Materiały źródłowe

• #1 Multiple System Atrophy | National Institute of Neurological Disorders and Stroke

  https://www.ninds.nih.gov/health-information/disorders/multiple-system-atrophy

  Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by a combination of symptoms that affect both the central nervous system (which controls how a person moves), and the autonomic nervous system, which controls involuntary functions such as blood pressure or digestion. […] The symptoms of MSA reflect the progressive loss of function and death of different types of nerve cells in the brain and spinal cord. […] The initial symptoms can be difficult to distinguish from those of Parkinson’s disease, and can include: Slowness of movement, tremor, or stiffness, Clumsiness or lack of coordination, Croaky, quivering voice, Fainting or lightheadedness, Bladder control problems. […] Symptoms tend to appear in a person’s 50s and advance rapidly over the course of five to 10 years. A person with MSA will have increased difficulty with movement and eventually become bedridden. People with MSA often develop swallowing problems that can lead to pneumonia in the later stages of the disease.

• #2 Multiple system atrophy (MSA)

  https://www.nhs.uk/conditions/multiple-system-atrophy/

  The main symptom of multiple system atrophy (MSA) is losing control of muscles in the body. This happens gradually in some people and quickly in others. […] MSA affects people in different ways, depending on which muscles are affected. Some of the most common symptoms include: bladder problems, such as needing to pee more often or being unable to pee; feeling dizzy and faint when standing up; erectile dysfunction (impotence); slow, clumsy or unsteady movement; slurred speech; stiff, tense muscles that may be painful. […] The symptoms of MSA most often begin in people over 50 years old. It does not usually affect people under 30 years old. […] A neurologist may diagnose MSA based on your symptoms, how long you’ve had them and how quickly they’re getting worse. […] There’s currently no cure for multiple system atrophy (MSA) and no treatments that can stop it getting worse. […] Multiple system atrophy (MSA) affects how long someone lives and can sometimes get worse quickly. Most people eventually need some help and support with their daily living. […] The type of support and how quickly it’s needed can vary, as MSA affects everyone differently.

• #3 Multiple system atrophy (MSA) | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/multiple-system-atrophy-msa/

  Everyone with MSA will experience different symptoms. Symptoms often start between the ages of 50 and 60, but they can begin anytime from the age of 30. […] You’re likely to experience muscle control or balance problems, like those of Parkinson’s disease or Ataxia. It’s a progressive disease which means symptoms will worsen over a period of time. […] MSA can cause symptoms including: bladder problems like a constant need to pee, loss of bladder control (urinary incontinence) or being unable to pee; low blood pressure when standing up which might cause dizziness or fainting (postural hypotension); erection problems like erectile dysfunction; problems with co-ordination, balance and speech (cerebellar ataxia); tremor, slowness and muscle stiffness; constipation. […] Someone with MSA might also have: uncontrollable laughing or crying; problems with sleep like insomnia, restless legs or nightmares; noisy breathing; unintentional sighing; weak, quiet voice; shoulder and neck pain; problems controlling sweating; swallowing problems including difficult chewing and choking episodes; blurred vision; cold hands and feet.

• #4 Multiple System Atrophy (MSA) – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/autonomic-nervous-system-disorders/multiple-system-atrophy-msa

  Multiple system atrophy is a progressive, fatal disorder that causes symptoms resembling those of Parkinson disease (parkinsonism), loss of coordination, and malfunction of internal body processes (such as blood pressure and bladder control). […] Symptoms include symptoms that resemble those of Parkinson disease, loss of coordination, low blood pressure when a person stands (orthostatic hypotension), problems with urination, and constipation. […] Multiple system atrophy usually begins when people are in their 50s. It affects men and women equally. […] Both types involve autonomic nervous system dysfunction. Although multiple system atrophy begins as one of these types, symptoms of the other type eventually develop. After about 5 years, symptoms tend to be similar regardless of which disorder developed first.

• #5 Multiple system atrophy – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/multiple-system-atrophy/symptoms-causes/syc-20356153

  MSA may cause: Color changes in the hands and feet. […] People with multiple system atrophy also may experience: Trouble controlling emotions, such as laughing or crying when not expected. […] Complications of multiple system atrophy (MSA) vary from person to person. But for everyone with the disease, MSA symptoms get worse over time. The symptoms can make daily activities harder as time goes on. […] People typically live about 7 to 10 years after multiple system atrophy symptoms first appear. However, the survival rate with MSA varies widely. Death is often due to trouble breathing, infections or blood clots in the lungs.

• #6 Multiple System Atrophy (MSA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17250-multiple-system-atrophy

  The average survival time for this condition is six to 10 years. In less severe cases, people can survive up to 15 years. However, in very severe cases, survival time may be much lower. […] The outlook for MSA is poor. The symptoms of this condition get progressively worse and always disrupt body function, leading to deadly complications.

