridor: CPAP
6. Dystonia: Botox
7. Gait disorder and falls: Walker, wheelchair

 

Following measures may help all patients:

1. Learn about this condition. This article is written for that purpose.
2. Make appropriate changes in living situation and lifestyle to minimize falls and injuries. This may include having one floor living space.
3. Avoid stairs.
4. Remove loose rugs.
5. Keep nightlight on.
6. Consider a walker or a wheelchair for safety.
7. Install handicap type features in the house and especially in the bathroom.
8. Take sitting showers.
9. Have a will, health proxy and financial power of attorney papers done.
10. Consider early retirement.
11. Minimize driving. Don’t drive at night, during rush hours, in bad weather, and long-distance.
12. Try speech therapy to improve and maintain speech.

• While drinking, do it slowly with smaller sips, in erect sitting or standing position.

1. While eating, do it slowly with smaller bites, in erect sitting or standing position. Avoid food that may seem difficult to chew or swallow. A different formulation of the same food item may help to avoid choking. For example, if eating meat, avoid steak or bigger pieces, try minced meat or burger.
2. Avoid alcohol and drug(s) of abuse.
3. If speech is affected, consider a microphone and a speaker for better communication. In more severe cases, consider electronic keyboard for communication.
4. If living at home, consider getting couple of hours of help during most days to help with cleaning and meals.
5. For patients with excessive blinking causing eye closure, consider Botox injections.
6. Physical therapy can help to improve strength and balance.
7. Occupational therapy may help to make appropriate changes in day to day living, especially to avoid falls and injuries.
8. If available, consider joining a support group. If not, at least contact Elder Care services for any help.
9. When coming for appointments, either bring the list of all medicines you take, or the prescription bottles. Also, write down the questions you may have for the doctor.

 

Who do I need to see if I have MSA type symptoms:

Other than your PCP, consult a neurologist. MSA is a neurological disorder under the category of Movement Disorders. There are some neurologists who specialize in this type of diseases. Some patients may benefit from consulting a movement disorder specialist. You may need multiple type of expertise to manage different aspects of this disease.

 

Is MSA a genetic disorder?

Probably yes, but its genetic basis has not been established. There is no evidence that it is a familial condition.

 

How is MSA distinguished from Parkinson disease?

It is determined by history and clinical examination. MRI brain can help by showing distinct MRI findings of progressive supranuclear palsy (PSP) or MSA. In some cases, PET scan be helpful though it is not clear if it is more useful than an MRI. Diagnosis of MSA can be difficult to make in early stages of the disease and may become obvious with a year or two of clinical follow up.

 

Where can I get more information about MSA?

American Academy of Neurology

International Parkinson and Movement Disorder Society