Summary about Disease
Multiple System Atrophy (MSA) is a rare, progressive neurodegenerative disorder that affects multiple systems in the body. It primarily involves the autonomic nervous system (which controls involuntary functions like blood pressure, heart rate, bladder control, and digestion) and movement. MSA is characterized by a combination of parkinsonism (slowed movement, rigidity, tremor), cerebellar dysfunction (problems with balance and coordination), and autonomic dysfunction. It progresses more rapidly than Parkinson's disease and has no cure.
Symptoms
Symptoms of MSA vary depending on the affected systems but often include:
Motor Problems: Slow movement (bradykinesia), rigidity, tremor, postural instability (tendency to fall), difficulty with coordination (ataxia).
Autonomic Dysfunction: Orthostatic hypotension (sudden drop in blood pressure upon standing), bladder problems (incontinence, difficulty emptying), bowel problems (constipation), erectile dysfunction (in men), sweating abnormalities, difficulty regulating body temperature.
Speech and Swallowing Difficulties: Slurred speech (dysarthria), difficulty swallowing (dysphagia).
Sleep Disturbances: REM sleep behavior disorder (acting out dreams), sleep apnea.
Visual Disturbances: Double vision, blurred vision.
Causes
The exact cause of MSA is unknown. Researchers believe it involves the abnormal accumulation of a protein called alpha-synuclein in glial cells (support cells in the brain) in multiple areas of the brain. Genetic factors are not considered to be a primary cause, and MSA is generally not considered hereditary.
Medicine Used
There is no cure for MSA, and treatment focuses on managing symptoms. Medications used may include:
For Parkinsonism: Levodopa (often less effective in MSA than in Parkinson's disease).
For Orthostatic Hypotension: Midodrine, fludrocortisone.
For Bladder Problems: Medications to reduce overactive bladder (e.g., oxybutynin).
For Constipation: Laxatives, stool softeners.
For REM Sleep Behavior Disorder: Clonazepam, melatonin. Symptomatic relief through physical, occupational, and speech therapy.
Is Communicable
No, MSA is not communicable. It is not contagious and cannot be spread from person to person.
Precautions
There are no specific precautions to prevent MSA, as the cause is unknown. However, individuals diagnosed with MSA can take precautions to manage their symptoms and improve their quality of life, such as:
Preventing Falls: Using assistive devices (cane, walker), modifying the home environment (removing tripping hazards, installing grab bars), and exercising to improve balance.
Managing Orthostatic Hypotension: Rising slowly from sitting or lying down, wearing compression stockings, increasing fluid and salt intake (as directed by a doctor).
Preventing Aspiration: Eating slowly, taking small bites, and modifying food consistency if swallowing is difficult.
Planning and adapting as symptoms change.
How long does an outbreak last?
MSA is not an outbreak-related disease. It is a chronic, progressive condition that gradually worsens over time. It does not have a defined "outbreak" period.
How is it diagnosed?
Diagnosis of MSA can be challenging and often involves a combination of:
Neurological Examination: Assessing motor skills, reflexes, balance, coordination, and autonomic function.
Medical History: Reviewing symptoms and other medical conditions.
Autonomic Testing: Evaluating blood pressure response to standing, heart rate variability, and sweating.
MRI of the Brain: Looking for specific patterns of brain atrophy characteristic of MSA.
DaTscan: (Dopamine transporter scan) This is more to rule out Parkinson's as MSA will not have the same dopamine deficiencies.
Other Tests: Urine tests to assess bladder function, sleep studies to evaluate sleep disorders.
Timeline of Symptoms
The timeline of MSA symptoms varies from person to person. However, the disease is generally progressive, meaning that symptoms worsen over time.
Early Stages: Subtle motor problems, mild autonomic dysfunction.
Middle Stages: More pronounced motor symptoms, increasing autonomic problems (orthostatic hypotension, bladder dysfunction), speech and swallowing difficulties.
Late Stages: Severe motor impairment, significant autonomic dysfunction, dependence on others for care. The average survival time after diagnosis is typically 7-10 years.
Important Considerations
Early Diagnosis: Early diagnosis is important for symptom management and planning.
Multidisciplinary Care: Management of MSA requires a team approach involving neurologists, physical therapists, occupational therapists, speech therapists, and other healthcare professionals.
Support Groups: Joining a support group can provide emotional support and practical advice for individuals with MSA and their families.
Advance Care Planning: Discussing advance care planning with a doctor and family members is important to ensure that the person's wishes are respected as the disease progresses.
Research: Participating in research studies may help advance understanding of MSA and develop new treatments.