• #7 Multiple system atrophy – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/multiple-system-atrophy/symptoms-causes/syc-20356153

  Multiple system atrophy, also called MSA, causes people to lose coordination and balance or become slow and stiff. It also causes changes in speech and loss of control of other bodily functions. […] MSA is a rare condition. It sometimes shares symptoms with Parkinson’s disease, including slow movement, rigid muscles and poor balance. […] Treatment includes medicines and lifestyle changes to help manage symptoms, but there is no cure. The condition gets worse over time and eventually leads to death. […] Multiple system atrophy (MSA) symptoms affect many parts of the body. Symptoms start in adulthood, usually in the 50s or 60s. […] There are two types of MSA: parkinsonian and cerebellar. The type depends on the symptoms a person has when diagnosed. […] This is the most common type of MSA. Symptoms are similar to those of Parkinson’s disease, such as: Stiff muscles. Trouble bending the arms and legs. Slow movement, known as bradykinesia. Tremors at rest or when moving the arms or legs. Slurred, slow or soft speech, known as dysarthria. Trouble with posture and balance.

• #8 Multiple system atrophy (MSA) // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/multiple-system-atrophy-msa

  Multiple system atrophy (MSA) is a rare, degenerative neurological disorder affecting your body’s involuntary (autonomic) functions, including blood pressure, and motor control. […] MSA shares many symptoms with Parkinson’s disease, such as slow movement, rigid muscles and poor balance. […] The condition progresses gradually and eventually leads to death. […] Symptoms usually start in adulthood, usually in the 50s or 60s. […] The type depends on the symptoms you have when you’re diagnosed. […] The signs and symptoms are similar to those of Parkinson’s disease, such as: Stiff muscles, Difficulty bending your arms and legs, Slow movement (bradykinesia), Tremors can occur at rest or when moving your arms or legs, Soft voice, Problems with posture and balance. […] The main signs and symptoms are problems with muscle coordination (ataxia), but others may include: Impaired movement and coordination, such as unsteady gait and loss of balance, Slurred, slow or low-volume speech (dysarthria), Visual disturbances, such as blurred or double vision and difficulty focusing your eyes, Difficulty swallowing (dysphagia) or chewing, Changes in speech, such as slurred speech.

• #9 Multiple system atrophy – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/multiple-system-atrophy/symptoms-causes/syc-20356153

  The main symptoms of the cerebellar type involve poor muscle coordination, known as ataxia. Symptoms may include: Trouble with movement and coordination. This includes loss of balance and not being able to walk steadily. Slurred, slow or soft speech, known as dysarthria. Changes in vision. This may include blurred or double vision and not being able to focus the eyes. Trouble chewing or swallowing, known as dysphagia. […] For both types of multiple system atrophy, the autonomic nervous system doesn’t work properly. The autonomic nervous system controls involuntary functions in the body, such as blood pressure. When this system doesn’t work properly, it can cause the following symptoms. […] Postural hypotension is a form of low blood pressure. People who have this type of low blood pressure feel dizzy or lightheaded when they stand up after sitting or lying down. They may even faint. Not everyone with MSA has postural hypotension.

• #10 Symptoms – Multiple System Atrophy Trust

  https://www.msatrust.org.uk/what-is-msa/symptoms/

  Having a diagnosis of MSA does not mean all possible symptoms will be experienced. Symptoms can change over time and progression will be individual. […] There is currently no specific treatment to prevent MSA from progressing (although clinical trials and research are being undertaken) but there are ways of assisting and alleviating symptoms. These include lifestyle adaptations, medications for specific symptoms and ensuring you get the support and advice from the professionals involved in your care. […] MSA is degenerative, which means that unfortunately symptoms are likely to worsen over a period of time. Over time the need to rely on others for help may arise. The speed of these changes is difficult to predict as people with MSA experience it differently and the speed of progression varies from person to person.

• #11 First symptoms in multiple system atrophy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5859695/

  The initial symptoms of multiple system atrophy (MSA) and, in particular, early autonomic symptoms, have received less attention than motor symptoms. […] The first symptom of MSA was autonomic in 22 (73%) and motor in 3 (10%) subjects (p 0.0001). The most frequent first symptom was erectile failure, which occurred in all men beginning 4.2 2.6 years prior to diagnosis. […] The first symptoms of MSA are frequently autonomic and may predate recognition of motor manifestations. Orthostatic hypotension and, in men, erectile failure are among the first symptoms that, when evaluated in the context of associated clinical findings, may facilitate accurate and earlier diagnosis. […] The results of this study indicate that early symptoms in MSA are frequently autonomic and predate recognition of motor manifestations. At the time of initial diagnosis, careful attention to historical details found that a majority (77%) of MSA patients recalled early autonomic symptoms that initially were not recognized as being a manifestation of a neurodegenerative disease. A history of erectile failure, in particular, in men was invariably present as early as 4 or more years prior to diagnosis and very often was the first symptom. […] This study highlights the importance of paying close attention to autonomic symptoms as potential early manifestations of MSA.

• #12

  https://movementdisorders.ufhealth.org/for-patients/movement-disorder-information/multiple-system-atrophy-primer-many-faces-same-disease/

  Importantly, it is possible for these other symptoms to precede motor symptoms by months to years. […] Disease progression unfortunately is usually more rapid than in PD and reflects a more widespread neurodegeneration in the brain. […] The combination of autonomic and motor symptoms, particularly if early in onset, can be fraught with more complications and shorter survival. […] Treatment of MSA remains largely supportive. […] About 30-60% of patients respond to typical Parkinsons medications such as carbidopa/levodopa (Sinemet), and dose trial of up to 1 gram/day of levodopa for a few months is recommended. […] Benefit seen early in disease often fades though, or becomes fraught with complications. […] Two major complications include exacerbation of orthostatic symptoms (lightheadedness, dizziness, or fainting on standing) and dyskinesias, or abnormal involuntary movements that often involve the jaw or face. […] Although there is often focus on motor symptoms, the non-motor symptoms of MSA can also be just as disabling. […] Orthostatic symptoms, dizziness and even fainting, can become very limiting and lead to the wheelchair or recliner-bound patient.

