Multiple System Atrophy (MSA) Treatment in Wittman, MD
Do you have rigid muscles, balance problems, or slurred speech? Do you feel difficulty swallowing or chewing, irregular heartbeat, or abnormal breathing? It could be multiple system atrophy (MSA), a rare degenerative neurological disorder that causes symptoms similar to Parkinson disease . It affects your body's involuntary functions, such as blood pressure, breathing, and bladder function. Causes of MSA are unknown, though genetic or environmental factors may be responsible.
Multiple system atrophy is rare, occurring in about five in every 100,000 people. While there is currently no permanent cure, there are many medications and procedures available to help you manage symptoms.
What are the symptoms of MSA?
Multiple system atrophy causes deterioration and shrinkage (atrophy) of the parts of your brain that regulate body functions like digestion and motor control. There are two different types of MSA: parkinsonian and cerebellar.
Parkinsonian is the most common type of MSA. Its symptoms include:
- rigid muscles
- difficulty bending your limbs
- slow movement (bradykinesia)
- posture issues like slumping
- balance issues that cause frequent falls
- tremors (rarely)
Symptoms of cerebellar multiple system atrophy include:
- reduced muscle coordination (ataxia), causing shuffling and freezing of movement
- slurred, slow, or low-volume speech (dysarthria)
- blurred or double vision
- abnormal eye movements like staring
- difficulty swallowing (dysphagia) or chewing
Other common symptoms of MSA include:
- loss of bladder control
- loss of libido
- low blood pressure that makes you feel dizzy or faint (orthostatic hypotension)
- the inability to move your face
- reduced sweating
- cold hands or feet
- irregular heartbeat
- difficulty controlling emotions
- confusion or
- involuntary, uncontrollable sighing or gasping
- a bending neck that droops the head down (antecollis)
- the leaning of your body to one side (Pisa syndrome)
Symptoms of MSA usually develop between the ages of 50-60. MSA is degenerative, so later symptoms of MSA will be more severe than early ones. As the condition continues, multiple system atrophy complications may include:
- breathing abnormalities during sleep
- increased swallowing difficulties
- gradual loss of your ability to walk
- injuries from falling
- vocal cord paralysis
- breakdown of your skin
As time goes on, MSA will make self-care progressively more difficult. Life expectancies vary from patient to patient, but lifespans are typically shortened. Those with the condition will live for about seven to nine years after developing it - usually succumbing to respiratory problems. In rare cases, patients can live up to 18 years after diagnosis.
What causes MSA?
Until recently, medical science was uncertain about MSA's causes. It's now known that MSA is a prion disease - that is, it's a neurological disease caused by exposure to a new type of protein. While researchers haven't proven conclusively that this is MSA's origin, it's strongly believed to be the cause.
How is MSA diagnosed?
No one specific test can help diagnose multiple system atrophy. Your medical provider can give you a physical examination and review your medical history. Tests that can indicate a higher likelihood of MSA and rule out other conditions that may cause similar symptoms include:
- tilt table test: you're slowly elevated vertically on a table while your blood pressure is measured
- positron emission tomography (PET) scan: to determine reduced metabolic brain function
- DaTscan: to assess your brain's dopamine transporter to rule out a dopamine system disorder
- administering the drug levodopa: to determine whether there's sustained improvement in symptoms - lack of improvement may indicate MSA
Other tests include:
- MRI: to detect the presence of brain deterioration
- electrocardiogram: to measure your heart's electrical signals
- blood and urine tests: to detect norepinephrine, which controls muscle contractions
- sweat test: to evaluate perspiration
- blood pressure evaluation
- bladder and bowel function tests
- sleep quality assessments
How is MSA treated?
Currently, there's no cure for MSA. Treatment involves managing symptoms with medication and lifestyle changes. As with any treatment, results will vary from patient to patient, depending on age, genetics, environmental conditions, and other health factors.
Medications that can treat the symptoms of MSA include:
- blood pressure increasing drugs like pyridostigmine and midodrine
- medications like levodopa and carbidopa can treat parkinsonian symptoms like stiffness and poor balance
- drugs like sildenafil to treat impotence
- anticholinergic drugs like tolterodine to reduce urinary urgency
The FDA has also approved droxidopa for treating orthostatic hypotension. Side effects of droxidopa include headache, dizziness, and nausea.
Side effects of other MSA medications can include:
- diarrhea and constipation
- urinary tract infection
- low blood pressure
- muscle aches
- vision issues
Medical marijuana is showing strong promise in treating prion diseases like MSA, MRSA (a family of bacterial strep infections), Mad Cow Disease, and Creutzfeld-Jakob disease (CDJ). While prions are historically very difficult to destroy, marijuana molecules found in cannabidiol have been shown to halt them and inhibit their formation and accumulation.
