Multiple system atrophy - parkinsonian type
Shy-Drager syndrome; Neurologic orthostatic hypotension; Shy-McGee-Drager syndrome; Parkinson plus syndrome; MSA-P; MSA-CMultiple system atrophy- parkinsonian type (MSA-P) is a rare condition that causes symptoms similar to Parkinson disease. However, people with MSA-P have more widespread damage to the part of the nervous system that controls important functions such as heart rate, blood pressure, and sweating.
Parkinson disease
Parkinson disease results from certain brain cells dying. These cells help control movement and coordination. The disease leads to shaking (tremors...
Read Article Now Book Mark ArticleThe other subtype of MSA is MSA-cerebellar. It mainly affects the cerebellum, an area deep in the brain, just above the spinal cord.
MSA-cerebellar
Multiple system atrophy - cerebellar subtype (MSA-C) is a rare disease that causes areas deep in the brain, just above the spinal cord, to shrink (at...
Read Article Now Book Mark ArticleCauses
The cause of MSA-P is unknown. The affected areas of the brain overlap with areas affected by Parkinson disease, with similar symptoms. For this reason, this subtype of MSA is called parkinsonian.
MSA-P is most often diagnosed in men older than 60.
Symptoms
MSA damages the nervous system. The disease tends to progress rapidly. About one half of people with MSA-P have lost most of their motor skills within 5 years of onset of the disease.
Symptoms may include:
- Tremors
- Movement difficulties, such as slowness, loss of balance, shuffling when walking
- Frequent falls
- Muscle aches and pains (myalgia), and stiffness
- Face changes, such as a masklike appearance to the face and staring
- Difficulty chewing or swallowing (occasionally), not able to close the mouth
- Disrupted sleep patterns (often during rapid eye movement [REM] sleep late at night)
- Dizziness or fainting when standing up or after standing still
- Erection problems
Erection problems
An erection problem occurs when a man cannot get or keep an erection that is firm enough for intercourse. You may not be able to get an erection at ...
Read Article Now Book Mark Article - Loss of control over bowels or bladder
- Problems with activity that requires small movements (loss of fine motor skills), such as writing that is small and hard to read
- Loss of sweating in any part of the body
- Decline in mental function
- Nausea and problems with digestion
- Posture problems, such as unstable, stooped, or slumped over
- Vision changes, decreased or blurred vision
Vision changes
There are many types of eye problems and vision disturbances, such as: Halos Blurred vision (the loss of sharpness of vision and the inability to see...
Read Article Now Book Mark Article - Voice and speech changes
Other symptoms that may occur with this disease:
- Confusion
Confusion
Confusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...
Read Article Now Book Mark Article - Dementia
Dementia
Dementia is a loss of brain function that occurs with certain diseases. It affects one or more brain functions such as memory, thinking, language, j...
Read Article Now Book Mark Article - Depression
Depression
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for shor...
Read Article Now Book Mark Article - Sleep-related breathing difficulties, including sleep apnea or a blockage in the air passage that leads to a harsh vibrating sound
Sleep apnea
Obstructive sleep apnea (OSA) is a problem in which your breathing pauses during sleep. This occurs because of narrowed or blocked airways.
Read Article Now Book Mark Article - Restless legs
Exams and Tests
Your health care provider will examine you, and check your eyes, nerves, and muscles.
Your blood pressure will be taken while you are lying down and standing up.
There are no specific tests to confirm this disease. A doctor who specializes in the nervous system (neurologist) can make the diagnosis based on:
- History of symptoms
- Physical examination results
- Ruling out other causes of symptoms
Testing to help confirm the diagnosis may include:
- MRI of head
MRI of head
A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...
Read Article Now Book Mark Article - Plasma norepinephrine levels
Norepinephrine
This test measures the levels of catecholamines in the blood. Catecholamines are hormones made by the adrenal glands. The three catecholamines are ...
Read Article Now Book Mark Article - Urine examination for norepinephrine breakdown products (urine catecholamines)
Urine catecholamines
Catecholamines are chemicals made by nerve tissue (including the brain) and the adrenal gland. The main types of catecholamines are dopamine, norepin...
Read Article Now Book Mark Article
Treatment
There is no cure for MSA-P. There is no known way to prevent the disease from getting worse. The goal of treatment is to control symptoms.
Dopaminergic medicines, such as levodopa and carbidopa, may be used to reduce early or mild tremors.
But, for many people with MSA-P, these medicines do not work well.
Medicines may be used to treat low blood pressure.
A pacemaker that is programmed to stimulate the heart to beat at a rapid rate (faster than 100 beats per minute) may increase blood pressure for some people.
Pacemaker
A pacemaker is a small, battery-operated device. This device senses when your heart is beating too slowly. It sends a signal to your heart that mak...
Read Article Now Book Mark ArticleConstipation can be treated with a high-fiber diet and laxatives. Medicines are available to treat erection problems.
Support Groups
More information and support for people with MSA-P and their families can be found at:
- National Organization for Rare Disorders -- rarediseases.org/rare-diseases/multiple-system-atrophy
- The MSA Coalition -- www.multiplesystematrophy.org/msa-resources/
Outlook (Prognosis)
Outcome for MSA is poor. Loss of mental and physical functions slowly get worse. Early death is likely. People typically live 7 to 9 years after diagnosis.
When to Contact a Medical Professional
Contact your provider if you develop symptoms of this disorder.
Contact your provider if you have been diagnosed with MSA and your symptoms return or get worse. Also contact your provider if new symptoms appear, including possible side effects of medicines, such as:
- Changes in alertness/behavior/mood
- Delusional behavior
- Dizziness
- Hallucinations
Hallucinations
Hallucinations involve sensing things such as visions, sounds, or smells that seem real but are not. These things are created by the mind.
Read Article Now Book Mark Article - Involuntary movements
- Loss of mental functioning
- Nausea or vomiting
- Severe confusion or disorientation
If you have a family member with MSA and their condition declines to the point that you are unable to care for the person at home, seek advice from your family member's provider.
References
Jankovic J. Parkinson disease and other movement disorders. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 96.
Romero-Ortuno R, Wilson KJ, Hampton JL. Disorders of the autonomic nervous system. In: Fillit HM, Rockwood K, Young J, eds. Brocklehurst's Textbook of Geriatric Medicine and Gerontology. 8th ed. Philadelphia, PA: Elsevier; 2017:chap 63.
Central nervous system and peripheral nervous system - illustration
The central nervous system comprises the brain and spinal cord. The peripheral nervous system includes nerves outside the brain and spinal cord.
Central nervous system and peripheral nervous system
illustration
- Alzheimer disease - InDepth(In-Depth)
Review Date: 11/2/2022
Reviewed By: Evelyn O. Berman, MD, Assistant Professor of Neurology and Pediatrics at University of Rochester, Rochester, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.