• #13 Multiple system atrophy | Altru Health System

  https://www.altru.org/health-library/conditions/multiple-system-atrophy

  The main symptoms of the cerebellar type involve poor muscle coordination, known as ataxia. Symptoms may include: Trouble with movement and coordination. This includes loss of balance and not being able to walk steadily. Slurred, slow or soft speech, known as dysarthria. Changes in vision. This may include blurred or double vision and not being able to focus the eyes. Trouble chewing or swallowing, known as dysphagia. […] For both types of multiple system atrophy, the autonomic nervous system doesn’t work properly. The autonomic nervous system controls involuntary functions in the body, such as blood pressure. When this system doesn’t work properly, it can cause the following symptoms. […] Postural hypotension is a form of low blood pressure. People who have this type of low blood pressure feel dizzy or lightheaded when they stand up after sitting or lying down. They may even faint. Not everyone with MSA has postural hypotension.

• #14 Multiple system atrophy | Altru Health System

  https://www.altru.org/health-library/conditions/multiple-system-atrophy

  People with MSA also can develop dangerously high blood pressure levels while lying down. This is called supine hypertension. […] These symptoms include: Constipation. Loss of bladder or bowel control, known as incontinence. […] People with multiple system atrophy may: Produce less sweat. Have heat intolerance because they sweat less. Have poor body temperature control, often causing cold hands or feet. […] Sleep symptoms may include: Agitated sleep due to „acting out” dreams. This is known as rapid eye movement (REM) sleep behavior disorder. Breathing that stops and starts during sleep, known as sleep apnea. A high-pitched whistling sound while breathing, called stridor. […] MSA may cause: Color changes in the hands and feet. […] People with multiple system atrophy also may experience: Trouble controlling emotions, such as laughing or crying when not expected.

• #15 Multiple System Atrophy: Practice Essentials, Background, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/1154583-overview

  Patients with MSA have a poor prognosis. The disease progresses rapidly. Median survivals of 6.2-9.5 years from the onset of first symptoms have been reported since the late 20th century. No current therapeutic modality reverses or halts the progress of this disease. MSA-P and MSA-C have the same survival times, but MSA-P shows more rapid dysfunctional progression. […] An older age at onset has been associated with shorter duration of survival in MSA. The overall striatonigral cell loss is correlated with the severity of disease at the time of death. […] Bronchopneumonia (48%) and sudden death (21%) are common terminal conditions in MSA. Urinary dysfunction in MSA often leads to lower urinary tract infections (UTIs); more than 50% of patients with MSA suffer from recurrent lower UTIs and a significant number die of related complications.

• #16 Multiple system atrophy – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/multiple-system-atrophy/symptoms-causes/syc-20356153

  People with MSA also can develop dangerously high blood pressure levels while lying down. This is called supine hypertension. […] These symptoms include: Constipation. Loss of bladder or bowel control, known as incontinence. […] People with multiple system atrophy may: Produce less sweat. Have heat intolerance because they sweat less. Have poor body temperature control, often causing cold hands or feet. […] Sleep symptoms may include: Agitated sleep due to „acting out” dreams. This is known as rapid eye movement (REM) sleep behavior disorder. Breathing that stops and starts during sleep, known as sleep apnea. A high-pitched whistling sound while breathing, called stridor. […] These symptoms may include: Trouble getting or keeping an erection, known as erectile dysfunction. Trouble with lubrication during sex and having an orgasm. Loss of interest in sex.

• #17

  https://link.springer.com/article/10.1007/s10286-017-0500-0

  The first symptom of MSA was autonomic in 22 (73%) and motor in 3 (10%) subjects. […] The most frequent first symptom was erectile failure, which occurred in all men beginning 4.2 2.6 years prior to diagnosis. […] After erectile failure, postural lightheadness or fatigue following exercise, urinary urgency or hesitancy, and violent dream enactment behavior consistent with REM behavioral sleep disorder were the most frequent initial symptoms. […] The first symptoms of MSA are frequently autonomic and may predate recognition of motor manifestations. […] Orthostatic hypotension and, in men, erectile failure are among the first symptoms that, when evaluated in the context of associated clinical findings, may facilitate accurate and earlier diagnosis. […] The first presenting symptom of MSA that was recalled in retrospect was autonomic in 22 (73%), sleep-related in 5 (17%), and motor in 3 (10%) of subjects.

• #18 Multiple system atrophy | Monash Health

  https://monashhealth.org/services/movement-disorders-program/understanding-movement-disorders/multiple-system-atrophy/

  MSA can cause a range of breathing problems, such as sleep apnoea and dyspnoea and inspiratory stridor. Breathing problems can develop in the early stages of MSA. […] Sleep disorders, in particular rapid eye movement sleep behaviour disorder (RBD), may be one of the first symptoms presenting in MSA. RBD affects most people with MSA. […] Mood changes are common and may include depression, anxiety and mood swings. […] Changes to thought processes, known as cognitive changes, also occur with MSA.

