Multiple System Atrophy - Diagnosis and Treatment

Diagnosis

Diagnosing multiple system atrophy (MSA) is not simple because its symptoms, like stiffness and trouble with balance, can also appear in other neurological disorders, including Parkinson’s disease.

Health professionals use a mix of physical exams, medical history, and specialized tests to narrow down the cause. Neurologists often see patients when symptoms such as ataxia, tremor, bradykinesia, and problems controlling involuntary functions appear.

Specialists look for signs of autonomic dysfunction, movement problems, parkinsonian features, and cerebellar issues.

Other signs, such as urinary urgency, erectile dysfunction, or coordination problems, guide testing. Imaging tests like MRI scans can reveal signs such as the “hot cross bun sign” or brain changes related to MSA.

Doctors evaluate involuntary functions, especially those controlled by the autonomic nervous system, as a key part of diagnosing MSA.

These tests track signs of disease progression and help distinguish MSA from other parkinsonian disorders, progressive supranuclear palsy, or Shy-Drager syndrome.

Upright Table Blood Pressure Assessment

Clinicians measure how the body controls blood pressure when a person’s position changes. The patient lies flat on a table and is secured with straps for safety. The table is then raised to an angle of about 70 degrees.

Medical staff monitor blood pressure and heart rate during the tilt. When blood pressure drops sharply or does not adjust as expected, this can signal orthostatic hypotension, a common issue in MSA and related movement disorders.

This highlights autonomic nervous system problems, which are central to the diagnosis.

Testing of Involuntary Bodily Functions

Doctors use several methods to check how the autonomic nervous system is working. Some of these tests include:

Measuring blood pressure while lying down and standing.
A sweat assessment to see which parts of the body sweat normally.
Bladder and bowel testing to find issues with urinary incontinence or control.
Electrocardiogram (ECG): Evaluates the heart’s electrical signals.

Sometimes, doctors recommend a sleep study if symptoms suggest sleep disorders, such as stopped breathing, snoring, or possible sleep apnea.

Treatment

Treatments for multiple system atrophy (MSA) focus on making daily life easier and slowing the effects of symptoms.

Since a cure does not exist, the main goal is to help people feel as comfortable as possible and support their health. Care often includes a mix of medication, therapies, and support devices.

Medications for Key Symptoms:

Symptom/Issue	Notes
Low blood pressure (postural)	Medications may be used to help manage postural low blood pressure by: -Retaining salt and water to increase blood volume. -Raising blood pressure while lying down. -Improving blood pressure when standing more than when lying down.
Parkinson-like movement problems	Not everyone improves; may work less well after years.
Erectile dysfunction	Can reduce blood pressure.
Swallowing or breathing issues	Severe swallowing problems may need a tube; sleep apnea can be managed with breathing machines.
Bladder symptoms	Early use of medicine, catheter used as symptoms worsen.

Therapies and Support:

Physical Therapy: Physical therapists help patients maintain movement and strength for as long as possible. They teach safe ways to move and help prevent falls.
Occupational Therapy: Occupational therapists adjust activities of daily living so daily tasks remain doable even with physical changes.
Speech-Language Therapy: Speech experts help patients keep speech clear for as long as possible and may teach new ways to communicate.
Botulinum Toxin Injections: Clinicians sometimes use these for certain symptoms like muscle stiffness or drooling.

Breathing Treatments:

When breathing problems or sleep issues like sleep apnea develop, patients can use devices such as CPAP (continuous positive airway pressure) or BiPAP (bilevel positive airway pressure) at home. These machines keep airways open while sleeping and reduce breathing problems.

Feeding and Nutrition:

If eating becomes difficult, switching to softer foods may help. In more severe stages, doctors may recommend a gastrostomy tube (feeding tube to the stomach) so a person can get enough nutrition.

Additional Care:

Medicines for bladder control can help early on, but as the disease progresses, clinicians may use a soft tube called a catheter to drain the bladder safely.
Patients can use assistive devices such as walkers, canes, or wheelchairs to support independence and safety as movement declines.

