Multiple system atrophy Parkinsonian type (MSA-P) is a rare neurodegenerative disease that progresses over time. It can cause problems with movement and coordination, digestion, bladder control, swallowing, and speech.

Multiple system atrophy (MSA) is a progressive neurodegenerative disease, meaning there is nerve cell loss in the brain over time.

The two types of MSA are the cerebellar type and the Parkinsonian type, depending on the key symptoms people have. MSA-P has symptoms similar to Parkinson’s disease.

This article looks at what MSA-P is, including its symptoms, diagnosis, treatment, and outlook.

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MSA-P is a neurodegenerative disease that affects the central nervous system and the autonomic nervous system.

The central nervous system helps control movement. The autonomic nervous system controls functions that happen involuntarily and automatically — these functions include digestion and blood pressure.

MSA-P is an atypical Parkinsonian disorder. Atypical Parkinsonian disorders are a group of neurodegenerative conditions that cause some of the symptoms of Parkinson’s disease but also other symptoms.

In atypical Parkinsonian disorders and Parkinson’s disease, some of the same areas of the brain degenerate. However, other brain areas are also affected in atypical Parkinsonian disorders.

MSA-P causes a loss of nerve cells in the brain and spinal cord, which progresses over time. This loss of nerve cells affects how the body functions and causes symptoms that affect movement, coordination, and bodily function, such as bladder control.

Read an overview of MSA.

Symptoms may first appear when a person is in their 50s. Initial signs of MSA can include:

  • changes in movement and coordination that Parkinson’s disease
  • changes in voice, such as a croaky or quivering voice
  • fainting or feeling lightheaded
  • issues with bladder control

Symptoms of MSA-P include the following:

  • slowed movement
  • stiffness
  • tremor
  • difficulties with balance and coordination
  • urinary issues
  • atypical issues with sweating
  • digestion problems
  • involuntary leaning to one side
  • bending of the neck and drooping of the head
  • mental health issues, such as anxiety or depression
  • sleep disorders, such as sleep apnea or acting out dreams

Learn about conditions similar to Parkinson’s disease.

MSA-P progresses more quickly than Parkinson’s disease and may progress rapidly within 5–10 years of the initial diagnosis.

Movement difficulties may increase over time, and people may require a walking aid within a few years after the first symptoms appear. MSA-P may eventually lead to a person being unable to get out of bed.

MSA-P can cause swallowing difficulties, which may cause pneumonia.

In MSA, brain atrophy, which refers to the loss of neurons and their connections, in the following areas causes symptoms:

  • brainstem
  • basal ganglia, which is involved in movement and speech
  • cerebellum

However, experts do not yet know what causes this brain atrophy.

People with MSA-P have more atrophy in the basal ganglia. People with the cerebellar variant of MSA (MSA-C) have more atrophy in the cerebellum. However, both types present with atrophy in all three areas.

There is no known cause for the brain atrophy in MSA-P, but the following factors may play a role:

  • genes
  • environmental toxins
  • trauma

In most cases, MSA occurs without any risk factors, with no other cases occurring within a person’s family.

Certain factors may affect the risk of developing MSA, including certain gene variations. The current research suggests a combination of genetic and environmental factors leads to its development.

MSA causes deterioration in parts of the brain, which causes the symptoms. With MSA, there is a buildup of the protein alpha-synuclein in glia cells.

Glia cells allow the nerve cells in the brain to function properly, and the atypical protein buildup disrupts this.

Learn about parts of the brain and their functions.

MSA-P symptoms can be very similar to those of Parkinson’s disease, particularly in the early stages. There is no set test for MSA-P, but doctors use a combination of tests to diagnose the condition and rule out other disorders.

Doctors may use the following to diagnose MSA-P:

  • MRI scan: People with MSA usually have visible signs of atrophy on an MRI scan, but those with Parkinson’s disease do not.
  • FDG-PET scan: An FDG-PET scan is an imaging test that shows how the brain uses glucose, which helps show how the brain functions.
  • DaTscan: A DaTscan is an imaging test that looks at how the dopamine system functions. This can show atypical features in the brain that may suggest MSA but cannot differentiate between MSA and Parkinson’s disease.
  • MIBG scan: An MIBG scan looks at the heart’s nervous system, which can help doctors tell the difference between MSA and Parkinson’s disease.
  • Tests for autonomic dysfunction: Doctors may conduct tests to check the function of the autonomic nervous system, such as checking for typical sweating and urination.

The key symptoms present will determine which type of MSA people have.

Treatment for MSA-P can help people manage symptoms and better cope with the disease.

Medications for MSA-P symptoms may include:

  • Levodopa: Levodopa increases dopamine levels in the brain, which can help manage some symptoms of MSA-P. The results of levodopa can vary for each person but may be effective for around 2–3 years.
  • Dopamine agonists: Dopamine agonists mimic the effects of dopamine in the brain but are usually not as effective as levodopa.
  • Amantadine: Amantadine is an antiviral medication that may help treat symptoms and decrease tremor and movement problems.
  • Antidepressants: Certain antidepressants may help improve symptoms.

People with MSA-P may also benefit from rehabilitation therapies. These can include:

  • Physical therapy: Physical therapy may include strengthening exercises to help improve mobility, balance, and motor symptoms. Yoga, tai chi, and pilates may also be beneficial for maintaining mobility and coordination.
  • Occupational therapy: Occupational therapy can help make day-to-day living easier for people with MSA-P. This may include making the home safer and easier to navigate.
  • Speech therapy: MSA-P can cause difficulties with speech and swallowing. Vocal exercises and breathing techniques may help improve these symptoms.

Other treatments may include Botulinum toxin (botox) injections to help reduce muscle contractions. If people experience drops in blood pressure, the following measures may help:

  • wearing compression stockings
  • wearing an abdominal binder
  • increasing salt intake
  • increasing water intake
  • avoiding eating heavy meals

As MSA-P progresses over time, it may lead to further symptoms, complications, or secondary conditions. Complications of MSA-P may include:

  • breathing problems, particularly during sleep, such as sleep apnea
  • severe swallowing difficulties, which may require a feeding tube
  • vision changes, such as double-vision
  • mental changes, such as slowed thinking or difficulty concentrating
  • severe changes in blood pressure
  • blood clots
  • falls, which may cause injuries
  • infections, such as urinary tract infections
  • pneumonia

Regular medical check-ups can help reduce the risk of complications. Doctors may perform tests such as testing a person’s swallowing function to ensure food does not reach the lungs and lead to pneumonia.

There is currently no cure for MSA-P, and treatments are currently unable to prevent or slow the progression of the disease. However, treatments can help manage symptoms.

On average, people with MSA may live for around 8–10 years after the first symptoms appear, although this varies.

MSA-P can cause complications, such as infections and pneumonia, which may affect life expectancy.

MSA-P is a neurodegenerative disease that progresses over time. A loss of nerve cells in the brain causes symptoms similar to Parkinson’s disease, such as movement problems, stiffness, and tremor.

Although there is currently no cure, treatments can help manage symptoms. Treatments may include lifestyle changes, medications, and therapies, such as physical, occupational, and speech therapy.