Description

The multiple system atrophy, also called MSA, causes people to lose coordination and balance, or become slow and rigid. It also causes changes in speech and loss of control of other bodily functions.

MSA is a rare condition. Sometimes it shares symptoms with Parkinson's disease, including slow movements, muscle stiffness, and balance problems.

The treatment includes medications and lifestyle changes to help control the symptoms, but there is no cure. The condition worsens over time and eventually leads to death.

In the past, this condition has been called Shy-Drager syndrome, olivopontocerebellar atrophy, or striatonigral degeneration.

Symptoms

Multiple system atrophy (MSA) symptoms affect many parts of the body. The symptoms begin in adulthood, usually in the 50's or 60 years.

There are two types of MSA: parkinson's disease and the cerebellum. The type depends on a person's symptoms when it is diagnosed.

Parkinsonian type

This is the most common type of MSA. The symptoms are similar to those of Parkinson's disease, such as:

  • The rigid muscles.
  • Difficulty bending of the arms and legs.
  • Slow motion, known as bradykinesia.
  • Tremors at rest or when moving the arms or legs.
  • Confusing, slow or soft speech, known as dysarthria.
  • Problems with posture and balance.

Cerebellum type

The main symptoms of cerebellar type of involving the poor muscle coordination, known as ataxia. Symptoms may include:

  • Problems with movement and coordination. This includes the loss of balance and not being able to walk steadily.
  • Confusing, slow or soft speech, known as dysarthria.
  • Changes in vision. This may include blurred or double vision and not being able to focus on the eyes.
  • Trouble chewing or swallowing, known as dysphagia.

General symptoms

For both types of multiple system atrophy, autonomic nervous system is not working properly. The autonomic nervous system controls the involuntary functions of the body, such as blood pressure. When this system is not functioning properly, it can cause the following symptoms.

The Postural hypotension, also known as orthostatic hypotension

Postural hypotension is a form of low blood pressure. People who have this type of low blood pressure, feeling dizzy or lightheaded when you stand up after sitting or lying down. They may even faint. Not everyone with MSA has postural hypotension.

People with msa also can develop dangerously high levels of blood pressure while lying down. This is called supine hypertension.

Urinary and bowel symptoms

These symptoms include:

  • The constipation.
  • Loss of bladder or bowel control, known as incontinence.

The changes in the production of sweat

People with multiple system atrophy may:

  • Produce less sweat.
  • Have intolerance to heat because we sweat less.
  • Have poor control of body temperature, often causing cold hands or feet.

Conditions that affect sleep

The sleep symptoms may include:

  • Agitated sleep due to "acting out" of dreams. This is known as rapid eye movement (REM) sleep behavior disorder.
  • The breathing stops and starts during sleep, known as sleep apnea.
  • A high-pitched whistling sound when breathing, called stridor.

Sexual symptoms

These symptoms may include:

  • Difficulty achieving or maintaining an erection, known as erectile dysfunction.
  • Problems with lubrication during sexual intercourse and have an orgasm.
  • Loss of interest in sex.

Cardiovascular symptoms

MSA can cause:

  • The Color changes in the hands and feet.

Psychiatric symptoms

People with multiple system atrophy also may experience:

  • Difficulty controlling emotions, such as laughter or crying when you do not expect.

When to see a doctor

If you experience any of the symptoms of multiple system atrophy, consult your health care professional. If you have been diagnosed with MSA, contact your health care professional if your symptoms get worse or if you develop new symptoms.

Causes

There is No known cause of multiple system atrophy (MSA). Some researchers are studying the possible role of the genetic or environmental causes, such as a toxin in the MSA. But there is substantial evidence to support these theories.

MSA causes parts of the brain to reduce the size. This is known as atrophy. The areas of the brain that reduce due to the MSA include the cerebellum, the basal ganglia and the brainstem. The atrophy of these parts of the brain affecting internal functions of the body and the movement.

Under a microscope, the brain tissue of people with msa shows the accumulation of a protein called alpha-synuclein. Some research suggests that the accumulation of this protein leads to multiple system atrophy.

Risk factors

A risk factor for the multiple system atrophy (MSA) is having rapid eye movement (REM) sleep behavior disorder. People with this disorder of the law of their dreams. Most of the people who have MSA has a history of behavior disorder REM sleep.

Another risk factor is having a disease caused by the autonomic nervous system is not working properly. Symptoms such as urinary incontinence can be an early sign of MSA. The autonomic nervous system controls involuntary functions.

Complications

The complications of multiple system atrophy (MSA) vary from person to person. But to all the world with the disease, MSA symptoms get worse with time. The symptoms can make daily activities more difficult as time passes.

