Overview

Multiple system atrophy (MSA) is a rare, degenerative neurological disorder affecting your body's involuntary (autonomic) functions, including blood pressure, breathing, bladder function and muscle control.

Formerly called Shy-Drager syndrome, MSA shares many Parkinson's disease-like symptoms, such as slow movement, rigid muscles and poor balance.

Treatment includes medications and lifestyle changes to help manage symptoms, but there is no cure. The condition progresses gradually and eventually leads to death.

Multiple system atrophy care at Mayo Clinic

Symptoms

Multiple system atrophy (MSA) affects many parts of your body. Symptoms typically develop in adulthood, usually in the 50s or 60s.

MSA is classified by two types: parkinsonian and cerebellar. The type depends on the symptoms you have at diagnosis.

Parkinsonian type

This is the most common type of MSA. The signs and symptoms are similar to those of Parkinson's disease, such as:

  • Rigid muscles
  • Difficulty bending your arms and legs
  • Slow movement (bradykinesia)
  • Tremors (rare in MSA compared with classic Parkinson's disease)
  • Problems with posture and balance

Cerebellar type

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

General signs and symptoms

In addition, the primary sign of multiple system atrophy is:

  • Postural (orthostatic) hypotension, a form of low blood pressure that makes you feel dizzy or lightheaded, or even faint, when you stand up from sitting or lying down

You also can develop dangerously high blood pressure levels while lying down.

MSA might cause other difficulties with involuntary (autonomic) body functions, including:

Urinary and bowel dysfunction

  • Constipation
  • Loss of bladder or bowel control (incontinence)

Sweating abnormalities

  • Reduced production of sweat, tears and saliva
  • Heat intolerance due to reduced sweating
  • Impaired body temperature control, often causing cold hands or feet

Sleep disorders

  • Agitated sleep due to "acting out" dreams
  • Abnormal breathing at night

Sexual dysfunction

  • Inability to achieve or maintain an erection (impotence)
  • Loss of libido

Cardiovascular problems

  • Irregular heartbeat

Psychiatric problems

  • Difficulty controlling emotions, such as laughing or crying inappropriately

When to see a doctor

If you develop any of the signs and symptoms associated with multiple system atrophy, see your doctor for an evaluation and diagnosis. If you've already been diagnosed with the condition, contact your doctor if new symptoms occur or if existing symptoms worsen.

Causes

There's no known cause for multiple system atrophy (MSA). Some researchers are studying a possible inherited component or environmental toxin involved in the disease process, but there's no substantial evidence to support these theories.

MSA causes deterioration and shrinkage (atrophy) of portions of your brain (cerebellum, basal ganglia and brainstem) that regulate internal body functions, digestion and motor control.

Under a microscope, the damaged brain tissue of people with MSA shows nerve cells (neurons) that contain an abnormal amount of a protein called alpha-synuclein. Some research suggests that this protein may be overexpressed in multiple system atrophy.

Complications

The progression of MSA varies, but the condition does not go into remission. As the disorder progresses, daily activities become increasingly difficult.

Possible complications include:

  • Breathing abnormalities during sleep
  • Injuries from falls caused by poor balance or fainting
  • Progressive immobility that can lead to secondary problems such as a breakdown of your skin
  • Loss of ability to care for yourself in day-to-day activities
  • Vocal cord paralysis, which makes speech and breathing difficult
  • Increased difficulty swallowing

People typically live about seven to 10 years after multiple system atrophy symptoms first appear. However, the survival rate with MSA varies widely. Occasionally, people can live for 15 years or longer with the disease. Death is often due to respiratory problems.