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What First Responders Need to Know About MSA

Emergency Treatment Can Save the Life of an MSA Patient

Multiple System Atrophy (MSA) is a rare and progressive neurological disorder that can be challenging to diagnose, especially in its early stages. While similar to Parkinson disease, there are key differences and specific emergencies in MSA that are critically important for a first responder, such as paramedics or Emergency Medical Technicians (EMTs), to know when encountering someone with MSA.

Persons with MSA typically have symptom onset in their 50’s to 60’s and may be even have signs of disease years or months earlier. MSA presents in two different ways. One type is presents similarly to Parkinson’s disease, causing confusion and early misdiagnosis. The parkinsonian-type of MSA has features including tremor, stiffness or rigidity, slowed movements, difficulty walking and poor balance. Speech and swallow difficulty occur early and are more severe than that in Parkinson’s disease, raising the possibility of choking and aspiration. The second type of MSA is cerebellar and presents with predominant ataxic features including slurred speech, poor coordination, and imbalance, similar to someone who appears drunk.

A feature common to both types of MSA is autonomic dysfunction that may manifest as orthostatic hypotension or urogenital issues, such as urinary urgency or retention, sometimes causing infection (and delirium). Orthostatic hypotension is characterized by precipitous drops in blood pressure with position change that causes dizziness, lightheadedness, and episodes of passing out, or fainting and falls. Individuals with severe hypotension may appear confused, lethargic, and even shake or convulse. Autonomic dysfunction in MSA can also affect the heart and in some cases lead to cardiac arrest. Disorders of sleep and breathing also occur in MSA and include sleep apnea, respiratory failure, and inspiratory stridor, characterized by constriction of the airway that may lead shortness of breath and an emergent need for an airway.

While some of these issues can also occur in an advanced Parkinson’s patient, in MSA such problems occur earlier and are often more severe. Additional complications occur in MSA making it important for first responders to be aware and cognizant of some of the differences between MSA and the typical Parkinson disease patient.

More About MSA Symptoms

Motor symptoms in MSA cause problems with movement, including speech, swallow, coordination, and balance. Common symptoms include:

  • Tremor, poor coordination, stiffness or rigidity, and slowed movements.
  • Abnormal postures including forward flexion, dropped head, or limb deformities.
  • Gait difficulty, imbalance, and falls.
  • Slurred speech and difficulty communicating.
  • Swallow difficulty that may cause choking, aspiration, and pneumonia.

The autonomic nervous system is essential for controlling blood pressure, body temperature, digestion, urination, and sexual function. MSA impairs the autonomic nervous system, often early in disease, preceding onset of motor symptoms. The severity of autonomic symptoms may vary from person to person, but in affected MSA patients may cause alarming highs and lows in blood pressure and body temperature. Autonomic symptoms to watch out for include:

  • Orthostatic hypotension: a sudden drop in blood pressure that occurs when standing up from a sitting or lying position, leading to brain fog, lethargy, dizziness, lightheadedness, and sometimes fainting and falls.
  • Reduced perspiration: increases risk overheating in the sun and heat, and combined with dehydration, result in fainting.
  • Urinary dysfunction: frequency, urgency, retention or incontinence.
  • Constipation and impactions.

If an EMT or paramedic encounters a person with any of these symptoms, they should consider the possibility of MSA and take appropriate action. For example, if a person experiences orthostatic hypotension, the EMT may need to help the person sit or lie down to prevent falls, monitor their blood pressure, and give fluids. Choking and stridor both require urgent attention and possible need to provide an airway and administer oxygen.

It is also important for EMTs and paramedics to be aware of the potential complications of MSA, such as respiratory and cardiac failure, which can occur as the disorder progresses. If a person with MSA experiences difficulty breathing, the EMT may need to provide oxygen or assist with ventilation.

In addition to these immediate interventions, EMTs and paramedics can play a critical role in helping to identify MSA and ensuring that the person receives appropriate follow-up care. This may involve referring the person to a neurologist or other specialist who can perform further tests, such as brain imaging or autonomic function testing, to confirm the diagnosis.

In conclusion, although MSA can be a challenging disorder to diagnose, emergency medical technicians and paramedics can play a critical role in recognizing the symptoms and providing appropriate care. By being aware of the key symptoms of MSA and the potential complications of the disorder, first responders can help ensure that people with MSA receive timely and appropriate treatment, which can help to improve their quality of life and long-term outcomes.

About the Multiple System Atrophy Coalition

Our Mission

Multiple System Atrophy is a rare condition of the nervous system that causes gradual damage to nerve cells in the brain. From our beginnings, the MSA Coalition has been devoted to improving quality of life and building hope for people affected by multiple system atrophy and their families, friends, and caregivers through:

  • Providing patients and care partners with trusted and compassionate emotional support.
  • Educating patients, care partners, and healthcare professionals with credible, critically important, and relevant information.
  • Building a sense of community by connecting and unifying people affected by MSA.
  • Funding patient-centric collaborative research aimed at alleviating symptoms, slowing disease progression, and discovering a cure.
  • Playing a leading role in raising awareness and advocating for those impacted by the disease.

Our Vision

Improve quality of life for the multiple system atrophy community by expanding access to care and support while advancing research toward treatment and a cure.

Want to learn the language of MSA? Here’s a useful glossary of associated MSA terms.