Learn About Multiple System Atrophy (MSA)

The rare nervous system disorder often mistaken for Parkinson's disease

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Multiple system atrophy (MSA) is a disorder that causes multiple parts of the nervous system to degenerate. The older names for MSA include three syndromes: Shy-Drager syndrome, striatonigral degeneration, and olivopontocerebellar atrophy.

MSA is a progressive disease affecting both the central nervous system (which controls how a person moves), and the ​autonomic nervous system, the part of your body that controls unconscious actions like blood pressure, digestion, and breathing.

This article discusses the symptoms, diagnosis, and treatment options for multiple system atrophy.

Older man with doctor

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What Is Multiple System Atrophy?

MSA affects anywhere from two to 15 individuals per 100,000. MSA diagnosis is often delayed by an average of almost four years because of the similarities between MSA and other conditions, such as Parkinson's disease.

MSA is usually diagnosed around 50 years of age and is seen in people of all ethnic backgrounds. Once symptoms begin, the disease tends to progress quickly over five to 10 years. Average life expectancy is 7–9 years.

Symptoms of Multiple System Atrophy

MSA symptoms stem from the loss of nerve cells in the nervous system including the basal ganglia and cerebellum. What causes this loss of nerve cells is still unknown. Many people with MSA first notice symptoms such as:

  • Urinary incontinence
  • Erectile dysfunction in men
  • Orthostatic hypotension (drop in blood pressure when standing)
  • Fainting
  • Constipation

As symptoms progress, they typically fall under one of two groups:

  • Parkinsonian type (MSA-P): this includes symptoms similar to Parkinson's disease such as tremors at rest, rigidity of muscles, and slow movements, including gait.
  • Cerebellar type (MSA-C): involves difficulty walking (ataxia), issues maintaining balance, and trouble coordinating voluntary movements.

Other symptoms associated with MSA include:

  • Difficulty speaking or swallowing
  • Anxiety or depression
  • Cold hands
  • Sleep disorders, including sleep apnea
  • Muscle and tendon shortening
  • Pisa syndrome (where the body appears to lean to one side)
  • Involuntary sighing
  • Antecollis (the neck bends forward and the head droops down)

How Is MSA Diagnosed?

It can be very difficult to distinguish MSA from Parkinson’s disease. One way to differentiate between the two is to look at how quickly the disease progresses. MSA tends to progress faster than Parkinson's does. Many people with MSA will need an assistive device, like a wheelchair or cane, within several years of being diagnosed.

Another way to differentiate between the two is to treat for Parkinson's. MSA does not respond well to levodopa, the medication that is used to treat Parkinson’s. Unfortunately, an autopsy is the only way to definitively diagnose MSA. Specialized testing, such as a PET scan (positron emission tomography), can rule out other types of rare neurological disorders.

Treatment for Multiple System Atrophy

Currently, there is no cure for MSA, nor are there any treatments specifically designed to reverse or stop disease progression. Some aspects of the disorder are debilitating and difficult to treat. Treatments may include:

  • Levodopa and carbidopa (Sinemet) for movement disorders, but they usually have limited results
  • Trihexyphenidyl (Artane), benztropine mesylate (Cogentin), and amantadine (Symmetrel)
  • Botulinum toxin (commonly known as botox) injections to ease abnormal muscle postures (dystonia)
  • Fludrocortisone, midodrine, and droxidopa for orthostatic hypertension
  • Physical and occupational therapy, including aqua therapy, can help maintain muscle function
  • Speech therapy to improve difficulties swallowing or speaking

What the Research Says

Little is known about the mechanisms at work in multiple system atrophy. Researchers are currently trying to figure out why the protein alpha-synuclein builds up in the glial cells (cells that protect neurons in the nervous system) of people with MSA and the neuronal (nerve) cells of people with Parkinson’s disease.

A clinical trial tried using the drug rifampicin to slow down disease progression, but the treatment was ineffective. Data from this study is now being used in other MSA studies.

Summary

Multiple system atrophy is a progressive disease that can affect physical movement, blood pressure, digestion, breathing, and swallowing. The cause of MSA is unknown and diagnosis is often delayed because the condition has similar symptoms as other neurodegenerative diseases. There currently is no cure so treatment options focus on reducing symptoms as best as possible.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Institute of Neurological Disorders and Stroke. Multiple system atrophy.

  2. Goh YY, Saunders E, Pavey S, et al. Multiple system atrophy. Pract Neurol. 2023 Jun;23(3):208-221. doi: 10.1136/pn-2020-002797

  3. Foubert-Samier A, Pavy-Le Traon A, Guillet F, et al. Disease progression and prognostic factors in multiple system atrophy: A prospective cohort study. Neurobiology of Disease. 2020;139:104813. doi: 10.1016/j.nbd.2020.104813

  4. Low PA, Robertson D, Gilman S, Kaufmann H, et al. Efficacy and safety of rifampicin for multiple system atrophy: a randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2014 Mar;13(3):268-75. doi: 10.1016/S1474-4422(13)70301-6

Additional Reading
  • National Institute of Neurological Disorders and Stroke. Multiple System Atrophy Fact Sheet. November 2014.

By Mary Kugler, RN
Mary Kugler, RN, is a pediatric nurse whose specialty is caring for children with long-term or severe medical problems.