Multiple System Atrophy (MSA) - Symptoms and Complications of Multiple System Atrophy

Multiple System Atrophy

Symptoms and Complications of Multiple System Atrophy

MSA can cause a wide range of symptoms, including:

Stiffness or rigidity
Freezing or slowed movements
Postural instability; loss of balance; incoordination
Tremor
Orthostatic hypotension
Male impotence
Urinary incontinence
Constipation
Speech and swallowing difficulties
Sleep disorder
Hyperreflexia

There are two forms of motor presentation in MSA:
MSA-P
Parkinsonism is seen in the majority of patients at onset, and is associated with a more rapid decline. Akinesia, rigidity, and tremor are asymetrical, and postural tremor more common than rest tremor. Dystonia of the head and neck is common. Unlike in progressive supranuclear palsy (PSP), falls are not common early in the disease.

MSA-C
Cerebellar symptoms are seen in about 20% of patients at onset, presenting as limb ataxia, gait ataxia, scanning dysarthria, and oculomotor dysfunction. MSA-C is difficult to distinguish from late-onset pure cerebellar ataxia until the disease progresses to include other MSA signs and symptoms.

In addition, autonomic disturbance is seen in both MSA-P and MSA-C. It is present at diagnosis in about 40% of patients, and develops shortly after diagnosis in virtually all other patients. In males, impotence is the most frequent initial symptom, while in females, urinary incontinence is seen most often. Orthostatic hypotension is present in about two-thirds of patients. Fecal incontinence affects about one-third of patients.

Dysphagia is common early in the disease. Sleep disorders occur in about two-thirds of patients. Memory impairment, vivid dreams, confusion, and hallucinations are also part of the spectrum of MSA symptoms.

MSA progresses over the course of several years to cause more widespread and severe symptoms. Orthostatic hypotension can cause fainting and falls. Loss of coordination, slowed movements, and rigidity can interfere with activities of daily living. Some patients with MSA have mild loss of cognitive abilities, with impairments in attention and speed of thinking.