Multiple System Atrophy – Symptoms and Causes

Overview

Multiple system atrophy (MSA) is a rare neurological disorder that affects movement, balance, and bodily functions.

The condition is progressive, meaning it worsens over time, and is eventually fatal. Treatments exist to manage symptoms through medications and lifestyle adjustments, but MSA has no cure.

This disorder has been known by several other names in medical history, including Shy-Drager syndrome, olivopontocerebellar atrophy, and striatonigral degeneration.

Signs and Symptoms

Movement Problems

People with MSA often show movement issues similar to Parkinson’s disease. These typically include:

• Muscle stiffness that makes limbs difficult to bend.
• Slow movements that affect daily activities.
• Trembling that happens during rest or movement.
• Unclear speech that sounds slurred or soft.
• Poor balance that increases fall risk.

These symptoms usually start in a person’s 50s or 60s. The stiffness and slow movement can make simple tasks like buttoning clothes or writing difficult.

Coordination Difficulties

Some people with MSA mainly have problems with muscle coordination. These issues include:

• Unsteady walking that looks like drunkenness.
• Balance problems that make standing difficult.
• Slurred speech that others find hard to understand.
• Vision changes including blurry or double vision.
• Eating difficulties including problems chewing and swallowing.

These symptoms affect a person’s ability to perform precise movements. Simple tasks like writing, using utensils, or walking in a straight line become challenging.

General Symptoms

Both types of MSA affect the body’s automatic functions. These are things your body does without thinking, like controlling blood pressure. Common symptoms include:

• Blood Pressure Problems:
  • Feeling dizzy when standing up
  • Possible fainting after position changes
  • Dangerous high blood pressure when lying down
• Bathroom Issues:
  • Constipation
  • Loss of bladder or bowel control
• Sweat and Temperature Changes:
  • Reduced sweating
  • Poor tolerance to heat
  • Cold hands and feet
• Sleep Disturbances:
  • Acting out dreams during sleep
  • Breathing pauses during sleep
  • Noisy breathing or whistling sounds
• Sexual Problems:
  • Erectile difficulties in men
  • Lubrication problems in women
  • Reduced interest in sex

Many people also experience unexpected emotional responses, like laughing or crying at inappropriate times.

When To Contact a Doctor

See a doctor if you notice any of these symptoms, especially:

1. Movement problems that affect daily activities.
2. Frequent dizziness when standing up.
3. Bladder control issues.
4. Sleep problems with noisy breathing.
5. Sudden emotional outbursts.

If you’ve already been diagnosed with MSA, contact your doctor when:

• Existing symptoms worsen
• New symptoms develop
• Medication seems less effective

Early medical attention helps with symptom management and improves quality of life.

Causes

Multiple system atrophy (MSA) has no clear cause that scientists have identified. Researchers continue to explore genetic factors and environmental triggers like toxins, but strong evidence for these theories remains lacking.

This condition leads to shrinkage (atrophy) in specific brain regions, including:

• Cerebellum
• Basal ganglia
• Brainstem

These affected areas control important body functions and movement abilities. When examined with microscopes, brain tissue from people with MSA shows unusual accumulations of a protein called alpha-synuclein.

Some scientific research points to these protein buildups as a potential trigger for the disease process.

Scientists continue studying these protein deposits to better understand how they might contribute to the development of multiple system atrophy and its progressive symptoms.

Risk Factors

Having rapid eye movement (REM) sleep behavior disorder increases your risk of developing multiple system atrophy (MSA). This disorder causes people to physically act out their dreams during sleep. Most MSA patients have a history of this sleep disorder.

Problems with the autonomic nervous system can also raise your risk for MSA. This system controls automatic body functions like heart rate and digestion. Early signs might include:

• Urinary incontinence
• Blood pressure problems
• Digestive issues

These symptoms may appear before other MSA signs develop.

Complications

MSA symptoms get worse over time. They can lead to several serious issues. These problems vary from person to person.

Common complications include:

• Sleep-related breathing problems that worsen at night.
• Fall injuries due to balance problems or fainting episodes.
• Skin breakdown in people with limited mobility.
• Loss of independence in daily activities.
• Vocal cord paralysis affecting both speech and breathing.
• Swallowing difficulties that become more severe over time.

People with MSA typically live 7 to 10 years after symptoms first appear. However, this timeline varies widely among individuals. Death usually results from respiratory complications, infections, or pulmonary blood clots.

As the disease progresses, daily tasks become increasingly difficult. Most patients eventually need significant assistance with basic care and mobility.