Treatment

There's no cure for multiple system atrophy. Managing the disease involves treating signs and symptoms to make you as comfortable as possible and to maintain your body functions.

To treat specific signs and symptoms, your doctor may recommend:

  • Medications to raise blood pressure. The corticosteroid fludrocortisone and other medications can increase your blood pressure by helping your body retain more salt and water.

    The drug pyridostigmine (Mestinon) can raise your standing blood pressure without increasing your blood pressure while you're lying down.

    Midodrine can raise your blood pressure quickly; however, it needs to be taken carefully as it can elevate pressure while lying down so people should not lay flat for four hours after taking the medication.

    The FDA has approved droxidopa (Northera) for treating orthostatic hypotension. The most common side effects of droxidopa include headache, dizziness and nausea.

  • Medications to reduce Parkinson's disease-like signs and symptoms. Certain medications used to treat Parkinson's disease, such as combined levodopa and carbidopa (Duopa, Sinemet), can be used to reduce Parkinson's disease-like signs and symptoms, such as stiffness, balance problems and slowness of movement. These medications can also improve overall well-being.

    However, not everyone with multiple system atrophy responds to Parkinson's drugs. They may also become less effective after a few years.

  • 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 surgically inserted feeding or breathing tube. In advanced MSA, 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.
  • Therapy. 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 improve or maintain your speech.

June 17, 2017
References
  1. Daroff RB, et al. Disorders of the autonomic nervous system. In: Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. Accessed March 15, 2017.
  2. Factor SA, et al. Multiple system atrophy: Clinical features and diagnosis. http://www.uptodate.com/home. Accessed March 15, 2017.
  3. Multiple system atrophy. National Organization of Rare Diseases. https://rarediseases.org/rare-diseases/multiple-system-atrophy/. Accessed March 19, 2017.
  4. Multiple system atrophy fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/msa/detail_msa.htm. Accessed March 13, 2017.
  5. Multiple system atrophy. Merck Manual Consumer Version. elizhttp://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/autonomic-nervous-system-disorders/multiple-system-atrophy. Accessed March 19, 2017.
  6. Factor SA, et al. Multiple system atrophy: Prognosis and treatment. http://www.uptodate.com/home. Accessed March 15, 2017.
  7. Drug approval package: Northera (droxidopa) capsules approval letter. U.S. Food and Drug Administration. http://www.accessdata.fda.gov/drugsatfda_docs/nda/2014/203202Orig1s000TOC.cfm. Accessed March 21, 2017.
  8. Sandroni P (expert opinion). Mayo Clinic, Rochester, Minn. March 22, 2017.
  9. Ferri FF. Multiple system atrophy. In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed March 15, 2017.
  10. Coon EA (expert opinion). Mayo Clinic, Rochester, Minn. March 22, 2017.