Understanding Multiple System Atrophy: Symptoms, Causes, and Hope
Learn about Multiple System Atrophy (MSA), its symptoms, causes, diagnosis, management, and ongoing research to improve quality of life for patients and caregivers.
Written by Dr. J T Hema Pratima
Reviewed by Dr. Rohinipriyanka Pondugula MBBS
Last updated on 4th Oct, 2025
Introduction
Multiple System Atrophy, or MSA, is a rare and progressive neurological disorder that can be challenging to understand and diagnose. Often mistaken for Parkinson's disease in its early stages, MSA is a distinct condition that affects multiple parts of the nervous system, leading to a wide range of symptoms that impact movement, balance, and automatic body functions like blood pressure and bladder control. This article aims to demystify this complex condition. We will break down what MSA is, explore its symptoms and causes, and walk through the diagnosis and management process. Most importantly, we will discuss strategies for maintaining quality of life and the latest advancements in research, offering a beacon of hope for patients and their families navigating this difficult journey. Whether you are newly diagnosed, a caregiver, or simply seeking to learn more, this guide provides a comprehensive overview of multiple system atrophy.
What is Multiple System Atrophy (MSA)?
A Rare Neurological Disorder
Multiple System Atrophy is classified as a rare neurodegenerative disorder. "Neurodegenerative" means it involves the progressive loss of structure or function of neurons, the essential cells of the brain and nervous system. In the case of MSA, this degeneration affects several areas of the brain, including the basal ganglia, cerebellum, and brainstem, which are responsible for controlling movement, balance, and autonomic functions. It is estimated that MSA affects about 3 to 5 per 100,000 people, making it a truly rare condition.
The Key Difference from Parkinson's Disease
While MSA shares some motor symptoms with Parkinson's disease, such as slowness of movement and stiffness, a fundamental difference lies in the underlying pathology. Both conditions involve the accumulation of a protein called alpha-synuclein. However, in Parkinson's, this protein clumps mainly inside neurons, forming Lewy bodies. In MSA, the alpha-synuclein clumps are found primarily in the support cells (glial cells) of the brain, forming structures called glial cytoplasmic inclusions (GCIs). This difference is crucial because it explains why MSA tends to progress more rapidly and why autonomic nervous system dysfunction is a prominent and early feature.
Recognising the Symptoms of MSA
The symptoms of multiple system atrophy are diverse and can be grouped into two main categories: autonomic dysfunction and motor disorders.
Autonomic Nervous System Dysfunction
The autonomic nervous system controls involuntary bodily functions. Its impairment is a hallmark of MSA.
Orthostatic Hypotension: Dealing with Dizziness
This is a sudden drop in blood pressure upon standing up, leading to dizziness, lightheadedness, blurry vision, or even fainting. It is one of the most common and disabling symptoms of MSA.Consult a Neurologist for the best advice
Urinary and Bowel Issues
Patients often experience urinary urgency, frequency, incontinence, or difficulty emptying the bladder. Constipation is also extremely common due to slowed digestive tract movement.
Other Autonomic Challenges
• Erectile Dysfunction: Often one of the earliest signs in men.
• Temperature Dysregulation: Difficulty sweating, leading to overheating, or excessive sweating in some cases.
• Sleep Disorders: Severe snoring, sleep apnoea, and REM sleep behaviour disorder (acting out dreams) are frequent.
Motor Symptoms and Movement Disorders
Motor symptoms help doctors classify MSA into two subtypes.
MSA-P (Parkinsonian Type)
This subtype is dominated by Parkinsonism signs:
• Bradykinesia: Slowness of movement.
• Rigidity: Stiffness in the muscles.
• Postural Instability: Impaired balance and coordination, leading to falls.
• Tremor: While less common than in Parkinson's, a jerky, postural tremor can occur.
MSA-C (Cerebellar Type)
This subtype primarily affects coordination:
• Ataxia: Unsteady gait, difficulty with coordination, and a wide-based walk.
