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. This can make diagnosis more difficult. The physical exam, along with various autonomic tests and imaging studies, can help your doctor determine whether the diagnosis is probable MSA or possible MSA. Because of difficulty with making the diagnosis, some people are never properly diagnosed.

If your doctor thinks that you may have multiple system atrophy, they will take your medical history, perform a physical exam and possibly order blood tests. Brain imaging scans, such as an MRI, can show signs that may suggest MSA and also help determine if there are other causes that may be contributing to your 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 positioned at a 70-degree angle.

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 areas of the body that sweat
  • 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.


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 (Orvaten) can raise your blood pressure quickly; however, it needs to be taken carefully as it can elevate pressure while lying down. You should not lie 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 (Sinemet, Rytary, others), 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.

  • Impotence drugs. Impotence can be treated with a variety of drugs, such as sildenafil (Revatio, Viagra), designed to manage erectile dysfunction, but these can lower blood pressure.
  • 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 consider a surgically inserted feeding or breathing tube. In advanced MSA, you may consider 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 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 condition.

Lifestyle and home remedies

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

  • Taking steps to raise your blood pressure. Add a little salt to your diet and drink more fluids, especially before exercise. Salt and fluids can increase blood volume and raise your blood pressure. Drink coffee and other caffeinated fluids to raise your blood pressure.
  • Elevating the head of your bed. Raising the head of your bed by about 4 to 6 inches will minimize increases in blood pressure when you sleep. Get up slowly from a reclining position.
  • Making dietary changes. Add more fiber to your diet in order to ease constipation. You may also benefit from over-the-counter laxatives or stool softeners. Eat small, low-carbohydrate meals.
  • Avoiding getting too hot. Stay in air-conditioned rooms on very hot days. Avoid excessive amounts of heat in the bathroom when bathing.
  • Wearing elastic support stockings up to your waist. This can help keep your blood pressure from dropping.

Preparing for your appointment

You may have your first appointment to discuss your symptoms with 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 blood relatives such as a parent, sibling, or grandparent have been diagnosed with neurological disorders such as Parkinson's disease or cerebellar ataxia. 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

July 13, 2022
  1. Daroff RB, et al. Disorders of the autonomic nervous system. In: Bradley and Daroff’s Neurology in Clinical Practice. 8th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed May 4, 2022.
  2. Factor SA, et al. Multiple system atrophy: Clinical features and diagnosis. https://www.uptodate.com/contents/home. Accessed May 4, 2022.
  3. Multiple system atrophy. Genetics Home Reference. https://rarediseases.org/rare-diseases/multiple-system-atrophy/. Accessed May 4, 2022.
  4. Multiple system atrophy fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/msa/detail_msa.htm. Accessed May 4, 2022.
  5. Multiple system atrophy. Merck Manual Consumer Version. http://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/autonomic-nervous-system-disorders/multiple-system-atrophy. Accessed May 4, 2022.
  6. Factor SA, et al. Multiple system atrophy: Prognosis and treatment. http://www.uptodate.com/home. Accessed May 4, 2022.
  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 May 4, 2022.
  8. Multiple system atrophy. Genetic and Rare Diseases Information Center. https://rarediseases.info.nih.gov/diseases/7079/multiple-system-atrophy. Accessed May 4, 2022.
  9. Ferri FF. Multiple system atrophy. In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed May 4, 2022.
  10. Coon EA (expert opinion). Mayo Clinic. May 10, 2022.
  11. Nguyen HT. Allscripts EPSi. Mayo Clinic. Jan. 28, 2022.


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