Multiple System Atrophy

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multiple system atrophy

MSA (multiple system atrophy) is a rare and degenerative neurological disorder, which is affecting the body’s autonomic (involuntary) functions, including muscle control, bladder function, breathing, and blood pressure. Multiple system atrophy was formerly known as Shy – Drager syndrome. Multiple system atrophy shares many symptoms of Parkinson’s disease, such as poor balance, rigid muscles, and slow movement. The treatment of multiple system atrophy includes medications and lifestyle changes, but there is no cure. This condition progresses gradually and eventually, it can lead to death.

multiple system atrophy

Symptoms

Multiple system atrophy affects many parts of the body, but the symptoms typically develop in adulthood, usually in the 50s or 60s. Multiple system atrophy is classified into two types – parkinsonian and cerebellar. The type of multiple system atrophy will depend on the symptoms that you have at diagnosis. [1]

Parkinsonian type

Parkinsonian type is the most common type of multiple system atrophy and the signs and symptoms are similar to those of Parkinson’s disease [2], such as

  • Problems with posture and balance
  • Rigid muscles
  • Tremors (rare in MSA compared with classic Parkinson’s disease)
  • Slow movement (bradykinesia)
  • Difficulty bending your arms and legs

Cerebellar type

 The main signs and symptoms of this type are problems with muscle coordination (known as ataxia), but there can be others, such as

  • Difficulty swallowing (called dysphagia) or chewing
  • Impaired movement and coordination, such as unsteady gait and loss of balance
  • Visual issues, such as blurred or double vision and difficulty focusing your eyes
  • Slurred, slow or low–volume speech (dysarthria)

General signs and symptoms

 In addition to the previously mentioned signs and symptoms, the primary sign of MSA is:

  • Postural (also called orthostatic) hypotension, which is a form of low blood pressure and it makes you feel dizzy or lightheaded, or even faint when you stand up from sitting or laying down.

Also, you can develop dangerously high blood pressure levels while you are lying down. Multiple system atrophy can cause other difficulties with autonomic (involuntary) body functions, such as

  • Urinary and bowel dysfunction: Loss of bladder or bowel control (incontinence);
  • Sweating abnormalities: Impaired body temperature control, often causing cold hands or feet; heat intolerance due to reduced sweating; reduced production of sweat, tears, and saliva. [3]
  • Sleep disorders: Abnormal breathing at night; agitated sleep due to acting out dreams. [4]
  • Sexual dysfunction: Loss of libido; inability to achieve or maintain an erection (impotence).
  • Cardiovascular problems: Irregular heartbeat. [5]
  • Psychiatric problems: Difficulty controlling emotions, such as crying inappropriately or laughing.

If you have some of the above-mentioned signs and symptoms of multiple system atrophy, then see your doctor for an evaluation and diagnosis. If you are already diagnosed with multiple system atrophy, then talk with your doctor if your new symptoms happen or if existing symptoms worsen.

Causes

There is no exact known cause for multiple system atrophy. In some studies are saying that it can possibly inherit components or environmental toxins involved in the disease process, but there is no enough evidence to support these theories. Multiple system atrophy is causing a deterioration and shrinkage (atrophy) of portions of the brain (brainstem, basal ganglia, and cerebellum) which is regulating the internal body functions, digestion, and motor control. When the damaged brain tissue of people with multiple system atrophy is looked under a microscope, then it shows nerve cells (called neurons), which have an abnormal amount of a protein, known as alpha-synuclein. In some studies is said that this protein can be over-expressed in the multiple system atrophy.

Complications

 The progression of multiple system atrophy varies, but this condition does not have into remission. As the multiple system atrophy progresses, daily activities can become increasingly difficult.

Some of the possible complications of multiple system atrophy include:

  • Increased difficulty swallowing
  • Breathing abnormalities during sleep [4]
  • Vocal cord paralysis, which makes a speech and breathing difficult
  • Some injuries from falls caused by poor balance or fainting
  • A loss of ability to care for yourself in day–to–day activities
  • The progressive immobility could lead to secondary problems, such as a breakdown of your skin

References:

[1] Fellner L, Wenning GK, Stefanova N. Models of multiple system atrophy. Current Topics in Behavioral Neurosciences. 2015;22:369–93. doi:10.1007/7854_2013_269

[2] Stocchi F, Badiali D, Vacca L, et al. Anorectal function in multiple system atrophy and Parkinson’s disease. Movement Disorders. 2000;15(1):71-6. doi:10.1002/1531-8257(200001)15:1<71::aid-mds1012>3.0.co;2-w.

[3] Coon EA, Fealey RD, Sletten DM, et al. Anhidrosis in multiple system atrophy involves pre- and postganglionic sudomotor dysfunction. Movement Disorders. 2017;32(3):397–404. doi:10.1002/mds.26864

[4] News Medical Life Sciences. Researchers uncover the mysteries of sleep disorders in multiple system atrophy. 2021. Retrieved from www.news-medical.net/news/20210409/Researchers-uncover-the-mysteries-of-sleep-disorders-in-multiple-system-atrophy.aspx

[5] Leys F, Fanciulli A, Ndayisaba JP, et al. Cardiovascular autonomic function testing in multiple system atrophy and Parkinson’s disease: an expert-based blinded evaluation. Clinical Autonomic Research. 2020;30(3):255–63. doi:10.1007/s10286-020-00691-4

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