Multiple System Atrophy

Diagnosis

Diagnosing multiple system atrophy can be difficult because its symptoms often overlap with other neurological conditions, especially Parkinson’s disease. Symptoms such as muscle stiffness, slow movement, and difficulty walking may appear similar, which can delay or complicate diagnosis.

Your healthcare professional begins by reviewing your medical history and performing a physical and neurological examination. Tests of autonomic nervous system function, such as blood pressure control, are often included. Blood tests and imaging studies such as MRI scans may also be ordered. These tests help support a diagnosis of multiple system atrophy or identify other conditions that may be causing your symptoms.

When multiple system atrophy is suspected, test results help classify the condition as clinically established MSA or clinically probable MSA. Because there is no single definitive test, some people are never formally diagnosed.

You may be referred to a neurologist or another specialist for further evaluation. Specialist assessment often plays an important role in confirming the diagnosis.

Tilt table test
A tilt table test evaluates how well your body controls blood pressure. During the test, you are secured to a motorized table that slowly tilts your body upward to a 70-degree angle.
Your healthcare professional monitors changes in blood pressure and heart rate to see how your body responds when you change position.

Tests of autonomic functions
Other tests may be used to assess involuntary body functions, including:

• Blood pressure measurements taken while lying down and standing

• Sweat testing to measure how different parts of the body sweat

• Tests that evaluate bladder and bowel function

• An electrocardiogram to monitor heart rhythm

If you have symptoms such as loud snoring or pauses in breathing during sleep, a sleep study may be recommended. This test can identify treatable sleep conditions such as sleep apnea.

Treatment

There is no cure for multiple system atrophy. Treatment focuses on managing symptoms and maintaining comfort and body function for as long as possible. Treatment plans are tailored to each person based on their symptoms and disease progression.

Medicines to raise blood pressure
Low blood pressure when standing, known as postural hypotension, is common in MSA. Medicines that may be prescribed include:

• Fludrocortisone, which helps the body retain salt and water to raise blood pressure

• Midodrine, which raises blood pressure quickly but must be used carefully to avoid high blood pressure when lying down

• Pyridostigmine, which increases standing blood pressure without significantly raising it when lying down

• Droxidopa, which treats postural hypotension but may cause headache, dizziness, or nausea

Medicines to reduce Parkinson’s disease-like symptoms
Medicines used for Parkinson’s disease, such as levodopa combined with carbidopa, may help some people with stiffness, balance problems, and slow movement.
Many people with multiple system atrophy respond poorly to these medicines, and their effectiveness may decline over time.

Medicines to treat erection problems
Erectile dysfunction may be treated with medicines such as sildenafil. These medicines can improve sexual function but may lower blood pressure and must be used cautiously.

Managing swallowing and breathing symptoms
If swallowing becomes difficult, eating softer foods may help. As symptoms worsen, surgery may be needed to place a feeding tube directly into the stomach.
Breathing problems during sleep, such as sleep apnea or stridor, may be treated with devices like CPAP or BiPAP. In severe cases, breathing support may be required.

Bladder care
Medicines may help with bladder control in the early stages of MSA. As the disease progresses, a soft tube called a catheter may be needed to empty the bladder.

Therapy
Physical therapy can help maintain mobility, balance, and muscle strength as long as possible.
A speech-language pathologist can assist with speech difficulties and help manage swallowing problems as the disease progresses.

Treatment for multiple system atrophy is aimed at improving quality of life, managing daily challenges, and supporting comfort over time.