Possible complications include:

  • Worsening of respiratory symptoms during sleep.
  • Injuries due to falls caused by the lack of balance or fainting.
  • The breakage of the skin in people who have trouble moving or may not move.
  • Not being able to take care of himself in the day-to-day activities.
  • Paralysis of the vocal cords, which affects the breathing and speaking.
  • Increase difficulty swallowing.

People tend to live around 7 to 10 years after the multiple system atrophy symptoms appear for the first time. However, the survival rate with MSA varies widely. Death is often due to the difficulty to breathe, infections or blood clots in the lungs.

Diagnosis

The diagnosis of multiple system atrophy (MSA) can be a challenge. Symptoms such as stiffness and difficulty with walking can occur in other diseases, including Parkinson's disease. This can make MSA difficult to diagnose.

Your health care professional gives you a physical exam, review of your medical history and testing of its autonomous functions, such as blood pressure. You may also need blood tests and imaging tests, such as magnetic resonance imaging. These tests can help to diagnose MSA, or point to another of the causes of their symptoms.

If your healthcare provider thinks that you have multiple system atrophy, the results of the test helps to determine if the diagnosis is clinically established MSA or clinically probable MSA. Because it is difficult to make a diagnosis, some people are never properly diagnosed.

You may be referred to a neurologist or other specialist for further evaluation. A specialist can help to diagnose the disease.

Tilt table test

This test evaluates your blood pressure control. In this procedure, it is placed on a motorized table. Straps to hold it in place. Then, the table is tilted upward so that his body is placed in a 70 degree angle.

During the test, the professional of the health of the watches of the changes in blood pressure and heart rate. The test can show if your blood pressure does not respond in a typical way when changing position.

Tests of autonomic functions

Other tests can look at blood pressure control, and other involuntary functions, including:

  • Measurement of the blood pressure, lying down and standing up, without the use of a tilt table.
  • A sweat test to assess the areas of the body that sweat.
  • The tests that are seen in bladder and bowel function.
  • Electrocardiograph for monitoring the electrical signals of your heart.

You might need a sleep study if you stop breathing during sleep, or if you snore or have another dream of the symptoms. The test can help diagnose a sleep condition that can be treated, such as sleep apnea.

Treatment

The treatment for multiple system atrophy (MSA) involves the management of their symptoms. There is No cure for MSA. The management of the disease can make you as comfortable as possible and help to maintain your body.

For the treatment of specific symptoms, your health care team may recommend:

  • Medications to increase blood pressure.These drugs can treat low blood pressure that occurs when standing up after sitting or lying position, known as postural hypotension. There are several medications that your health care professional may recommend. Corticosteroids fludrocortisone may raise your blood pressure, helping your body to retain more water and salt. Midodrine (Orvaten) can raise your blood pressure quickly. This medication should be taken with caution, as it can increase the blood pressure while lying down. Do not lie down for four hours after taking this medication. The medicine of the pyridostigmine (Mestinon, Regonol) can raise your blood pressure while standing without causing a large increase when you are lying. Another medication called droxidopa (Northera) is also used to treat postural hypotension. The most common side effects of droxidopa include headaches, dizziness, and nausea.
  • Medications to reduce Parkinson's disease-like symptoms.Medicines to treat Parkinson's disease, such as levodopa and carbidopa combination (Sinemet, Duopa, others), may help some people with msa. Medications can treat the stiffness, balance problems and slow movements. Many people with multiple system atrophy do not respond to the Parkinson's disease drugs. The drug also may be less effective after a couple of years.
  • Medications to treat erection problems.If you have problems getting or maintaining an erection, it can be treated with medications such as sildenafil (Revatio, Viagra). This medicine helps to control erectile dysfunction, but it can decrease the blood pressure.
  • Steps to manage swallowing and breathing symptoms.If you have difficulty swallowing, try to eat soft foods. If the ingestion or inhalation symptoms get worse, you may need surgery to insert a feeding tube or breathing. A gastrostomy tube delivers food directly to your stomach. If you have sleep apnea, it can be treated with continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP). Stridor may also be treated with CPAP.
  • Bladder care. If you have problems with bladder control, medications may help in the earlier stages. But as MSA worse, you may need to have a smooth tube to drain the bladder. The soft tube known as a catheter.
  • Of the therapy.A physical therapist can help you to maintain, as a part of his movement and strength as possible as the disease gets worse. A speech-language pathologist can help to improve or maintain his or her speech.

Medications to increase blood pressure. These drugs can treat low blood pressure that occurs when standing up after sitting or lying position, known as postural hypotension. There are several medications that your health care professional may recommend.

Corticosteroids fludrocortisone may raise your blood pressure, helping your body to retain more water and salt.

Midodrine (Orvaten) can raise your blood pressure quickly. This medication should be taken with caution, as it can increase the blood pressure while lying down. Do not lie down for four hours after taking this medication.

The medicine of the pyridostigmine (Mestinon, Regonol) can raise your blood pressure while standing without causing a large increase when you are lying.

