Multiple System Atrophy (MSA)

What is Multiple System Atrophy?

Multiple System Atrophy (MSA) is a rare neurodegenerative 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. The disease was first known as Shy-Drager Syndrome. Currently, it is believed that MSA is “sporadic,” meaning that there are no established genetic or environmental factors that cause the disease. A few reports have described families with MSA, but this finding is probably very rare.

What are the symptoms of MSA?

Most often, the first clinical symptom a patient will note will be lightheadedness, dizziness, and episodes of passing out, but the first symptoms in some patients may include difficulty initiating movement, body stiffness, urinary incontinence, and increased falls. The autonomic nervous system is essential for controlling blood pressure, body temperature, digestion, urination, and sexual function, so MSA is largely a disease that impairs the autonomic nervous system. However, some patients don’t seem to have severe autonomic symptoms, thus emphasizing the range of symptoms from person to person.

The difference between MSA and Parkinson’s Disease

Although many clinical symptoms are also present in those with Parkinson’s disease, patients with MSA typically show symptom onset at a younger age, with the average onset in the early 50s. The journey to a diagnosis can be long and difficult. Many patients are diagnosed with Parkinson’s disease first, but over time, the extent, severity, and type of symptoms change, making a diagnosis of MSA more likely.

One of the most important symptoms in MSA patients is the presence of sleeping abnormalities such as snoring and apnea, stridor, and acting out dreams. Also, subtle changes to a person’s speech such as low pitch or quivering voice can also be evident and the clinician may notice symptoms that look slightly different from those of Parkinson’s disease. The diagnosis of MSA is made clinically, and neuroimaging can sometimes assist with confirmation of a clinical suspicion.

Common and Distinguishing Features of MSA

    • Similarities to Parkinsonism: Both Parkinson’s disease and MSA are characterized by deposits of a type of protein known as alpha-synuclein in the nervous system. Both conditions also specifically affect cells that produce dopamine, a neurotransmitter that controls motor commands. As a result, many of the same motor dysfunctions occur in the two conditions.
    • Unique features: Important differences distinguish the symptoms and course of MSA from Parkinson’s disease and other conditions of the nervous system, such as cerebellar ataxia or pure autonomic failure (PAF). Notably, MSA affects several areas of the brain, including the cerebellum, the brain’s balance and coordination centers, and the autonomic nervous system, as mentioned above.
    • Another distinguishing feature of MSA Is the types of cells involved. While Parkinson’s disease affects the dopamine-producing neurons of a motor-controlling portion of the brain known as the nigro-striatal area, MSA affects both neurons and glial cells – the support cells that maintain the health of neurons and which outnumber neurons 10:1. Additionally, some of the glial cells affected in MSA produce myelin, the fatty substance that insulates neurons.

For all references listed in the About MSA section please download the MSA Coalition's "MSA - What You Need to Know"

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