Multiple System Atrophy

Treatment of Multiple System Atrophy

There are no treatments that halt or slow the neurodegenerative process. There are also no symptomatic treatments for cerebellar symptoms. Treatments are available for parkinsonism and autonomic symptoms, although they become less effective as the disease progresses.

Ataxia
A cane, walker, or wheel chair may be needed for mobility.

Parkinsonism
Levodopa: Between 30% and 70% of MSA patients experience benefit from levodopa. Responsiveness may be tested with increasing doses over 3 months up to 1000 mg/day. (Wenning, 2004) Levodopa-induced dyskinesias emerge in about half of MSA patients. These uncontrolled movements manifest primarily as dystonia, especially of the head and neck region.

Dopamine agonists: These should be used as second-line agents, in patients for whom levdopa is ineffective.

Autonomic dysfunction
Symptomatic orthostatic hypotension:

• Fludrocortisone
• Midodrine
• Liberal salt intake
• Postural changes
• Compressive stockings
• Head-up tilt of the bed at night
• Avoid large meals, alcohol, strain during elimination

Male impotence:

• Penile implants
• Sildenafil (but may worsen hypotension)
• Intracavernosal papaverine
• Prostaglandin E1

Incontinence:

• Anticholinergics (but may induce retention)
• Catheterization

Constipation:

• Increased dietary fiber
• Laxatives

Other
Inspiratory stridor:

• Continuous positive airway pressure
• Botulinum toxin injection into the vocal cords
• Trachesotomy

Swallowing and speaking difficulty:

• Speech-language pathologist referral
• Softer foods
• Gastrostomy tube

Psychological support for the patient and family are valuable throughout the course of the disease.