Multiple system atrophy (MSA)

The exact cause of MSA is unclear. It doesn't seem to be inherited, and it doesn't happen because of anything the person did. It has no connection to multiple sclerosis (MS). Research into the causes of MSA is ongoing.

There isn't a specific test for MSA, and since several other neurological conditions look similar early on, getting a clear diagnosis can take time.

Your doctor will look at your symptoms and rule out other conditions, such as Parkinson's disease.

MSA becomes more likely if:

• your symptoms have progressed quickly
• you've had falls early in the condition
• you don't respond well to the medicine levodopa
• your speech has been severely affected
• you gasp and breathe noisily

If your doctor suspects MSA, they'll check your reflexes and bodily functions like bladder control and blood pressure. You might also have a brain scan, such as an MRI, to check for loss of brain cells.

Treating multiple system atrophy

There isn’t a cure for MSA and there isn’t a way of slowing its progress.

As symptoms worsen, you might need help managing day to day life.

Visit the MSA Trust website for information and support about living with MSA. They have a dedicated MSA charity nurses who can help to support you.

Treatment of MSA involves a combination of medication, specialist equipment and the involvement of therapists to manage specific symptoms. It might take time to find the right combination of treatments which work best for you.

You might be prescribed medication to help with the stiffness and slowness caused by MSA. Their benefits are limited and they can make blood pressure problems worse.

A physiotherapist can give you regular exercises to do. This can help strengthen your muscles and prevent your joints from stiffening.

They’ll also consider if there’s any equipment that would help you like a walking frame or shoes that can help reduce your risk of falls.

You might be taught breathing exercises to reduce the chance of developing aspiration pneumonia (a chest infection caused by inhaling particles of food into your lungs) when you eat.

Physiotherapists and occupational therapists can provide advice and equipment to help you live safely. For example, they might suggest you have handrails fitted to help you keep your balance. They can teach you exercises and strategies to help you avoid falls.

Urology and continence specialists can recommend treatment to help manage bladder problems.

If you’re having problems emptying your bladder, you might have intermittent catheterisation. This involves putting a tube into the bladder to drain the pee.

This can be done intermittently then removed. Or it can be placed permanently either through the urethra or abdominal (stomach) wall.

People with MSA who have postural hypotension produce less pee during the day and more at night. There are medications that can help manage this if it becomes disruptive during the night and affects your sleep.

You might want to use a commode or urinal at your bedside for during the night. This might be useful if you have low blood pressure or are prone to falls.

You should try to drink plenty fluids and eat a well balanced diet to try to avoid becoming constipated.

If you do experience constipation you’ll be offered medication to take regularly. Suppositories can be helpful to avoid straining.

If you have episodes of diarrhoea (loose stools) this is likely to be caused by severe constipation. Speak to your doctor if this happens to you.

Less commonly, someone with MSA might have regular diarrhoea. Speak to your doctor if this happens to you.

Erectile dysfunction (inability to get or maintain an erection) is often the first symptom of MSA. There’s medication available to help with erectile dysfunction but it can cause problems with your blood pressure.

You might experience problems with your libido and sexual function.

The MSA Trust have more information relationships, sex and MSA.

You might feel dizzy when you stand up or change position because your blood pressure falls quickly.

Sometimes this can be helped by drinking more fluids and eating more salt. Leg exercises that increase blood flow in your calves can help too. You should avoid sudden changes in position like standing up quickly.

If your blood pressure can’t be controlled by these practical methods, you might be offered medication to help with this.

Read more about living with postural hypotension (dizziness)

You might see a speech and language therapist who’ll try to help with your problems with speech and swallowing (dysphagia).

Together with a dietitian they might suggest changing the consistency of your food to make it easier to swallow.

They might be able to give you techniques you can use to make your voice clearer. They’ll suggest communication aids or devices if they think they might help you.

You might be offered a feeding tube if you:

• experience coughing or choking when eating or drinking
• struggle to eat and drink enough to stay well

A dietitian will help advise you how to eat a healthy balanced diet including more food and liquids that are easy to swallow.

If there’s a risk of malnutrition and dehydration, you might be offered a feeding tube.

You might be referred to a respiratory team if you have breathing problems like sleep apnoea or stridor.

They might recommend overnight non invasive ventilation, like CPAP.

Palliative care

You can choose to have palliative care at any stage of MSA in addition to other treatments.

The aim of palliative care is to relieve pain and other symptoms alongside psychological, spiritual and social support.

You might receive palliative care:

• at home
• in a hospice or care home
• as an outpatient in a hospital
• in a hospital

Future care planning

You might want to consider making plans for the future to help your family and health professionals plan your medical care.

This will be useful if you’re unable to communicate later on because you’re too ill.

You don’t have to make these plans if you don’t want to.

Read more about future care planning

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