• #19 The Pathobiology of Behavioral Changes in Multiple System Atrophy: An Update

  https://www.mdpi.com/1422-0067/25/13/7464

  Anxiety is defined as a neuropsychiatric disorder characterized by nervousness and loss of concentration, due to the anticipation of impending danger. At baseline, anxiety may be mild, but its severity is associated with increased disease duration and severity. […] Patients with MSA-P show deficits in executive function and higher anxiety (and depression) scores than healthy controls. […] Impulse control disorders are a group of symptoms that, according to the DSM-5, are characterized by destructive behaviors related to impulse control, including problems with self-control over one’s emotions and behaviors. […] Isolated RBD, a parasomnia, was recently recognized as a risk factor for MSA. It is estimated that 4–5% of patients with idiopathic RBD will develop MSA, and approximately 30–40% of those with MSA exhibit RBD symptoms prior to the onset of the disease.

• #20 Multiple System Atrophy/Shy-Drager Syndrome | Vanderbilt Autonomic Dysfunction Center

  https://www.vumc.org/autonomic-dysfunction-center/multiple-system-atrophyshy-drager-syndrome

  The most common causes of death in patients with MSA are pulmonary embolus, apnea, and intercurrent infection. […] Symptoms of MSA include: Orthostatic hypotension, or a significant fall in blood pressure when standing, causing dizziness, lightheadedness, fainting, or blurred vision; urinary difficulties or constipation; motor control symptoms, including tremor, rigidity, and loss of muscle coordination, loss of balance; male impotence (inability to achieve or maintain an erection); speech or swallowing difficulties.

• #21 Multiple System Atrophy/Shy-Drager Syndrome | Vanderbilt Autonomic Dysfunction Center

  https://www.vumc.org/autonomic-dysfunction-center/multiple-system-atrophyshy-drager-syndrome

  Patients frequently note emotional lability, with short (sometimes only one or two minutes) episodes of crying due to happiness or sadness in response to relatively minor environmental stimulus, such as a song, a television program, or a movie. […] A final symptom which occurs in occasional patients with multiple system atrophy is diplopia, not unlike that seen in multiple sclerosis. […] The prognosis is more guarded in the multiple system atrophy patient than in pure autonomic failure. […] It is rare for a patient to survive 10 years. […] A significant number of patients develop laryngeal stridor and difficulty swallowing, which can lead to pneumonia. […] In addition, many patients with MSA experience Cheyne-Stokes or periodic respiration and in some cases this may lead to a critical loss of respiratory drive, so called Ondine’s curse.

• #22 Multiple System Atrophy: Causes and Treatment | Doctor

  https://patient.info/doctor/multiple-system-atrophy

  Multiple system atrophy (MSA) is a rare progressive neurodegenerative disorder, caused by cell loss in areas of the brain and the spinal cord, leading to a variety of symptoms affecting especially the functions of the autonomic nervous system and the motor system. These are characterised by Parkinsonian features of varying severity, cerebellar ataxia and autonomic (particularly urogenital) dysfunction. […] The first symptoms are often autonomic and may predate recognition of motor manifestations. Orthostatic hypotension and, in men, erectile failure are among the first symptoms. Patients may also present with Parkinsonian symptoms, often with a poor or temporary response to levodopa therapy, or cerebellar dysfunction. […] Up to 49% of patients with MSA have been shown to have executive dysfunction. Cognitive impairment is more prominent in older patients with greater physical disability. Other neuropsychiatric problems may include depression, insomnia, daytime sleepiness, restless legs, hallucinations and dementia.

• #23 Multiple System Atrophy: Advances in Diagnosis and Therapy

  https://www.e-jmd.org/journal/view.php?doi=10.14802/jmd.22082

  Multiple system atrophy (MSA) is a progressive neurodegenerative disease characterized by varying degrees of autonomic failure (AF), parkinsonism, and cerebellar ataxia. […] Symptomatic treatment has limited efficacy in MSA, and no treatments suppress or alleviate disease progression. […] The clinical diagnosis of MSA requires the presence of various combinations of AF and/or parkinsonism or cerebellar ataxia. […] The median time from disease onset that meets the criteria for probable diagnosis based on the second consensus criteria is approximately two years. […] Patients often have only AF, parkinsonism, or cerebellar ataxia early during the disease. […] In a study, following the onset of MSA, 40% of patients had mild to moderate cognitive dysfunction with or without orthostatic hypotension, which was characterized by executive dysfunction and verbal memory impairment, with depression in 28% and anxiety disorders in 22% of patients.

• #24 Multiple System Atrophy | National Institute of Neurological Disorders and Stroke

  https://www.ninds.nih.gov/health-information/disorders/multiple-system-atrophy

  MSA tends to progress more rapidly than Parkinson’s disease, and most people with MSA will require an aid for walking, such as a cane or walker, within a few years after symptoms begin. […] Other symptoms of MSA include: Stiffness in the hands or limbs caused by contractures (chronic shortening of muscles or tendons around joints, which prevents the joints from moving freely), A posture in which the body leans involuntarily to one side (known as Pisa syndrome), Anterocollis, in which the neck bends forward and the head drops down, Anxiety or depression, REM (Rapid Eye Movement) sleep behavior disorder (RBD) – a tendency to act out dreams, Other sleep disorders, including sleep apnea.