Another medication called droxidopa (Northera) is also used to treat postural hypotension. The most common side effects of droxidopa include headaches, dizziness, and nausea.

Medications to reduce Parkinson's disease-like symptoms. Medicines to treat Parkinson's disease, such as levodopa and carbidopa combination (Sinemet, Duopa, others), may help some people with msa. Medications can treat the stiffness, balance problems and slow movements.

Many people with multiple system atrophy do not respond to the Parkinson's disease drugs. The drug also may be less effective after a couple of years.

Medications to treat erection problems. If you have problems getting or maintaining an erection, it can be treated with medications such as sildenafil (Revatio, Viagra). This medicine helps to control erectile dysfunction, but it can decrease the blood pressure.

Steps to manage swallowing and breathing symptoms. If you have difficulty swallowing, try to eat soft foods. If the ingestion or inhalation symptoms get worse, you may need surgery to insert a feeding tube or breathing. A gastrostomy tube delivers food directly to your stomach.

If you have sleep apnea, it can be treated with continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP). Stridor may also be treated with CPAP.

Of the therapy. A physical therapist can help you to maintain, as a part of his movement and strength as possible as the disease gets worse.

A speech-language pathologist can help to improve or maintain his or her speech.

Lifestyle and home remedies

Lifestyle and home remedies can help to minimize the system atrophy (MSA) of the symptoms.

  • Take steps to increase your blood pressure. Add a bit of salt to your diet and drinking more fluids, especially before exercise. The salt and fluids to increase blood volume and raise your blood pressure. Drink coffee and other liquids that contain caffeine to increase your blood pressure.
  • Raise the head of your bed. Elevate the head of your bed by about 4 to 6 inches (10 to 15 centimeters) helps to control the blood pressure when you sleep. Get up slowly after lying down.
  • Make changes to your diet. Eating more fiber to relieve constipation. Laxatives or stool softeners can help. You can get without a prescription. Also eat small, low-carb meals.
  • Not too hot. Stay in rooms with air conditioning on very hot days. Make sure that the bath is not too hot when you shower or bathe.
  • Wear elastic support stockings to the waist. This can help to keep your blood pressure does not fall.

Preparing for your appointment

First of may consult your health care professional. This person can refer you to a medical doctor trained in nervous system conditions, call a neurologist.

Here's some information to help you prepare for your appointment.

What you can do

  • Write down the symptoms you are experiencing, and for how long. Include all the recent changes in the physical or emotional well-being. For example, if you or your loved ones have noticed that your mood is changing more quickly, share this with your health care professional.
  • Make a list of your medical information. Include other conditions. Also included are the names of the medications you are taking prescription or non-prescription, along with the dose.
  • Write down key personal information, including any change in your sex life. For example, let your healthcare provider know if you have less interest in sex, or trouble getting an erection.
  • Find a family member or friend who can come with you to the appointment, if possible. A family member or a friend can help you remember what your provider tells you.
  • Write down questions to ask during your appointment.

For the multiple system atrophy, some basic questions include:

  • What is likely causing my symptoms?
  • There are other possible causes of these symptoms, such as Parkinson's disease?
  • How are you going to make a definitive diagnosis?
  • What tests do I need?
  • What treatment options are available for the multiple system atrophy?
  • What are the possible side effects of the treatment options?
  • How is my condition can change over time?
  • Treatment is slow disease, or simply relieve the symptoms?
  • Can measures of self-care to help relieve my symptoms?
  • How is my health monitored over time?
  • Is it necessary to adjust the medications that I am taking for other health conditions?

Don't hesitate to ask any questions you may have.

What to expect from your doctor

It is likely to be a series of questions. Questions about the symptoms may include:

  • What are the symptoms and when they started?
  • Do you feel lightheaded or dizzy when you stand up? Have you ever fainted?
  • Do your symptoms include emotional changes, such as laughing, then crying?
  • Have you noticed any change in your voice?
  • Have you been told that you snore loudly or interrupted breathing while sleeping?
  • Has suffered from constipation or problems with bladder control?
  • Have you had any sexual symptoms, such as decreased sexual desire or difficulty achieving or maintaining an erection?
  • Do you have trouble chewing or swallowing?
  • Do you have trouble breathing?
  • Do you have some movement of the symptoms, such as slow or poor coordination?

General questions may include:

  • Do you have a family history of Parkinson's disease or other neurological diseases?
  • Are you being treated for any other health conditions?

What you can do in the meantime

While you wait for your appointment, find out if any of your blood relatives have been diagnosed with a nervous system condition, such as Parkinson's disease or cerebellar ataxia. Blood relatives include a parent, brother, or grandfather. Multiple system atrophy (MSA) is not known to be passed down through the families. A family history of a disease with similar symptoms may help to rule out MSA.

Symptoms and treatment of Multiple system atrophy