• Intentional Tremor: Shaking that worsens when trying to perform a task like reaching for a cup.
• Slurred Speech: Difficulty articulating words (dysarthria).
• Visual Disturbances: Difficulty focusing on objects.
Additional Symptoms and Complications
Other signs may include a characteristic quivering, high-pitched voice, abnormal neck posture (anterocollis), cold hands and feet, and mood changes like anxiety or depression. If you or a loved one are experiencing a combination of these symptoms, it is crucial to seek professional evaluation. Consulting a neurologist online with Apollo24|7 can be a good first step to discuss your concerns.
What Causes Multiple System Atrophy?
The Role of Alpha-Synuclein Protein
The primary known cause of multiple system atrophy is the abnormal accumulation of the alpha-synuclein protein in glial cells. These protein clumps, or GCIs, are toxic and interfere with cellular function, leading to the progressive degeneration of neurons. Why this happens remains the central question in MSA research. It is not currently believed to be directly inherited in the vast majority of cases.
Known Risk Factors
There are no clear environmental or lifestyle risk factors definitively linked to MSA. The only consistent risk factors are age (typically onset in the 50s or 60s) and a slight predominance in men compared to women.
How is MSA Diagnosed?
The Challenge of Diagnosis
Diagnosing MSA is notoriously difficult, especially early on. Its symptoms overlap significantly with Parkinson's disease, pure autonomic failure, and other ataxias. A definitive diagnosis can only be made by examining brain tissue posthumously. Therefore, clinicians rely on a clinical diagnosis based on established criteria.
Key Diagnostic Tools and Tests
There is no single test for MSA. Diagnosis involves:
• Detailed Medical History and Neurological Exam: This is the cornerstone.
• Autonomic Function Tests: These assess blood pressure and heart rate responses to postural changes.
• MRI Brain Scan: An MRI may show specific signs, such as shrinkage (atrophy) in the cerebellum or brainstem, or a distinctive "hot cross bun" sign in the pons.
• DaTscan: This imaging test can help distinguish Parkinsonism (seen in MSA-P) from other tremor disorders, but it cannot differentiate MSA from Parkinson's disease.
The Importance of a Neurologist
Given the complexity, receiving a diagnosis from a neurologist, particularly a movement disorder specialist, is essential. They have the expertise to interpret symptoms and test results accurately.
Treatment and Management of MSA
Currently, there is no cure for multiple system atrophy. Treatment focuses on managing symptoms to improve quality of life.
Managing Autonomic Symptoms
• For Orthostatic Hypotension: Increased salt/water intake, compression stockings, and medications like fludrocortisone or midodrine.
• For Urinary Issues: Medications or catheterisation may be necessary.
• For Constipation: High-fibre diets, stool softeners, and laxatives are recommended.
Addressing Motor Symptoms
• Levodopa: This primary Parkinson's medication may be tried for MSA-P symptoms. However, only about one-third of MSA patients respond, and the benefits are often limited and temporary
• Physical, Occupational, and Speech Therapy: These are vital. PT helps with balance and mobility, OT with daily activities, and ST with speech and swallowing difficulties.
The Role of Therapy and Supportive Care
A multidisciplinary approach is best. This includes a neurologist, physiotherapist, occupational therapist, speech and language therapist, and a dietitian. Palliative care specialists can also provide immense support in managing symptoms and improving comfort as the disease progresses. Apollo24|7 offers convenient access to a range of specialists who can contribute to this collaborative care model.
Prognosis and Living with MSA
What to Expect
MSA is a progressive disease. The rate of progression varies, but the average life expectancy after the onset of symptoms is typically between 7 to 10 years. The most common causes of death are respiratory or cardiac problems.
The Critical Role of Caregivers and Support Systems
The physical and emotional demands on both patients and caregivers are significant. Building a strong support system is non-negotiable. This includes family, friends, healthcare professionals, and connecting with support groups for MSA caregivers. Sharing experiences and practical tips can be incredibly helpful.