• #25

  https://link.springer.com/article/10.1007/s00415-020-09881-6

  In this review, we describe the wide clinical spectrum of features that can be seen in multiple system atrophy (MSA) with a focus on the premotor phase and the non-motor symptoms providing an up-to-date overview of the current understanding in this fast-growing field. […] We describe the progression of clinical features to aid the diagnosis of MSA early in the disease course. […] Their presence at presentation, even in the absence of ataxia and parkinsonism, should be regarded as highly suggestive of the premotor phase of MSA. […] MSA is characterized by worsening of motor and non-motor features over an average of 10 years, with a fast progression from disease onset, helping to distinguish it from similar degenerative conditions, described above. […] Approximately 50% of patients require walking aids within 3 years from the onset of motor symptoms; 60% require a wheelchair after 5 years with a median time to becoming bedridden of 68 years.

• #26 Multiple system atrophy – Wikipedia

  https://en.wikipedia.org/wiki/Multiple_system_atrophy

  The average lifespan after the onset of symptoms in patients with MSA is 6-10 years. Approximately 60% of patients require a wheelchair within five years of onset of the motor symptoms, and few patients survive beyond 12 years. The disease progresses without remission at a variable rate. Those who present at an older age, those with parkinsonian features, and those with severe autonomic dysfunction have a poorer prognosis. Those with predominantly cerebellar features and those who display autonomic dysfunction later have a better prognosis.

• #27 What is MSA? – Defeat MSA New Zealand Trust

  https://defeatmsa.org.nz/what-is-msa/

  MSA is a rare, rapidly progressing neurodegenerative disorder that affects the brain. MSA impairs the systems that regulate blood pressure, heart rate and the bladder many of the basic bodily functions that people take for granted every day. People with MSA suffer from dangerously low blood pressure, speech and swallowing difficulties, sleep disturbances, breathing problems, rigidity and tremors. The life expectancy for those with MSA is typically 5 to 10 years. There is no remission of the disease. Almost 80% of patients are disabled within five years of the onset of the motor symptoms, and less than 20% of the cases survive beyond 10 years. Rate of progression and the speed of decline may vary widely from case to case. Patients with advanced MSA often become bed-bound, unable to speak and immobile.

• #28 Multiple System Atrophy: Essential Facts for Patients

  https://www.movementdisorders.org/MDS/Resources/Patient-Education/Multiple-System-Atrophy.htm

  Multiple System Atrophy (MSA) is a rare disorder that affects the functioning of multiple systems in the brain. Patients may experience: Slowness of movement, muscle stiffness and/or shaking/tremor. Problems with balance and coordination. Feeling lightheaded or dizzy while standing. Problems controlling bladder function and constipation. […] Over time, symptoms increase and treatments become less effective. You may experience difficulties using utensils, swallowing solid food or liquids, walking and controlling bladder or bowels. […] In advanced stages, MSA patients have increased risk of infections. Bladder symptoms can lead to urinary tract infections. Swallowing problems increase the risk of pneumonia. Overall, long-term care planning may be needed as the disease progresses.

• #29 Dysautonomia International: Summary of Multiple System Atrophy

  http://www.dysautonomiainternational.org/page.php?ID=33

  Unfortunately, MSA usually progresses rapidly over a period of 7 to 10 years, with the mean survival rate of 9.3 years from the time of the first symptom. About 80% of patients are disabled within 5 years of the onset of motor symptoms. It is estimated that only 20% of MSA patients survive beyond 12 years. Patients continue to experience neurological degeneration until they lose motor skills, become confined to bed, and eventually pass away. Many MSA patients succumb to pneumonia and other respiratory infections, choking or cardiac arrest. MSA does not go into remission and there is no cure at this time.

• #30 Multiple System Atrophy: Advances in Diagnosis and Therapy

  https://www.e-jmd.org/journal/view.php?doi=10.14802/jmd.22082

  A natural history study showed that low vitamin B12 levels were associated with shorter survival, increased frequency of falls within three years of onset, and a lower body mass index, suggesting a potential new target for therapeutic intervention. […] Further studies are needed to determine whether serotonin-targeted therapy alleviates several symptoms and modifies the disease course of MSA.

• #31 Laboratory prognostic factors for the long-term survival of multiple system atrophy | npj Parkinson’s Disease

  https://www.nature.com/articles/s41531-022-00413-9

  Multiple system atrophy (MSA) is a rapidly progressive neurodegenerative disease with a mean survival of 6-10 years from disease onset. […] Among clinical biomarkers, early autonomic failure, older age of onset, and absence of response to levodopa have been associated with shorter survival. […] In laboratory biomarkers, there is growing evidence that biomarkers reflecting high systemic inflammation are associated with disease severity and progression of MSA. […] Furthermore, recent studies revealed that biomarkers associated with neuronal damage and malnutrition are associated with disease severity, low quality of life, and high mortality in MSA. […] The median survival duration from the onset was 8.0 years. […] The median survival of MSA-P patients and MSA-C patients were 9.0 and 8.0 years, respectively, with no statistical difference between the two subtypes.

