There's no cure for multiple system atrophy. Management of the disease involves treating signs and symptoms to make you as comfortable as possible and to maintain your body functions and capabilities.
To treat specific signs and symptoms, your doctor may recommend:
Medications to raise blood pressure. Medications such as the corticosteroid fludrocortisone can increase your blood pressure by leading to more retention of salt and water. This drug, which is a steroid, is often prescribed on a twice-a-day regimen.
The drug pyridostigmine (Mestinon) can raise your standing blood pressure without increasing your blood pressure while you're lying down.
Other medications to increase standing pressure, such as midodrine (Orvaten), are available and can raise your blood pressure quickly; however, midodrine has been shown to elevate pressure while lying down, which can increase the risk of stroke in some people.
The FDA has recently approved droxidopa (Northera) for treating orthostatic hypotension. The most common side effects of droxidopa include headache, dizziness and nausea.
Medications to reduce Parkinson's-like signs and symptoms. Certain anti-Parkinson's medications, such as combined levodopa and carbidopa (Parcopa, Sinemet), can be used to reduce Parkinson's-like signs and symptoms, such as stiffness, balance problems and slowness of movement, as well as improve an overall feeling of well-being.
However, not everyone with multiple system atrophy responds to Parkinson's drugs, and the effectiveness of these medications may decline after a few years of therapy.
- Pacemaker. Your doctor may advise implanting a heart pacemaker to keep your heart beating at a rapid pace, which can increase your blood pressure.
- Impotence drugs. Impotence can be treated with a variety of drugs, such as sildenafil (Revatio, Viagra), designed to manage erectile dysfunction.
- Steps to manage swallowing and breathing difficulties. If you have difficulty swallowing, try eating softer foods. If swallowing or breathing becomes increasingly problematic, you may need a feeding tube or breathing tube inserted surgically to manage the problem. Late in the disease process, you may require a tube (gastrostomy tube) that delivers food directly into your stomach.
- Bladder care. If you're experiencing bladder control problems, medications can help in the earlier stages. Eventually, when the disease becomes advanced, you may need to have a soft tube (catheter) inserted permanently to allow you to drain your bladder.
A physical therapist can help you maintain as much of your motor and muscle capacity as possible as the disorder progresses. A speech-language pathologist can help you learn to improve or maintain your speaking ability.
May 20, 2014
- Daroff RB, et al. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. https://www.clinicalkey.com. Accessed March 1, 2014.
- Ubhi K, et al. Multiple system atrophy: A clinical and neuropathological perspective. Trends in Neurosciences. 2011;34:581.
- Wenning GK, et al. The natural history of multiple system atrophy: A prospective European cohort study. The Lancet Neurology. 2013;12:264.
- Multiple system atrophy fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/msa/detail_msa.htm. Accessed March 1, 2014.
- Ferri FF. Ferri's Clinical Advisor 2014: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2014. https://www.clinicalkey.com. Accessed March 1, 2014.
- Factor SA, et al. Multiple system atrophy: Prognosis and treatment. http://www.uptodate.com/home. Accessed March 4, 2014.
- FDA approves Northera to treat neurogenic orthostatic hypotension. U.S. Food and Drug Administration. http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm386311.htm. Accessed March 11, 2014.
- Sandroni P (expert opinion). Mayo Clinic, Rochester, Minn. March 11, 2014.
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