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or other parkinson syndromes, with time disappear completely, and tremors are usually absent. Patients need more help from caretakers and more time and effort to accomplish activities of daily living (ADL's).
WHAT IS MULTIPLE SYSTEM ATROPHY (MSA)?
MSA is a progressive neurodegenerative disorder sometimes referred to as a "Parkinson's plus syndrome" or "atypical Parkinsonism." This disorder shares many features with Parkinson's disease (PD), and results in patients often initially being diagnosed with PD. However, there are certain characteristics that help differentiate MSA from classic PD.
specific symptoms will appear that provide clues to the diagnosis. These may include: • • • • • • • • • • Symmetrical onset of symptoms Dizziness, fainting upon standing Labile blood pressure (highs & lows) Nausea, constipation Urinary incontinence/retention Erectile dysfunction Clumsiness, incoordination Speech, swallow difficulty Functional decline, disability Poor response to medications
IS THERE A TREATMENT FOR MSA?
Unfortunately, there is currently no one treatment or pill to cure MSA. Nevertheless, there are medications that may help with the symptoms of the disease. Even though the benefit is often not as dramatic as that seen in Parkinson's disease, carbidopa/levodopa (Sinemet) is frequently tried for "motor symptoms." When dizziness upon standing or fainting is a problem, drinking fluids, wearing pressure stockings, and increasing salt intake are often recommended. Medications that boost blood pressure, such as fludrocortisone and midodrine, are also helpful. Treatments for constipation and bladder problems are also available, as well as help for excessive drooling.
WHAT IS PARKINSONISM?
An individual is said to have Parkinsonism if they have at least 2 out of the four following symptoms: 1) tremor at rest, 2) stiffness or rigidity, 3) slowness, or 4) gait and balance problems.
The constellation of symptoms that you may actually develop will depend on the "flavor" of MSA you have. While similar, three types have been characterized: 1) Shy-Dragger (MSA-A), which has prominent autonomic symptoms; 2) striatonigral degeneration (MSA-P), which looks most like Parkinsons; and 3) olivopontocerebellar atrophy (OPCA or MSA-C), in which patients develop slurred speech and significant gait and limb ataxia, or clumsiness, incoordination. Some of these symptoms can also be seen in more advanced stages of PD, but in MSA they are usually seen in earlier stages and more prominent.
HOW IS MSA SIMILAR TO PARKINSON'S DISEASE?
MSA and PD are both gradual, progressive disorders and share features, such as balance problems/unsteadiness, tremor, stiffness and slowed movements. The volume of your speech may also decrease, your handwriting may become smaller and you may develop the masked facial expression and shuffling of gait seen in PD. Initially, these symptoms may respond to Parkinson's medications such as carbidopa/levodopa (Sinemet).
WHAT ELSE CAN BE DONE TO HELP WITH THE SYMPTOMS?
Depending on your ability, regular activity and exercise are helpful and may include walking, biking, swimming, weight lifting, tai chi, yoga, or Pilates. Exercise keeps you active, and may improve symptoms such as stiffness, walking, balance, and constipation. A physical therapy evaluation will help to decide the best program for you, and will teach you some techniques to improve your balance and to prevent falls. Occupational therapy can help with ADL's. When speech is soft, slurred or there is difficulty swallowing, an evaluation by a speech pathologist is essential.
WHAT IS THE PROGRESSION OF THE DISEASE?
MSA is characterized by a more rapid progression of symptoms—still over years— compared to that in Parkinson's disease. There can be significant problems waking and functioning within the first five years, with unsteady gait and dizziness being the predominant clinical picture. The initial response to Sinemet may decrease or
HOW IS MSA DIFFERENT FROM PARKINSON'S DISEASE?
Although initially the symptoms of MSA may be indistinguishable from Parkinson's disease
AM I GOING TO LOSE MY MEMORY?
Some cognitive deficits may occur in MSA, but not nearly to the degree seen in conditions like Alzheimer's disease. If severe memory problems or dementia occur, this may be the result of a secondary process.
WHAT SHOULD I DO NOW THAT I HAVE BEEN DIAGNOSED?
Do not despair and remain optimistic. Despite the lack of a cure there are of therapeutic options that can help you. Treatment will require a multidisciplinary approach, including your neurologist, a physical and occupational therapist, speech pathologist (for regular speech and swallow evaluations), and possibly even a psychiatrist. It is important that your physician help coordinate these. Your doctor may recommend some medications that may make you feel unwell initially, but with effort will become tolerable after a few days. If there are undesirable side effects, talk to your doctor and see if there is any way to avoid them or make them more tolerable. MSA affects not only you, but your family and loved ones too. Caregiver burden should be recognized and acknowledged. Obtaining help from a social worker and aides at home can often go a long way to ease this burden and to keep you healthy. Finally, knowledge is your best weapon. Your first and primary resource is your doctor as he/she will be your ally. Additional information may come from support groups and other patients. For research and support information see — http://www.ninds.nih.gov/disorders/msa orth ostatic hypotension/rasa orthostatic hyooten sion.htm.
MULTIPLE SYSTEM ATROPHY
IS SURGERY AN ALTERNATIVE FOR MSA?
No surgical procedure has been proven to provide consistent benefit in patients with MSA. Deep brain stimulation (or DBS) surgery is currently not recommended for MSA. Stem cell therapy is unavailable but a focus of active research.
IS THIS DISEASE HEREDITARY?
Although there are rare familial cases of MSAC (olivopontocerebellar type), most MSA cases are sporadic. The fact that you have MSA does not mean that your children will develop the condition.
MY DOCTOR IS NOT FAMILIAR WITH THIS CONDITION. WHAT
SHOULD I DO?
Give your doctor a copy of this brochure as an introduction, and make sure your primary care provider (PCP) has a good relationship with your neurologist, as this will ensure that they will work together for your benefit.
University of Florida Center for Movement Disorders & Neurorestoration located at the Orthopedics & Sports Medicine Institute in Gainesville, FL.
FOR MORE INFORMATION, CONTACT:
Nikolaus McFarland, MD, PhD, Assistant Professor University of Florida Center for Movement Disorders & Neurorestoration, Department of Neurology 3450 Hull Road, Gainesville, FL, 32607 Ph (352) 294-5400 or visit http://mdc.mbi.ufl.edu
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