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What is MSA?
Multiple System Atrophy (MSA) is a rare and progressive neurological disorder that can cause a multitude of symptoms in any combination, including impairments to balance, difficulty with movement, poor coordination, bladder dysfunction, sleep disturbances, and poor blood pressure control.
MSA, formerly known as Shy-Drager Syndrome, is a complex and challenging condition with no known cure. The exact cause remains uncertain, and it is currently considered a sporadic disorder, although there have been rare reports of familial cases. It is often misdiagnosed as other neurodegenerative diseases, like Parkinson’s disease, due to some overlapping symptoms. This makes early and accurate diagnosis a critical challenge for healthcare professionals.
Types of Multiple System Atrophy
MSA-C presents with symptoms that affect the part of the brain known as the cerebellum, which coordinates and regulates muscular activity. Due to the cerebellum’s role in synchronizing motor movements, people with MSA-C often have difficulty with coordination when it comes to walking, hand movements, speech, and eye movements.
Common symptoms include:
- Dropping things
- Finding it difficult to fasten buttons
- Feeling unsteady or clumsy in crowds
- Unable to balance without support
- Difficulty writing
- Slurred speech
MSA-C presents with symptoms that affect the part of the brain known as the cerebellum, which coordinates and regulates muscular activity. Due to the cerebellum’s role in synchronizing motor movements, people with MSA-C often have difficulty with coordination when it comes to walking, hand movements, speech, and eye movements.
Common symptoms include:
- Dropping things
- Finding it difficult to fasten buttons
- Feeling unsteady or clumsy in crowds
- Unable to balance without support
- Difficulty writing
- Slurred speech
MSA-P is the more common type of multiple system atrophy. The most common symptoms seen with MSA-P are those that are similar to Parkinson’s disease. These symptoms may include slowness or difficulty initiating movement, increased falls due to walking problems associated with shuffling of gait, tremor, rigidity or muscle stiffness, slurred speech, voice changes, drooling, difficulty swallowing, and lack of facial expression.
In the early stages, MSA-P may respond to medications used for Parkinson’s disease; however, MSA-P progresses more rapidly than Parkinson’s and eventually, most patients no longer respond to those medications.
Other common symptoms may include:
- Problems with balance and posture
- Writing becoming small and spidery
- Sleep disturbances
- Difficulty turning in bed
MSA-P is the more common type of multiple system atrophy. The most common symptoms seen with MSA-P are those that are similar to Parkinson’s disease. These symptoms may include slowness or difficulty initiating movement, increased falls due to walking problems associated with shuffling of gait, tremor, rigidity or muscle stiffness, slurred speech, voice changes, drooling, difficulty swallowing, and lack of facial expression.
In the early stages, MSA-P may respond to medications used for Parkinson’s disease; however, MSA-P progresses more rapidly than Parkinson’s and eventually, most patients no longer respond to those medications.
Other common symptoms may include:
- Problems with balance and posture
- Writing becoming small and spidery
- Sleep disturbances
- Difficulty turning in bed
Symptoms
MSA presents with a diverse range of symptoms, and while there are two different types of MSA, many symptoms are commonly presented in both types.
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In the early stages of MSA, some patients may find that they are displaying classic symptoms of Parkinson’s disease. These symptoms may include a tremor, muscle rigidity or stiffness, and slowness when moving. Often, these symptoms can cause trouble walking, causing a patient to drag or shuffle their feet, or even freeze and feel like their feet are stuck to the ground. Other symptoms may be small and spidery handwriting (micrographia) or slower, quieter, and/or slurred speech.
Patients with cerebellar symptoms struggle primarily with coordination and movement. These symptoms may include feeling clumsy when walking or talking, feeling unbalanced or unsteady, or feeling uncoordinated when trying to complete intricate tasks like fastening buttons.
Dysautonomia, which impairs the autonomic nervous system, is a hallmark of MSA. Resulting in issues with blood pressure regulation, heart rate, breathing, and digestion, dysautonomia can lead to problems such as dizziness, fainting when transitioning from lying down to standing (neurogenic orthostatic hypotension), or after eating a meal high in sugar or carbs (postprandial hypotension). Sometimes, patients have high blood pressure while lying down (supine hypertension).
Sleep disturbances are a prevalent and challenging aspect of the disease. An early symptom of MSA is REM Sleep Behavior Disorder (RBD) which causes an individual to act out their dreams, often leading to shouting or thrashing movements while the patient is completely asleep and unaware of their actions. Individuals with MSA also often grapple with irregular breathing at night, which can lead to conditions like sleep apnea, snoring, stridor, and excessive daytime sleepiness. These disturbances not only disrupt the quality of sleep but also contribute to feelings of fatigue and lethargy during the day, further impacting the overall well-being of those affected by the condition.
Dysphagia, or difficulties swallowing, can lead to problems when eating and drinking, increasing the risk of choking and aspiration pneumonia. As MSA progresses, the weakening of the muscles involved in swallowing can make mealtime a challenging and potentially dangerous experience. Managing dysphagia in MSA often requires a multidisciplinary approach, involving speech therapists and dietary modifications, to ensure safe and comfortable eating and drinking for individuals living with this condition.
As many as 75% of MSA patients may grapple with various cognitive issues, including difficulties with memory, attention, problem-solving, and emotional control. This cognitive decline often necessitates additional time and effort to concentrate on tasks, as fatigue, another common symptom in MSA, can further impact cognitive abilities. Emotional well-being can also be affected, with high rates of depression, anxiety, panic attacks, and even thoughts of suicide observed among patients. While dementia is considered rare in MSA, it may still affect 12 to 18 percent of individuals, emphasizing the need for comprehensive care and support in managing the cognitive aspects of this complex condition.
Bladder control is often an early symptom of MSA, with up to 96% of individuals experiencing urinary symptoms. These symptoms include urinary urgency, frequency, incontinence, and/or leakage. Often, individuals don’t expect that their urinary symptoms may have an underlying concern, and their urinary symptoms may progress to a urinary tract infection. Diagnosing and managing urinary issues often requires a multidisciplinary approach, typically involving a urologist, who may perform tests to determine the best course of treatment.
Patients often experience additional challenges including erectile dysfunction and constipation.
Signs It Could Be More Than Parkinson's Disease
Close to one million people in the US have a diagnosis of Parkinson’s disease (PD). Unfortunately, for a small percentage of these people, the diagnosis just doesn’t seem right. They feel like something more is wrong. Their medicines may not be very effective. They might have severe dizziness and even be prone to fainting. They just sense the disease is progressing faster than expected.
