Multiple System Atrophy

UT Southwestern Medical Center offers personalized treatment of multiple system atrophy (MSA) to maximize mobility, independence, and quality of life. We provide access to the latest research and clinical trials, as well as multidisciplinary support for patients and their families.

UT Southwestern’s multidisciplinary MSA clinic is designated as a Center of Excellence by Mission MSA.

What Is Multiple System Atrophy?

MSA – formerly known as Shy-Drager syndrome, olivopontocerebellar atrophy, or striatonigral degeneration – is a rare, progressive neurodegenerative disorder.

MSA causes deterioration and shrinkage of the parts of the brain that regulate internal body (autonomic) functions such as blood pressure and bowel and bladder control, as well as the brain circuits involved in motor control (balance and coordination).

While we know the pathological changes in the brain and understand some of the proteins involved, there is currently no effective treatment for the underlying causes of MSA.

Why Choose UT Southwestern for Multiple System Atrophy Care?

UT Southwestern neurologists have specialized expertise in MSA and offer patients a multidisciplinary approach to treatment, including access to leading-edge research. Our neurologists are also experts in detecting other neurological conditions that may look like MSA.

With our extensive experience in diagnosing and treating neurodegenerative disorders such as MSA, UT Southwestern is a referral center for cases throughout the region.

MSA is difficult to diagnose and manage, and it requires specialized, ongoing care. We use a customized approach to diagnose and evaluate symptoms in people who might have MSA. This includes formal autonomic function testing and detailed assessments of neurological function and symptoms.

Neurologists with expertise in autonomic disorders and movement disorders lead our multidisciplinary MSA team, which also includes experts in physical medicine, urology, and palliative care. Additional staff include social workers, nutritionists, and research coordinators.

The multidisciplinary MSA Center of Excellence clinic meets one day a month and gives patients access to the entire MSA team in one location. Our MSA patients typically come to the clinic every four months, although more frequent appointments are scheduled for more urgent needs. The MSA clinic continues to provide support and consultation (through virtual visits and regular communication) even when patients are no longer able to come to the clinic in person due to their illness.

What Are the Symptoms of Multiple System Atrophy?

Signs of MSA usually begin appearing in a person’s 50s. Some symptoms are similar to those of Parkinson’s disease, but they advance much more rapidly, and MSA patients often have symptoms that differ from typical Parkinson’s disease.

The earliest symptoms of MSA may include:

Loss of balance
Loss of bladder control
Abnormal drop in blood pressure when standing

Autonomic Symptoms

All people with MSA have autonomic dysfunction, but it varies in severity from person to person. Symptoms can include:

Cold hands or feet and heat intolerance, because control of body temperature is impaired
Impotence
Fainting or lightheadedness when standing, caused by orthostatic hypotension, a condition in which blood pressure drops when a person rises from a seated or prone position
Sleep disorders, such as sleep apnea or a tendency to act out dreams
Urinary or bowel dysfunction, such as constipation or incontinence (loss of bladder or bowel control)

Motor Control Symptoms

Movement problems may develop later than autonomic problems in people with MSA. Depending on which types of motor symptoms are most prominent at the time of diagnosis, MSA can fall into one of two categories:

Parkinsonian type (MSA-P) symptoms resemble those of Parkinson’s disease and include:

Low-volume speech
Muscle stiffness
Slow movements
Slow or shuffling walk, leading to falls
Tremor (usually mild)

Cerebellar ataxia (MSA-C) symptoms resemble those of ataxia (lack of coordination) and include:

Limb incoordination
Slurred speech
Swallowing difficulty
Unsteady gait and loss of balance, causing falls
Visual disturbances, such as blurred or double vision and difficulty focusing the eyes

Other MSA-related symptoms include:

Dystonia (involuntary muscle contractions that can cause abnormal posture of limbs or the neck)
Vocal cord impairment causing stridor, a harsh, high-pitched sound when breathing

How Is Multiple System Atrophy Diagnosed?

Multiple system atrophy (MSA) can be challenging to diagnose because it is rare (many physicians are not familiar with it) and its symptoms mimic more common diseases such as Parkinson’s. As a result, diagnosis is sometimes delayed.

UT Southwestern brings together specialists who are trained in the diagnosis of MSA. Our team uses a customized examination process to arrive at an accurate diagnosis and treatment plan.

