Multiple System Atrophy

Multiple system atrophy (MSA) is an alarming neurological disease that can cause adverse effects on the body. The primary targets for this condition are the involuntary muscles. MSA is a rare form of neurological disorder. It damages the control and co-ordination of muscle related physiology. This degenerative disease has no underlying etiology. The damage is predominantly in the striatonigral and olivopontocerebellar regions of the brain.

This disease was also known as Shy Drager syndrome. Due to its association with Parkinsons-like symptoms and also partly with amyotrophic lateral sclerosis (ALS), it has been categorized as Multiple System Atrophy to specify the symptoms. This has enabled medical centers to evaluate and diagnose the disorder in an effective manner. Studies indicate that the populations that are affected by the MSA are often elderly groups.

Classification and clinical manifestations

Multiple system atrophy is classified into two types for definitive diagnosis during the evaluation of the patient based on the symptoms.

The Parkinsonian category: In this form of MSA, the symptoms associated are very closely related to the Parkinson's pattern. It is also called MSA-P. Muscle rigidity is observed along with slow movements of the muscles, which are also referred to as Bradykinesia. Muscle cell degeneration predominantly occurs in the striatonigral region leading to tremors, lack of balance and postural impairment.

Cerebellar category: This form of MSA is called MSA-C, which is associated with the ataxia of cerebellar region. Loss of balance and prominent gait are the noticeable symptoms. The onset of dysarthria affects the vocal muscles and the patient's voice slows down and sometimes becomes inaudible. This is followed by difficulty in swallowing as the muscles lose their control sustenance from the cerebral region. In addition to this, blurred vision and dizziness have been reported in MSA-C.

Other associated symptoms of Multiple System Atrophy are urinary incontinence, orthostatic hypotension, erectile dysfunction, urinary retention, constipation and uncontrolled bowel movements. Patients experience light-headedness, dizziness and also low blood pressure because of the slow responses associated with the autonomic nervous system. The reflex arc and its respective functions are also impaired especially in Parkinsonian category.

Autonomic function tests are done to detect the onset of MSA-P and MSA-C at an earlier stage. Research affirms that although MSA is a rare form of neurological disorders, the occurrence in elderly people is slowly increasing. This is because of the lifestyle patterns and also underlying medical conditions such as diabetic neuropathy and Alzheimer's. Statistics indicate that the MSA occurs in 4 in every 100,000 people.

In most cases, diagnosis is done through a complete study of the muscle physiology and skeletal muscle responses after a certain age. In males, prostrate related carcinomas and myelomas can also aggregate this disorder in a larger way as it deteriorates the muscle tissue causing abnormal rise of non-functional proteins in the body.

Diagnosis and Treatment

MSA is diagnosed by evaluating the history of the patient and through physical examination. Tests such as muscle extension, flexion, and response to stimuli, vocal tone strength and posture are done to evaluate the muscle dexterity and functionality. Laboratory diagnosis of blood samples are done to evaluate liver and kidney function tests. In men prostrate examination is also done to study the urological coherence to the respective disease. Urology tests such as uroflowmetry and urinary control is investigated to study the extent of atomic nervous system and cerebellar functionality. Cardiac evaluations are performed to study hypotension and arrhythmia associated with it. Radiological examinations such as CT, PET and MRI are done to understand the involvement of central nervous control damage.

Therapeutic treatments are most often used with MSA. In many cases physical, occupational and speech therapies are done to increase the muscle movements and response of the patient. For Parkinsonian related MSA, L-Dopa, amantadines are administered for better results. Other drugs include Fludrocortisone, Midodrine, Oxybutinin, and Trospium chloride and botulinum toxin incase of dystonia.