• #32 Multiple system atrophy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/multiple-system-atrophy/diagnosis-treatment/drc-20356157

  Diagnosing multiple system atrophy (MSA) can be challenging. Symptoms such as stiffness and trouble walking can happen in other diseases, including Parkinson’s disease. This can make MSA hard to diagnose. […] Treatment for multiple system atrophy (MSA) involves managing your symptoms. There’s no cure for MSA. Managing the disease can make you as comfortable as possible and help you maintain your body functions. […] Many people with multiple system atrophy do not respond to Parkinson’s medicines. The medicines also may become less effective after a few years. […] If you have trouble swallowing, try eating softer foods. If swallowing or breathing symptoms become worse, you might need surgery to insert a feeding or breathing tube. A gastrostomy tube delivers food directly into your stomach.

• #33 Multiple system atrophy (MSA) | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/multiple-system-atrophy-msa/

  It’s more likely you have MSA if: your symptoms have progressed quickly; you’ve had falls in the early stages of the condition; you don’t respond well to the medicine levodopa; your speech has been severely affected; you gasp and breathe noisily. […] There isn’t a cure for MSA and there isn’t a way of slowing its progress. […] As symptoms worsen, you might need help managing day to day life. […] Movement problems: You might be prescribed medication to help with the stiffness and slowness caused by MSA. Their benefits are limited and they can make blood pressure problems worse. […] Balance difficulties: Physiotherapists and occupational therapists can provide advice and equipment to help you live safely. […] Bladder control: Urology and continence specialists can recommend treatment to help manage bladder problems.

• #34 Multiple System Atrophy – Parkinson’s Group

  https://parkinsonstreatment.org/multiple-system-atrophy/

  The condition progresses gradually and eventually leads to death. […] More crippling symptoms, such as severe tightness muscles or contractures can be treated with muscle relaxants and sometimes by injection of botulinum toxin (i.e., Botox). […] Prevention of falls and aspiration (pneumonia) are major goals as these frequently lead to worsening disability and even death. […] If these are not enough, drugs like droxidopa and blood volume increasers (fludrocortisone) or pressor agents (e.g., midodrine) are used to prevent changes in blood pressures.

• #35 Multiple system atrophy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/multiple-system-atrophy/diagnosis-treatment/drc-20356157

  If you have trouble with bladder control, medicines can help in the earlier stages. But as MSA gets worse, you may need to have a soft tube inserted to drain your bladder. The soft tube is known as a catheter. […] A physical therapist can help you maintain as much of your movement and strength as possible as the disease gets worse.

• #36 Multiple system atrophy (MSA) | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/multiple-system-atrophy-msa/

  Constipation: You should try to drink plenty fluids and eat a well balanced diet to try to avoid becoming constipated. […] Sexual problems: Erectile dysfunction (inability to get or maintain an erection) is often the first symptom of MSA. […] Dizziness: You might feel dizzy when you stand up or change position because your blood pressure falls quickly. […] Communication and swallowing problems: You might see a speech and language therapist who’ll try to help with your problems with speech and swallowing (dysphagia). […] Eating problems: A dietitian will help advise you how to eat a healthy balanced diet including more food and liquids that are easy to swallow. […] Breathing problems: You might be referred to a respiratory team if you have breathing problems like sleep apnoea or stridor.

• #37 Multiple System Atrophy Symptoms & Treatment | Pacific Movement Disorders

  https://www.pacificneuroscienceinstitute.org/movement-disorders/conditions/atypical-parkinsonism/multiple-system-atrophy/

  Cerebellar MSA, previously known as Olivopontocerebellar atrophy (OPCA) or olivopontocerebellar degeneration (OPCD). This combines parkinsonism, autonomic dysfunction as above, and cerebellar findings such as imbalance, staggering gait, lack of coordination, and eye movement abnormalities. The cerebellar findings may precede the parkinsonism. […] Parkinsonian MSA, previously known as striatonigral degeneration (SND), manifests with parkinsonism (moving slowly, tremor and stiffness) and autonomic dysfunction. Other symptoms associated with MSA include REM sleep behavior disorder (RBD), which is where there is an absence of the usual paralysis during dream sleep (rapid eye movement REM), resulting in acting out dreams; contractures; leaning to one side; depression and anxiety. […] The treatment of MSA is primarily based on alleviating symptoms; no cure exists at this time. Patients should be monitored closely for severe issues such as breathing problems during sleep, supine hypertension (high blood pressure when lying down) and orthostatic hypotension (low blood pressure upon standing).

• #38 Multiple System Atrophy: Symptoms & Treatment | Massachusetts General Hospital

  https://www.massgeneral.org/neurology/treatments-and-services/multiple-system-atrophy

  In addition to the shared symptoms of MSA, patients with cerebellar MSA may experience: Movement problems: Poor coordination and balance can make walking difficult or cause falls. Speech problems: You may notice slurred speech, slow speech patterns, or speaking at a very low volume. Vision problems: Blurred vision, double vision, or trouble focusing may occur. […] MSA-P symptoms can be similar to Parkinson’s disease. Common symptoms include: Low vocal volume, Muscle stiffness that makes it difficult to bend your arms and legs, Posture and balance issues, Slow movement, Abnormal movements. […] Unlike some other diseases (like cancer), multiple system atrophy doesn’t have clearly defined stages. However, MSA tends to progress steadily after diagnosis. One of the earliest symptoms for many people is sexual dysfunction, such as erectile dysfunction in men or decreased sensitivity in women. However, most cases of sexual dysfunction are not caused by MSA. Other early symptoms can include orthostatic hypotension, urinary retention, and REM sleep behavior disorder. End-stage complications often include pneumonia and issues related to prolonged bedrest or breathing problems, such as aspiration pneumonia or pulmonary embolus.

