Diagnosis

Diagnosing multiple system atrophy (MSA) can be challenging. Certain signs and symptoms of MSA — such as muscle rigidity and unsteady gait — also occur with other disorders, such as Parkinson's disease, making the diagnosis more difficult. The clinical examination, with various autonomic tests and imaging studies, can help your doctor determine whether the diagnosis is probable MSA or possible MSA.

As a result, some people are never properly diagnosed. However, doctors are increasingly aware of the disease and more likely to use physical examination and autonomic tests to determine if MSA is the most likely cause of your symptoms.

If your doctor suspects multiple system atrophy, he or she will obtain a medical history, perform a physical examination, and possibly order blood tests and brain-imaging scans, such as an MRI, to determine whether brain lesions or shrinkage (atrophy) is present that may be triggering symptoms.

You may receive a referral to a neurologist or other specialist for specific evaluations that can help in making the diagnosis.

Tilt table test

This test can help determine if you have a problem with blood pressure control. In this procedure, you're placed on a motorized table and strapped in place. Then the table is tilted upward so that your body is nearly vertical.

During the test, your blood pressure and heart rate are monitored. The findings can document both the extent of blood pressure irregularities and whether they occur with a change in physical position.

Tests to assess autonomic functions

Doctors may order other tests to assess your body's involuntary functions, including:

  • Blood pressure measurement, lying down and standing
  • A sweat test to evaluate perspiration
  • Tests to assess your bladder and bowel function
  • Electrocardiogram to track the electrical signals of your heart

If you have sleep irregularities, especially interrupted breathing or snoring, your doctor may recommend an evaluation in a sleep laboratory. This can help diagnose an underlying and treatable sleep disorder, such as sleep apnea.

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.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Doctors often advise using certain self-care measures to help minimize MSA symptoms, such as:

  • Take steps to raise your blood pressure. Add a little salt to the diet and drink more fluids. Salt and fluids can increase blood volume and raise your blood pressure. Drink coffee and other caffeinated fluids to raise your blood pressure.
  • Elevate the head of your bed. Raising the head of your bed to about a 30-degree angle will minimize increases in blood pressure when you sleep. Get up slowly from a reclining position.
  • Make dietary changes. Add more fiber to your diet in order to ease constipation. You may also benefit from over-the-counter laxatives. Eat small, low-carbohydrate meals.
  • Avoid getting too hot. Stay in air-conditioned rooms on very hot days. Avoid excessive amounts of heat in the bathroom when bathing.
  • Wear elastic support stockings up to your waist. This can help keep your blood pressure from dropping.

Preparing for your appointment

You're likely to start by seeing your family doctor, but you may be referred to a doctor who specializes in the diagnosis and treatment of conditions that affect the brain and nervous system (neurologist).

Here's some information to help you prepare for your appointment.

What you can do

  • Write down any symptoms you're experiencing, and for how long. Include all recent changes in your physical or emotional well-being. For example, if you or your loved ones have noticed your moods shifting more quickly, share this with your doctor.
  • Make a list of your key medical information, including other conditions with which you've been diagnosed, and the names of any prescription and over-the-counter medications you're taking.
  • Write down key personal information, including any changes in your sex life, such as reduced interest in sex or difficulty getting an erection.
  • Find a family member or friend who can come with you to the appointment, if possible, to help you remember what the doctor says.
  • Write down the questions to ask your doctor.

For multiple system atrophy, some basic questions to ask your doctor include:

  • What is likely causing my symptoms?
  • Are there any other possible causes for these symptoms, such as Parkinson's disease?
  • How will you make a firm diagnosis?
  • What tests do I need?
  • What treatment options are available for multiple system atrophy?
  • What are the possible side effects of those treatment options?
  • How is my condition likely to progress?
  • Will treatment slow the progression of my illness or simply relieve symptoms?
  • Are there self-care steps that could help ease my symptoms?
  • How will you monitor my health over time?
  • Do I need to adjust the medications I'm taking for other health conditions?

Don't hesitate to ask any other questions that you have.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • What are your symptoms?
  • When did you begin having symptoms?
  • Do you feel lightheaded or dizzy when you stand up?
  • Have you ever fainted?
  • Do your symptoms include any emotional changes, such as swinging between laughter and tears?
  • Have you noticed any changes in your voice?
  • Have you been told that you snore loudly or have interrupted breathing while sleeping?
  • Have you had problems with bladder control?
  • Have you been constipated?
  • Have you had any sexual problems, such as reduced libido or impotence?
  • Do you have difficulty chewing or swallowing?
  • Do you have difficulty breathing?
  • Do you have any movement problems, such as slowness or poor coordination?
  • Do you have any family history of Parkinson's disease or other neurological disease?
  • Are you being treated for any other health conditions?

What you can do in the meantime

While you wait for your appointment, find out if any relatives have been diagnosed with neurological disorders such as Parkinson's or Huntington's disease. Multiple system atrophy (MSA) is not known to be an inherited condition, so a family history of a condition with similar symptoms may help your doctor rule out MSA.

Multiple system atrophy (MSA) care at Mayo Clinic

June 17, 2017
References
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