Cannabidiol (CBD), a cannabinoid naturally occurring in marijuana plants, has also been documented to cause no side effects or complications. Speak with your medical provider about this treatment option or go online to discover whether your state or region permits medical marijuana.
Induced pluripotent stem cell (iPSC) shows some clinical promise for treating neurodegenerative diseases like MSA. This treatment involves injecting transplanted stem cells into body to stimulate a regenerative response. These are typically mesenchymal stem cells harvested from your bone marrow. These stem cells secrete proteins called growth factors that may make your nerves more resilient to the damaging effects of MSA while reducing general inflammation.
Stem cells can be injected into your bloodstream, where they'll migrate to your central nervous system, or they can be implanted directly into your brain. In the latter case, they may morph into dopamine-producing cells. This method shows much promise in relieving Parkinsonian symptoms in many patients, reducing and slowing disease progress while improving function.
Research into its long-term effectiveness is ongoing.1
Physical, occupational, and speech therapy
These methods can help Parkinsonian-related movement problems. They include:
- exercise: treadmill use, yoga, tai chi, Pilates, and other exercises requiring challenges to endurance, flexibility, and range of movement may help make your muscles more flexible and reduce Parkinsonian-related muscle rigidity and tension
- motor skills practice: an occupational therapist can use specialized technology to help you practice timing your movements in accordance with sensory stimuli, such as eating, dressing, writing, and other daily activities
- speech therapy: can help you master voice steadiness, control rapid speech, and manage facial and lip muscle coordination; may improve self-perception about your voice while activating areas of your brain responsible for motor functions related to speech
Nutrition and lifestyle
Eating properly can help reduce your symptoms and keep you generally healthy. Proper nutrition for MSA includes:
- low-protein and protein redistribution: if you're taking the drugs levodopa or carbidopa, a low-protein diet may promote more efficient use of these drugs, especially if eaten at your evening meal; if taking monoamine oxidase inhibitors (MAOIs), which can prevent absorption of tyramine (raising your blood pressure), avoid fermented foods like cheese, soy sauce, pickled fish, tofu, beer, and sauerkraut
- caloric restriction: low-calorie diet can boost brain levels of glutamate, a neurotransmitter that contributes to motor control and is lessened in patients with Parkinsonian-type illnesses
- anti-inflammatory: eating healthy fats instead of trans-fats or saturated fats can help reduce the chronic inflammation of MSA; these include olive oil, cold-water fish like herring and salmon, flax seeds and oil, chia seeds, plus lots of whole grains like oats and barley
- antioxidant: eat at least 3 servings of fresh fruit per day, including strawberries, blueberries, grapes, citrus, and other fruit that contains antioxidants that can reduce inflammation, plus fresh leafy or cruciferous vegetables like broccoli, spinach, cauliflower; these have cellular antioxidant defense mechanisms
- general: avoid processed or sugary foods like ice cream, soda, and packaged or canned foods, which can be full of preservatives and sodium; instead, choose fresh foods with low sugar and carbs; eating small meals and adding more fiber to your diet to ease constipation
You can also control your blood pressure by raising the head of your bed to a 30-degree angle and wearing elastic support stockings. You will also likely need a cane or walker to help you move around as the condition progresses.
Seeking professional mental health therapy or counseling is also a great idea. Living with MSA can cause anxiety, stress, depression, and many other negative emotional challenges. Speaking with a therapist or counselor can help reduce or relieve your emotional hardships and provide you with much-needed emotional support. Speak with your medical provider about finding a therapist, or research counselors online. Always select a licensed therapist with great reviews who specializes in your area of need.
Other MSA treatments include:
- using a pacemaker to keep your heartbeat stable
- inserting a soft tube (catheter) into your urethra to allow bladder drainage
- inserting feeding and breathing tubes
- Botox injections to treat abnormal muscle postures (dystonia)
- using over-the-counter laxatives to ease constipation
Reserve Your Appointment Now
While multiple system atrophy can make certain everyday activities like eating and sleeping more difficult, there are many ways that you can lessen the impact of your symptoms. Proper diet, exercise, occupational and speech therapy, and a medical provider who cares about you as a whole person are the keys to a happier you and an improved quality of life.
1. Abati, Elena, et al. "In Vitro Models of Multiple System Atrophy from Primary Cells to Induced Pluripotent Stem Cells." Journal of Cellular and Molecular Medicine, vol. 22, no. 5, 2018, pp. 2536–2546., doi:10.1111/jcmm.13563.
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