• #39

  https://pspawareness.com/blogs/psp-q-a/navigating-the-four-stages-of-multiple-system-atrophy-msa?srsltid=AfmBOorCnP_Gi19iPDsvf2OSd7e2tmSIafnfpuOrnC3RP_Pyb13FavQU

  Multiple System Atrophy (MSA) is a rare, degenerative neurological disorder that impacts various systems in the body, notably the autonomic functions, movement, and sometimes cognition. While the progression of MSA can differ greatly from one individual to another, understanding the typical stages can be invaluable for planning care, setting realistic expectations, and preparing for the journey ahead. Here, we outline the four general stages of MSA, each marked by distinctive symptoms and challenges. […] It’s essential to approach this guide with the understanding that MSA does not follow a one-size-fits-all path. Each person’s experience with this condition can vary in symptoms, progression speed, and severity. This blog post serves as a guideline to help anticipate potential changes, but always consult with healthcare professionals for advice tailored to your or your loved one’s unique circumstances.

• #40

  https://pspawareness.com/blogs/psp-q-a/understanding-the-four-stages-of-multiple-system-atrophy-msa-with-detailed-symptom-description?srsltid=AfmBOor7BW-hQO2cmitOgETtHpW9WHioi-jLBdcNPeBXlje86juRA5v0

  Multiple System Atrophy (MSA) is a rare, progressive neurodegenerative disorder that impacts movement, balance, and autonomic functions. […] Here’s a closer look at the symptoms across its four stages: […] Stage 1: Early Symptoms […] Motor Symptoms: – Mild Ataxia: Slight awkwardness or unsteadiness, particularly noticeable when walking or performing fine motor tasks. – Mild Parkinsonism: Subtle rigidity or slowness in movement, often mistaken for early Parkinson’s disease. […] Autonomic Symptoms: – Orthostatic Hypotension: Dizziness or lightheadedness upon standing due to a drop in blood pressure. – Urinary Symptoms: Increased frequency, urgency, or hesitancy in urination. […] Other Symptoms: – Sleep Disorders: REM Sleep Behavior Disorder, where individuals act out their dreams, often leading to disrupted sleep. – Mild Cognitive Changes: Slight difficulties with concentration or executive function.

• #41

  https://pspawareness.com/blogs/psp-q-a/understanding-the-four-stages-of-multiple-system-atrophy-msa-with-detailed-symptom-description?srsltid=AfmBOor7BW-hQO2cmitOgETtHpW9WHioi-jLBdcNPeBXlje86juRA5v0

  Stage 2: Progression of Symptoms […] Motor Symptoms: – Increased Rigidity: More pronounced stiffness in muscles. – Tremor: May develop or become more noticeable, particularly postural or action tremor. – Balance Issues: Increased risk of falls due to worsening ataxia or Parkinsonism. […] Autonomic Symptoms: – Worsening Orthostatic Hypotension: More frequent and severe drops in blood pressure upon standing. – Bladder Dysfunction: Incontinence or retention becomes more problematic. – Sexual Dysfunction: Reduced libido or erectile dysfunction in men, vaginal dryness in women. […] Other Symptoms: – Sleep Disorders: Intensification of sleep issues, including loud snoring or sleep apnea. – Sweating Abnormalities: Either excessive or reduced sweating. […] Stage 3: Significant Disability […] Motor Symptoms: – Severe Ataxia and Parkinsonism: Walking becomes challenging; many require assistance or mobility aids. – Dysarthria: Speech becomes slurred, making communication difficult. – Dysphagia: Swallowing difficulties, increasing the risk of choking or aspiration.

• #42

  https://pspawareness.com/blogs/psp-q-a/understanding-the-four-stages-of-multiple-system-atrophy-msa-with-detailed-symptom-description?srsltid=AfmBOor7BW-hQO2cmitOgETtHpW9WHioi-jLBdcNPeBXlje86juRA5v0

  Autonomic Symptoms: – Extreme Blood Pressure Fluctuations: Can lead to syncope (fainting) or severe hypertension. – Gastrointestinal Issues: Constipation or, less commonly, diarrhea. – Thermal Regulation Problems: Difficulty maintaining body temperature. […] Other Symptoms: – Cognitive Decline: More pronounced issues with memory, attention, or executive functions. – Vision Problems: Blurred vision or difficulty with eye movements. […] Stage 4: End-Stage Disease […] Motor Symptoms: – Severe Mobility Limitation: Most or all mobility lost, often bedridden. – Severe Dysarthria and Dysphagia: Communication is severely impaired, and feeding might require tube feeding due to swallowing risks. […] Autonomic Symptoms: – Critical Autonomic Failures: Life-threatening drops in blood pressure, severely impaired body temperature regulation. – Respiratory Complications: Increased risk of pneumonia due to aspiration or weakened respiratory muscles.

