17250 Multiple System Atrophy

Overview

Multiple system atrophy (MSA) is a rare brain disorder that affects how your body controls movement, balance, and automatic functions like blood pressure, heart rate, and digestion. It happens when certain areas of the brain slowly become damaged over time. The word 'atrophy' means the brain tissue shrinks or wastes away. 'Multiple system' means it affects more than one part of the nervous system.

No, MSA is rare. About 5 in every 100,000 people are affected. Because it is rare, many doctors may not see it often, so getting a specialist’s opinion is important.

MSA usually begins in middle age, most often after age 50, but it can occur younger. Both men and women can develop it, although some studies suggest it may be slightly more common in men.

Symptoms

Common symptoms

• Problems with balance and coordination, such as stumbling or feeling unsteady.
• Slow or stiff movements, sometimes mistaken for Parkinson's disease.
• Dizziness or fainting when standing up, due to a sudden drop in blood pressure (orthostatic hypotension).
• Bladder problems, such as urgency, frequent urination, or trouble emptying the bladder.
• Constipation or other digestive issues.
• Slurred or softer speech.
• Trouble swallowing.
• Sleep disturbances, including acting out dreams or breathing pauses.

Symptoms in children

• MSA is an adult disease. It is not known to occur in children. If a child has similar symptoms, they likely have a different condition and should be evaluated by a pediatric specialist.

Symptoms in older adults

• Older adults may have additional symptoms like increased balance problems, falls, and more noticeable blood pressure drops. It can be harder to tell MSA apart from normal aging or other brain disorders, so a thorough evaluation by a specialist is essential.

Causes

Main causes

• The exact cause of MSA is unknown. Researchers believe it may involve a buildup of a protein called alpha-synuclein in certain brain cells, which damages them over time.
• There is no evidence that MSA is caused by lifestyle, diet, or injuries.
• It is not passed down directly from parent to child in most cases, though rare genetic factors may play a role in some people.

Risk factors

• Age: MSA most often begins after age 50.
• Being male: Some research suggests a slightly higher risk in men.
• Having a family history of MSA or similar disorders is very rare, but can slightly increase risk.

When to see a doctor

See a doctor urgently if:

• If you faint or fall, especially more than once.
• If you have trouble breathing or swallowing.
• If you notice sudden weakness or changes in your speech.
• If you develop a fever along with changes in your usual symptoms.

Book a routine appointment if:

• If you have ongoing dizziness when standing, bladder problems, or difficulty with balance that does not go away.
• If your family or friends notice changes in your speech, movement, or sleep behavior.
• If you have symptoms that worry you, even if they are mild.

Diagnosis

There is no single test that confirms MSA. Doctors usually make the diagnosis after a thorough medical history, a neurological exam, and tests that rule out other conditions. A specialist (usually a neurologist) will look for the typical pattern of symptoms over time.

Tests that may be done

• A neurological exam to check balance, movement, reflexes, and eye movements.
• Blood pressure and heart rate measurements while lying down and then standing up.
• Brain imaging, such as an MRI, which looks for changes in certain brain areas.
• Autonomic function tests, which check how well your body controls heart rate, blood pressure, sweating, and bladder function.
• Sometimes additional tests like a sleep study or swallowing evaluation.

What to expect at your appointment

The diagnostic process can take time, sometimes months, because MSA symptoms slowly develop and overlap with other conditions. Your doctor may want to see you several times. You may be referred to a specialist center. It is important to be patient and to bring a family member or friend to appointments to help remember what is said.

Treatment

There is no cure for MSA, but treatment focuses on managing symptoms, maintaining independence, and improving quality of life. A team of healthcare professionals—such as neurologists, physical therapists, occupational therapists, speech therapists, and nutritionists—work together to create a plan tailored to your needs.

Self-care at home

• Move slowly when changing positions, from lying to sitting or from sitting to standing, to reduce dizziness.
• Ask your doctor or physical therapist about safe exercises to keep your muscles strong and balance as stable as possible.
• Keep your bedroom and bathroom well-lit and free of clutter to prevent falls.
• Drink plenty of fluids, but talk to your doctor about how much is right for you, especially for blood pressure control.
• Eat smaller, more frequent meals to help with blood pressure and digestion.
• Consider using assistive devices like a cane, walker, or shower chair to stay safe.

Medical treatments

Treatments are tailored to each person and may include physical and occupational therapy, speech therapy, and medications to help with blood pressure, bladder, or movement symptoms. Medicines are chosen carefully because MSA can respond differently to them than Parkinson's disease does. Your healthcare team will monitor you regularly to adjust your plan as needs change.

When is surgery considered?

Surgery is not a standard treatment for MSA. In rare cases, a tube may be inserted into the stomach (feeding tube) or a tube into the bladder (catheter) to manage severe swallowing or bladder problems. These decisions are made with your healthcare team when necessary.

Living with this condition

Living with MSA means adapting routines to match how your body feels from day to day. Planning ahead can help. For example, have a shower chair ready, keep walking aids near where you need them, and let family or friends know how they can support you. It is okay to ask for help.

Lifestyle tips

• Stay as active as your condition allows; gentle activities like stretching or chair exercises can help.
• Keep a regular sleep schedule and talk to your doctor about sleep problems.
• Try relaxation techniques like deep breathing or gentle music to reduce stress.
• Stay socially connected with family and friends, even if it is by phone or video.
• Keep a diary of your symptoms to share with your healthcare team.

Diet and exercise

Eat a balanced diet with plenty of fiber to help with constipation. Some people find that raising the head of the bed helps with morning dizziness. Your doctor or dietitian may recommend adding salt or increasing fluids if you have low blood pressure, but always follow their advice. Exercise, if safe, can help with balance and mood. A physical therapist can design a program that is right for you.

Mental health and emotional wellbeing

A diagnosis of MSA can bring feelings of anxiety, fear, or sadness. It is completely normal to grieve changes in your body and lifestyle. Talking with a counselor, joining a support group, or leaning on loved ones can help. You are not alone, and your feelings matter.

Prevention

At this time, there is no known way to prevent MSA. It is not caused by diet, exercise, or lifestyle choices. Research is ongoing to better understand the disease and possible future approaches.

Vaccines

No vaccine prevents MSA. However, stay up to date with recommended vaccines, such as flu and pneumonia vaccines, because infections can make MSA symptoms worse.

Screening programmes

There is no routine screening for MSA. Diagnosis happens when symptoms lead a person to seek medical help.

Complications

If left untreated

• Without proper management, falls can lead to serious injuries like fractures or head injuries.
• Swallowing problems can increase the risk of choking or inhaling food into the lungs, causing pneumonia.
• Severe blood pressure drops can lead to fainting and related injuries.
• Bladder problems can increase the risk of urinary tract infections.

Long-term outlook

MSA is a serious and progressive condition, and it affects each person differently. While it can be life-limiting, many factors—including good medical care, a strong support system, and adaptive strategies—can help you live as actively and comfortably as possible. Researchers are learning more every day, and there is always hope. Focus on what you can do today to feel your best, and let your healthcare team guide you.

Find support

International organisations

• Multiple System Atrophy Coalition ↗
• The MSA Trust (UK-based, also serves international) ↗

Local organisations

• Ask your neurologist or GP about local MSA support groups or hospital-based palliative care teams · Ask locally

Helplines

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