Multiple System Atrophy Types and Symptoms

Two forms of MSA, are recognized, according to whether Parkinsonian or cerebellar symptoms predominate1. Both types involve autonomic dysfunction, or dysautonomia. Autonomic symptoms usually appear first, though either motor symptoms or autonomic symptoms may appear first in the Parkinsonian type7.

MSA-P produces Parkinson-like symptoms, including a slow, shuffling gait, rigid muscles, slurred speech and lack of facial expression. Patients with MSA-P may also develop a form of tremor known as resting tremor, which occurs when they are still and disappears when they are moving.

In the early stages, this form of MSA may respond to medications used for Parkinson’s disease. However, MSA-P tends to progress more rapidly than Parkinsonism and as patients pass through the initial stages they no longer respond to Parkinson’s medications. Individual variation with regard to the course of the disease varies widely. Some MSA-P patients require assistance with daily activities as early as 5 years after diagnosis and others are able to remain independent for much longer1.

MSA-C is characterized by progressive loss of coordination and balance; functions controlled by the area of the brain known as the cerebellum. MSA-C patients may experience a form of tremor known as action tremor, which occurs when they reach for an object. Muscle weakness associated with MSA-C can lead to slurred speech and problems swallowing. This form of MSA can appear as early as the 20’s or not until the 60’s1.

Dysautonomia in MSA leads to problems regulating heart rate, blood pressure, breathing, digestion and other internal organ functions. Patients may become dizzy or faint when they sit up or stand up; a condition known as neurogenic orthostatic hypotension. Conversely, blood pressure may be excessively high when lying down<sup8. Loss of bladder or bowel control, abnormal sweating, sexual impotence in men and sleep disturbances, including sleep apnea, and flailing movements during sleep also occur.