• #43

  https://pspawareness.com/blogs/psp-q-a/understanding-the-four-stages-of-multiple-system-atrophy-msa-with-detailed-symptom-description?srsltid=AfmBOor7BW-hQO2cmitOgETtHpW9WHioi-jLBdcNPeBXlje86juRA5v0

  Other Symptoms: – Cognitive Impairment: Significant cognitive decline, potentially leading to dementia-like symptoms. – General Health Decline: Increased susceptibility to infections, pressure sores from immobility, and other complications. […] The progression of MSA is individual, with symptoms varying in intensity and onset. Early recognition of these stages can guide medical management, focusing on symptom control, safety, and quality of life.

• #44 Multiple System Atrophy vs. Parkinson’s Disease

  https://www.healthline.com/health/parkinsons/multiple-system-atrophy-vs-parkinsons

  Multiple system atrophy and Parkinsons disease are progressive nervous system disorders that affect everyday movements. Multiple system atrophy is rarer and tends to progress more quickly. […] Both MSA and PD progress over time if they are not treated. Depending on the MSA subtype, the two conditions can have some of the same symptoms. […] MSA can also cause: joint stiffness, Pisa syndrome (sideways leaning), anterocollis (a forward tilt of your head), sleep apnea, autonomic dysfunction, such as problems with your heart rate and digestion. […] MSA can progress rapidly, within 5 to 10 years. Many people need walking aids within a few years of diagnosis, and many lose the ability to move around. […] Life expectancy for people with MSA is 7 to 9 years.

• #45 Multiple System Atrophy (MSA) – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/autonomic-nervous-system/multiple-system-atrophy-msa

  Multiple system atrophy is a relentlessly progressive neurodegenerative disorder causing pyramidal, cerebellar, and autonomic dysfunction. Symptoms include hypotension, urinary retention, constipation, ataxia, parkinsonism, and postural instability. […] After symptoms appear, patients live about 9 to 10 years. […] Both types involve autonomic nervous system dysfunction. Although multiple system atrophy begins as one type, symptoms of the other type eventually develop. After about 5 years, symptoms tend to be similar regardless of which disorder developed first. […] Parkinsonian symptoms predominate in striatonigral degeneration. They include rigidity, bradykinesia, postural instability, and jerky postural tremor. […] In contrast to Parkinson disease, multiple system atrophy usually does not usually cause resting tremor and dyskinesia, and symptoms respond poorly and transiently to levodopa.

• #46 Multiple system atrophy – Wikipedia

  https://en.wikipedia.org/wiki/Multiple_system_atrophy

  Multiple system atrophy (MSA) is a rare neurodegenerative disorder characterized by tremors, slow movement, muscle rigidity, postural instability (collectively known as parkinsonism), autonomic dysfunction and ataxia. This is caused by progressive degeneration of neurons in several parts of the brain including the basal ganglia, inferior olivary nucleus, and cerebellum. […] Many people affected by MSA experience dysfunction of the autonomic nervous system, which commonly manifests as orthostatic hypotension, impotence, loss of sweating, dry mouth and urinary retention and incontinence. Palsy of the vocal cords is an important and sometimes initial clinical manifestation of the disorder. […] MSA often presents with some of the same symptoms as Parkinson’s disease. However, those with MSA generally show little response to the dopamine agonists used to treat Parkinson’s disease and only about 9% of MSA patients with tremor exhibit a true parkinsonian pill-rolling tremor.

• #47 Multiple System Atrophy-D Maybe Something Altogether–Different

  https://practicalneurology.com/diseases-diagnoses/movement-disorders/multiple-system-atrophy-d-maybe-something-altogetherdifferent/30257/

  The incidence of MSA is 3:100,000 in adults aged over 50 years, and the course of illness lasts 5 to 10 years. There are 2 known groups: MSA-P (parkinsonian) and MSA-C (cerebellar) that have clinical presentations associating them closely with more common movement disorders (eg, Parkinsons disease [PD] and ataxia). Patients with MSA often move slowly and have gait and balance problems, autonomic dysfunction, corticospinal tract findings, and sometimes tremor or stiffness. MSA is not as responsive to treatment, and the clinical course of worsening symptoms seems accelerated compared to PD. […] Many nonmotor symptoms seen in patients with PD are more clinically significant in patients with MSA. […] For establishing orthostatic hypotension to diagnose probable MSA, the 2008 consensus criteria give a definition of a drop in systolic blood pressure by 30 mm Hg or more, or a drop in diastolic blood pressure by 15 mm Hg or more after 3 minutes. Diagnosis of possible MSA does not require such strict parameters for orthostatic hypotension.

• #48 Multiple System Atrophy-D Maybe Something Altogether–Different

  https://practicalneurology.com/diseases-diagnoses/movement-disorders/multiple-system-atrophy-d-maybe-something-altogetherdifferent/30257/

  Bladder dysfunction occurs in patients with both PD and MSA, and measurement of postvoid residuals (PVRs) can also help distinguish between PD and MSA. PVR is elevated in patients with MSA because there is more urinary retention compared to those with PD, which has more prevalence of detrusor overactivity. […] Although it is likely that MSA and PD will always be intertwined, MSA is emerging as a distinct pathology.

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