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MSA is like the three flavoured Neapolitan ice cream

MSA is like the three flavoured Neapolitan ice cream

What is MSA? An Analogy of Neapolitan Ice Cream Can Help Explain

Written by Pam Bower, a volunteer and member of the MSA Coalition Board of Directors.

I first thought of this analogy many years ago to describe Multiple System Atrophy, I’ve modified it a little bit: MSA is like the three flavoured Neapolitan ice cream. Everyone with MSA gets a scoop of the MSA ice cream just as everyone at a birthday party gets a scoop of Neapolitan ice cream in their dish. If you were at the party and looked at your dish and at the dish of the person next to you you would notice that there is not the exact same amount of vanilla, chocolate and strawberry in both of the dishes.

In someone with Multiple System Atrophy, if their symptoms are mainly CEREBELLAR like ataxia (loss of balance), slurred speech or difficulty swallowing they have mostly vanilla ice cream in their dish .

If their symptoms are mainly PARKINSONISM like tremors and slowness of movement they have mostly chocolate ice cream in their dish.

If their symptoms are mainly AUTONOMIC like orthostatic hypotension (low blood pressure when standing) or urinary incontinence or urinary retention or sexual dysfunction they have mostly strawberry ice cream in their dish.

Everyone needs to have some strawberry symptoms to be diagnosed with MSA. On top of this they need to have some vanilla and some chocolate symptoms too. Note that they may have a whole lot of vanilla and a tiny bit of chocolate. If so they are called MSA-C (cerebellar). If they have a whole lot of chocolate and a tiny bit of vanilla they are called MSA-P (parkinsonism).

People with MSA have a changing bowl of ice cream though … their vanilla and chocolate and strawberry amounts increase over time as they develop more symptoms from the cerebellar or the parkinsons or the autonomic sides. … but this will vary from person to person. This is because the disease is spreading throughout the brain. It does not spread exactly the same way in every person.

I hope this helps you understand Multiple System Atrophy a bit better.


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Download the 50+ page document “MSA What You Need to Know” from the Multiple System Atrophy Coalition website.

To find support and educational resources check out the MSA Resources page.

Remember: March is Multiple System Atrophy Awareness month and October 3rd is World MSA Day.

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