Conclusion
Receiving a diagnosis of multiple system atrophy is life-altering. While the path ahead is undeniably difficult, the focus must remain on maximising quality of life, preserving dignity, and finding moments of joy. Advances in research are ongoing, with studies exploring the mechanisms of alpha-synuclein spread and potential neuroprotective therapies. For now, proactive symptom management, strong support networks, and compassionate care are the most powerful tools. If you suspect you or a loved one may have symptoms suggestive of MSA, take the first step and seek a neurological evaluation. Early and accurate diagnosis opens the door to appropriate management and support.Consult a Neurologist for the best advice
Consult a Neurologist for the best advice
Dr. Sathish Kumar V
Neurologist
16 Years • D.M Neurology (PGIMER, Chandigarh), • M.D General Medicine (GSVM Medical College, Kanpur )
Chennai
Apollo Speciality Hospitals OMR, Chennai
(200+ Patients)
Dr. H Rahul
Neurologist
10 Years • MBBS, MD(Gen. Med.), DM(Neuro)
Secunderabad
Apollo Hospitals Secunderabad, Secunderabad
(100+ Patients)
Dr. Ganeshgouda Majigoudra
Neurologist
10 Years • MBBS, MD ( GENERAL MEDICINE) DM (NEUROLOGY)
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr. Lakshaman K
Neurologist
19 Years • MBBS,MS General Medicine,MCH Neurosurgery
Bengaluru
R V speciality Clinic, Bengaluru
Dr. B Nataraju
Neurologist
32 Years • MBBS, MD, DM (Neurology)
Bengaluru
Apollo Medical Center, Marathahalli, Bengaluru
(50+ Patients)
Consult a Neurologist for the best advice
Dr. Sathish Kumar V
Neurologist
16 Years • D.M Neurology (PGIMER, Chandigarh), • M.D General Medicine (GSVM Medical College, Kanpur )
Chennai
Apollo Speciality Hospitals OMR, Chennai
(200+ Patients)
Dr. H Rahul
Neurologist
10 Years • MBBS, MD(Gen. Med.), DM(Neuro)
Secunderabad
Apollo Hospitals Secunderabad, Secunderabad
(100+ Patients)
Dr. Ganeshgouda Majigoudra
Neurologist
10 Years • MBBS, MD ( GENERAL MEDICINE) DM (NEUROLOGY)
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr. Lakshaman K
Neurologist
19 Years • MBBS,MS General Medicine,MCH Neurosurgery
Bengaluru
R V speciality Clinic, Bengaluru
Dr. B Nataraju
Neurologist
32 Years • MBBS, MD, DM (Neurology)
Bengaluru
Apollo Medical Center, Marathahalli, Bengaluru
(50+ Patients)
Frequently Asked Questions
1. Is Multiple System Atrophy hereditary?
In most cases, no. MSA is generally considered a sporadic disease, meaning it occurs randomly without a clear family history. However, there are extremely rare familial cases, but these are the exception.
2. What is the difference between MSA and Parkinson's disease?
The key differences are the prominence of early autonomic symptoms (like severe dizziness and urinary issues) in MSA, a typically more rapid progression, and a poorer response to Parkinson's medication like Levodopa. The underlying protein pathology also occurs in different brain cells.
3. Can MSA be cured?
Currently, there is no cure for MSA. Treatment strategies are focused on managing the individual symptoms, such as blood pressure problems, stiffness, and urinary incontinence, to maintain the best possible quality of life.
4. What is the life expectancy for someone with MSA?
The disease progression varies, but the average survival from the onset of symptoms is between 7 and 10 years. This can be influenced by the quality of care and the specific complications an individual experiences.
5. Are there any new treatments for MSA on the horizon?
Research is active, focusing on understanding the role of the alpha-synuclein protein. Clinical trials are investigating drugs that might slow disease progression by targeting this protein or its toxic effects, offering hope for future therapies.