Multiple System Atrophy

Multiple System Atrophy

(MSA; Sporadic Olivopontocerebellar Atrophy; Shy-Drager Syndrome; Parkinson Plus Syndrome; Multi-system Degeneration; Multi-system Atrophy; Idiopathic Autonomic Failure; Idiopathic Orthostatic Hypotension;)


Multiple system atrophy (MSA) is a disorder of the nervous system that gets worse over time. It affects the part of the nervous system that controls automatic functions like balance and coordination. This can lead to early death.

MSA is sometimes called a Parkinson plus syndrome because some symptoms are similar. There are different types of MSA.


MSA happens when nerve cells to break down in the brain and spinal cord. These nerves control automatic functions. The damage to the cells may be caused by a buildup of a certain protein. It is not known why this happens.

Nervous System

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Risk Factors

This problem is more common in men and people who are older than 54 years of age.


Symptoms vary from person to person and by type of MSA. At first, symptoms may be like that of Parkinson disease. They may also differ by type of MSA:

  • Type MSA-A may cause lightheadedness or fainting when moving from sitting to standing
  • Type MSA-P has problems that are like Parkinson disease, such as:
    • Slow, stiff movements
    • Tremors
    • Loss of balance and coordination
    • Shuffling when walking
  • Type MSA-C problems may be:
    • Difficulty swallowing
    • Problems speaking and hoarseness
    • Trouble breathing
    • Coordination problems

As MSA worsens, a person may have:

  • Problems with bladder and bowel control
  • Erection problems (in men)
  • Muscle tightening that makes it hard to move
  • Problems with posture, such as leaning to one side and forward head bend
  • Reduced sweating
  • Excess yawning
  • Problems seeing
  • Changes in writing


The doctor will ask about your symptoms and health history. A physical exam will be done. An exam of the nervous system will also be done. It will focus on the parts of the nervous system that control automatic functions. You will likely need to see a specialist.

Images may be taken. This can be done with an MRI scan.


There is no cure. The goal of treatment is to manage the symptoms a person has. Choices are:


Medicines may be given to ease problems like:

  • Muscle stiffness
  • Mood problems
  • Lightheadedness that happens when standing
  • Other symptoms, such as constipation, urinary control problems, or erectile dysfunction


Some therapies that may be needed are:

  • Physical therapy to help with strength and range of motion
  • Occupational therapy to help with everyday tasks and self-care
  • Speech therapy to improve swallowing and speaking
  • Respiratory therapy to support breathing

Dietary Support

Dietary changes may help manage symptoms. For example, soft foods may make it easier for people who have problems swallowing.


There are no known guidelines to prevent this health problem.


The Multiple System Atrophy Coalition
National Institute of Neurological Disorders and Stroke


Canadian Institutes of Health Research


Flabeau O, Meissner WG, et al. Multiple system atrophy: current and future approaches to management. Ther Adv Neurol Disord. 2010 Jul;3(4):249-263.
Multiple system atrophy. EBSCO DynaMed website. Available at: Accessed January 22, 2021.
Multiple system atrophy information page. National Institute of Neurological Disorders and Stroke website. Available at: Accessed January 22, 2021.
Multiple system atrophy orthostatic hypotension information page. National Institute of Neurological Disorders and Stroke website. Available at: Accessed January 22, 2021.
Olivopontocerebellar atrophy information page. National Institute of Neurological Disorders and Stroke website. Available at: Accessed January 22, 2021.
Stefanova N. Translational therapies for multiple system atrophy: Bottlenecks and future directions. Auton Neurosci. 2017; doi: 10.1016/j.autneu.2017.09.016.
Last reviewed December 2020 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 1/22/2021

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