The care team—doctors, nurses, therapists, and support staff—work together to address a wide range of symptoms and help people live as fully as possible with MSA.

Daily Habits and Home Care Tips

Managing multiple system atrophy (MSA) at home often means making small changes to daily routines.

Boosting Blood Pressure: Increasing fluid intake and adding some salt to meals can help keep blood pressure from dropping too low. Caffeinated drinks like coffee may also give a slight boost.
Positional Changes: Raising the head of the bed by about 4 to 6 inches supports better blood pressure during sleep. Moving slowly from a lying to a standing position can prevent dizziness and falls.
Diet Adjustments: Eating high-fiber foods can ease constipation, a common problem in MSA. Many find that using over-the-counter stool softeners helps. Smaller, low-carbohydrate meals may help control blood sugar swings.
Managing Temperature: Staying in cool environments and avoiding very hot showers can reduce the risk of symptoms worsening, especially dizziness.
Support Stockings: Wearing elastic stockings that go up to the waist can help control blood pressure by improving blood flow.

Proper daily routines can also support sleep quality, reduce excessive daytime sleepiness, and help with issues like sleep apnea or REM sleep disturbances.

Getting Ready for Your Visit

Steps You Can Take Before Your Appointment

Being prepared can help people make the most of their medical visits. Bringing organized notes and records ensures important information is not missed.

Checklist to Prepare:

Write down all symptoms. Note when each symptom started, how often they happen, and any changes you have noticed in your body or mood.
List current and past health issues. Include information about other medical conditions.
Record all medications. List all prescription and non-prescription medications, including the dosage amounts. Don’t forget vitamins or herbal products if you use them.
Note important changes in personal life. Write down any changes in sexual health, such as lower interest in sex or problems with erections.
Ask someone to accompany you. Having a family member or friend at your appointment can help you remember what was discussed.
Prepare questions for the healthcare provider. Creating a list ahead of time may help cover all concerns.

Example Questions to Bring:

Topic	Sample Questions
Symptoms	What do you think is causing my symptoms?
Diagnosis	What tests will help confirm the diagnosis?
Other Possibilities	Could these be signs of something else, like Parkinson’s disease?
Treatment	What treatments are available?
Side Effects	What should I know about possible risks or side effects?
Future Outlook	How might my condition change over time?
Symptom Management	Can changes in daily habits help reduce symptoms?
Ongoing Health Monitoring	Will you track my health over time and how?
Other Medicines	Should I adjust medications for other health problems?

Writing down any other questions you have is helpful. The list does not need to be limited to these topics.

Types of Questions Your Doctor May Ask

Doctors typically ask about both specific symptoms and general health. Being ready to answer their questions can help save time and improve care.

Below are examples of questions patients may hear:

What symptoms are you experiencing, and when did each one begin?
Have you noticed feeling dizzy or faint when standing up?
Are there any changes in your emotions, such as sudden laughter or crying?
Has there been any change in your voice?
Have you ever been told that you snore loudly or stop breathing at night?
Are you dealing with constipation or bladder control problems?
Are you experiencing any sexual difficulties, such as changes in sex drive or trouble with erections?
Do you have trouble swallowing or chewing?
Have you experienced problems with breathing?
Are you having trouble with movement, like slowness or poor balance?
Do you have a family history of nervous system conditions?
Are you being treated for any other conditions right now?

Having written notes about your symptoms and history can help provide clear answers.

Helpful Actions While Waiting for the Visit

While you wait for the medical appointment, gather certain family information.

Ask about family history. Find out if any close relatives—such as parents, siblings, or grandparents—have ever been diagnosed with conditions like Parkinson’s disease or cerebellar ataxia. Although multiple system atrophy (MSA) is not inherited, family history may help doctors rule out other diseases.
Track any changes. If you notice new symptoms or worsening of current issues while you wait, write these down to share at the visit.
Continue healthy habits. Follow any current advice from other healthcare professionals, such as taking medicines or following a specific diet, unless told otherwise.
Organize your notes. Keep your lists and questions in one place to make the appointment go more smoothly.

Multiple System Atrophy – Diagnosis and Treatment