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Symptoms and Treatment

MSA-P is the Parkinsonian form of multiple system atrophy. It is the most common form of MSA with signs and symptoms similar to those of Parkinson’s disease.

  • Rigid muscles
  • Difficulty bending arms and legs
  • Slow movement (bradykinesia)
  • Problems with balance and posture

It should be noted that MSA patients can have a mix of MSA-P, MSA-C and dysautonomia. Depending on theblend of these three types of MSA, symptoms and their severity can vary.

Non-Pharmacological Treatment Options

Physical Therapy and Exercise

Physical therapy can significantly improve motor symptoms through one-on-one exercises and personalized exercise plans. Many of the activities used to enhance movement of individuals with Parkinson’s disease are used for people with MSA. The goal of physical therapy is to maintain mobility through strengthening exercises. Assisted treadmill exercises where part of the person’s weight is supported lead to better balance, stability, and gait. If a treadmill is unavailable, other walking activities can be performed in a pool. Alternative forms of exercise such as yoga, tai chi, and Pilates can improve strength, flexibility, and coordination. The key to maintaining good daily function is continued activity through exercise.

Occupational Therapy

Occupational therapy has been shown to have a positive impact on individuals with MSA. An occupational therapist aims to make day-to-day living and activities easier by improving symptoms management, use of home equipment to improve mobility, and home adaptations. Occupational therapy may benefit individuals that have difficulty dressing, eating, using the computer, and other daily activities. An occupational therapist can visit the home to identify fall risks and offer recommendations to improve patient safety at home.

Speech Therapy

A speech therapist can help provide a holistic approach to taking care of individuals with MSA-P with speech difficulties. Difficulty swallowing is a frequent complaint of individuals with MSA-P and is noted to develop early in the disease2. Some of the speech difficulties may include talking with a softer tone, changes in pitch, or difficulty pronouncing words. A speech therapist may recommend a series of oral motor exercises, breathing techniques, communication support groups, and vocal exercises to improve speech.

Pharmacological treatment


Levodopa, also known as Sinemet, is a medication that helps increase dopamine in the brain to treat Parkinson’s disease. A potential side effect seen with levodopa is an abnormal increase in body movement, called dyskinesia. The success of this medication for MSA-P individuals varies for each patient and can diminish over time. Consequently, symptoms may return between doses, and an initial effect may lessen. Typically, levodopa has been seen to be useful for MSA-P individuals for about 2 to 3 years. Therefore, to maximize its therapeutic effect and minimize side effects, patients should have a levodopa trial as soon as possible.

Dopamine Agonists

Dopamine agonists work very similarly to levodopa as they try to mimic dopamine but are less effective. However, some of the side effects of this class of medication include increased sleepiness, dizziness, fainting, uncontrolled movements, or behavioral changes known as impulse control disorder. Pramipexole, trade name Mirapex, has been used with success in MSA patients who do not resond to levodopa. In one study, pramipexole improved speech, swallowing, and activities of daily living such as the ability to dress or to use eating utensils. Potential side effects of pramipexole include daytime sleepiness, dizziness, fainting, nausea, difficulty sleeping, and uncontrolled movements. Another dopamine agonist includes apomorphine, trade name Apokyn, that can help treat muscle stiffness and loss of muscle control. This medication can cause a drop in blood pressure.


This antiviral medication can be used to treat mild symptoms of Parkinson’s disease. This medication is thought to act on receptors on the muscle to reduce tremor and other movement disorder symptoms. Some of the potential side effects include blurred vision, confusion, and urinary retention.


Certain antidepressants work by increasing the levels of serotonin, a neurotransmitter used in mood and movement, in the brain to improve speech, facial expression, and depression. Side effects from this medication may include irregular heart rhythm, dizziness, nausea, restless legs, and sexual dysfunction.

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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