After discussing family history and current treatments with a patient and conducting a physical examination, our experts might use several tests to evaluate involuntary (autonomic) body functions, such as:

Electrocardiogram and blood pressure (BP) monitoring to find out if the brain is sending the right signals to the heart to control BP and heart rate
Sweat test to determine if the nerves to the sweat glands are working properly
Tilt table test to see if the blood pressure and heart rate are regulated properly during changes in body position
Bladder function tests to make sure the bladder is emptying correctly
Blood tests to look for or rule out other diseases causing similar symptoms
Brain-imaging scans, such as magnetic resonance imaging (MRI), which can show signs of degeneration in the brains of people with MSA or other neurodegenerative diseases
Skin biopsy tests to determine if the small nerve fibers are degenerating or if there is an abnormal deposition of alpha-synuclein (a protein involved in neurodegeneration in MSA)

People who have difficulty sleeping might be evaluated by the Sleep and Breathing Disorders Clinic to determine whether the issue is an underlying and treatable sleep disorder.

People who are having difficulty swallowing or speaking may be evaluated by UT Southwestern otolaryngologists (ear, nose, and throat) providers or by our radiology team to evaluate swallowing function.

People with bladder difficulties may be evaluated by experts in urology who are uniquely familiar with the bladder control problems that occur in MSA patients.

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How Is Multiple System Atrophy Treated?

Multiple system atrophy (MSA) is a rare neurodegenerative disorder without a cure, and every patient’s experience with MSA is different. UT Southwestern specialists offer expert, holistic approaches to managing MSA’s symptoms, as well as support to help patients understand what to expect from the disease and its treatments.

Each symptom is treated separately, with the goal of allowing patients to continue their everyday activities for as long as possible. Any combination of the following treatments might be used.

Medications

Medications used for Parkinson’s disease, such as carbidopa-levodopa and amantadine, can provide relief of muscle rigidity, slowness, and other motor symptoms, as long as they do not cause side effects. These medications are not as effective for MSA as they are for Parkinson’s disease.

Medication might also be used to treat:

Bladder dysfunction
Constipation
Blood pressure problems
REM behavior disorder (acting out dreams when asleep)
Mood disorders

Physical Therapy

UT Southwestern’s neurorehabilitation program, which includes physical, speech, and occupational therapy, can ease symptoms and help patients maintain as much motor and muscle capacity as possible as MSA progresses. Therapists also provide family members with information to help them be part of the patient’s successful rehabilitation. A Physical Medicine and Rehabilitation (PM&R) physician is a core member of our MSA team.

A speech-language pathologist can help treat voice, speech, drooling, and swallowing problems.

Other Treatments for Multiple System Atrophy (MSA)

Depending on a patient’s needs, evaluation and treatment might be performed by specialists from a range of other disciplines, such as:

Autonomic experts
Cardiovascular physicians
Nutritionists
Otolaryngologists
Palliative care physicians
Sleep specialists
Pulmonary specialists (sleep and breathing)
Urologists

The team at the UT Southwestern Movement Disorders Clinic helps coordinate these specialty services and follows up with patients with MSA and their caregivers throughout the course of the illness.

What Support Services for Multiple System Atrophy Does UT Southwestern Offer?

Neurodegenerative diseases such as MSA can be difficult, not just for patients but also for their families and caregivers. As MSA advances, patients require help with mobility, blood pressure management, and bowel and bladder function. This loss of independence affects quality of life for patients and their family members.

Our licensed clinical social workers (LCSWs) provide emotional support for patients and family members, in partnership with psychologists and psychiatrists as needed. Our LCSW team organizes patient and caregiver meetings and conducts conference calls with patients, caregivers, and clinicians between clinic visits.

Palliative care experts are part of our clinical team to assist with focused attention on goals of care, quality of life, pain control, and coordination of care.

What Clinical Trials Are Available for Multiple System Atrophy?

While there is no cure for MSA or specific treatments to slow its progression, research has brought us closer to identifying the cause of MSA, which is the first step toward finding a cure. Patients at UT Southwestern have the opportunity to participate in this research through clinical studies.

UT Southwestern is currently conducting a longitudinal study to track the effect of integrated treatment on the quality of life of MSA patients and their families. UT Southwestern researchers are also involved in new clinical therapeutic trials, as well as studies that will contribute to a better understanding of MSA.