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Multiple System Atrophy is a rare and progressive neurological disorder, historically considered a Parkinson’s Plus disease.  A distinguishing feature of MSA is the accumulation of the protein alpha-synuclein associated with the dysfunction of nerve cells in specific areas of the brain. 

There are two classifications of Multiple System Atrophy:

  • MSA–C (Cerebellar – prominent symptoms)
  • MSA–P (Parkinsonian – prominent symptoms)

MSA–A was once used to denote autonomic difficulties but recent standards in diagnosis recognize these symptoms are present in both MSA–C and MSA–P.

It is estimated that the incidence of MSA is 0.6 per 100,000 with the average onset in the mid-fifties. MSA is a terminal disease. Seven to nine years is the typical life expectancy from diagnosis, however there is an extremely wide range of survival.

Common Symptoms

Multiple System Atrophy presents differently in patients. Symptoms may include:

  • Orthostatic Hypotension
  • Gait and Mobility Difficulties
  • Balance and Coordination Impairment
  • GU Dysfunction
    • Urinary issues
    • Impotence in men
  • GI Dysfunction
    • Constipation
    • Dysphagia/Swallowing Difficulties
  • Speech Difficulties
  • Sleep Issues
  • Cognitive Impairment
  • Breathing Difficulties


Due to the rareness of the disease, combined with the variation in presentation, diagnosis is difficult. After a taking a clinical history and performing a neurological examination, tests may include:

  • autonomic testing (such as blood pressure control, heart rate control);
  • assessment of bladder function;
  • neuroimaging such as an MRI, PET scan, or DaTscan; and
  • HD-OCT;

Individuals with MSA typically do not have sustained improvement in their symptoms with levodopa (a commonly used Parkinson’s Disease medication), a result that may support the diagnosis of MSA. Diagnosis can only be confirmed upon autopsy.

Treatment & Management

There is no cure for Multiple System Atrophy. Symptoms are treated, working with a team of medical professionals with relevant areas of specialty practices. These specialties may include:

  • Neurologist
  • Cardiologist
  • Urologist
  • Gastroenterologist
  • Pulmonologist

Moreover, multiple therapies and support are recommended to provide practical strategies for daily living. These may include:

  • Physical Therapy
  • Speech Therapy
  • Occupational Therapy
  • Nutritionist
  • Psychologist
  • Alternate Therapies (Music, Art, Dance, Pet, etc.)
  • Support Groups

Patients are encouraged to exercise, maintain a careful diet, utilize assistive devices, take medication as prescribed, and coordinate care among their medical professionals.

Additional Information

National Institute of Neurological Diseases & Stroke Information & Clinical Trials

Multiple System Atrophy Coalition

This information is intended for informational purposes only. Patients must confer with their treating physicians regarding their individual progress and management of MSA.

If any information on this page is in error or inappropriate and requires editing or removal, please report it immediately.