Multiple system atrophy (MSA) is a progressive disorder of the nervous system. The neurodegenerative disease is characterized by symptoms that affect movement and the autonomic nervous system. The autonomic nervous system is responsible for involuntary actions like digestion and blood pressure regulation. The symptoms progress as different kinds of nerve cells within the spinal cord and brain lose their function and die. The disease is rare and estimated to affect only fifteen to fifty thousand individuals in the United States.
The symptoms usually appear when an individual is in their fifties. Eventually, symptoms lead to a patient being bedridden because they no longer have motor function. Patients with multiple system atrophy might die suddenly from respiratory or cardiac problems.
Balance And Posture Issues
There are two main types of multiple system atrophy: Parkinsonian and cerebellar. The cerebellar type is the less common of the two. The typical symptoms involve issues with muscle coordination, otherwise known as ataxia, which can be a symptom of an overarching disease or exist by itself. This condition, like multiple system atrophy, is a degenerative disease affecting the nervous system. Patients with ataxia may look like they're drunk: their speech may be slurred, and they may stumble or fall.
These balance and posture issues occur because the nerves in the cerebellum degenerate. The cerebellum is the portion of the brain that coordinates muscle movements. An individual's gait may be unsteady, and they may have trouble keeping their balance. In addition, patients may have difficulty chewing or swallowing. Balance and posture issues can also occur in the Parkinsonian type of multiple system atrophy. It's very difficult to distinguish this disease from Parkinson's disease at first.
Multiple system atrophy patients may have rigid muscles, particularly with the Parkinsonian type of the condition. Many of the symptoms of this form of multiple system atrophy mimic the symptoms of Parkinson's disease, making it difficult to reach a diagnosis. An unsteady gait and muscle rigidity are both seen in Parkinson's disease. Diagnosis is usually done through clinical examinations and imaging tests.
Doctors usually determine the condition is possibly or probably multiple system atrophy, but they have trouble definitively diagnosing it, and some patients never receive a proper diagnosis. When patients present with rigid muscles, doctors will often use medications to reduce the symptoms that mimic Parkinson's disease. Patients can sometimes benefit from the same medications that treat Parkinson's disease.
Bradykinesia is the medical term for slowed movements and overall slowness of movement. This is one of the main symptoms involved in the diagnosis of Parkinson's disease. It's also another reason multiple system atrophy is often misdiagnosed as Parkinson's disease. Depending on the presentation of symptoms, doctors may decide not to rule out multiple system atrophy, but they may also not definitively diagnose it.
The slowness may happen in different ways. Automatic movements like blinking might be reduced. It might also be difficult to initiate movements, so getting up from chairs may be difficult. Physical actions might be slow. In addition, facial expressions may decrease, and the face may seem abnormally still. Right now, there's not enough research to differentiate bradykinesia in multiple system atrophy from bradykinesia in Parkinson's disease. The symptom makes it difficult to perform basic everyday tasks like cutting food, brushing teeth, or buttoning a shirt. It's also frustrating because the slowness seems to come and go unpredictably.
Dysphagia is the medical term for difficulty swallowing. Patients with this symptom need to expend more effort and use more time to move liquid and food to the stomach. Some patients also experience pain when swallowing. For some individuals, swallowing is completely impossible. A common sign of dysphagia is the feeling food is getting stuck in the chest, throat, or sternum. Patients might regurgitate their food or have frequent heartburn. They may also gag or cough when they swallow. The irritation to the throat may cause patients to sound hoarse. If individuals are having trouble swallowing their saliva, they may drool. Some individuals avoid certain foods or cut their portions into very small pieces because of the trouble swallowing.
Postural hypotension, otherwise known as orthostatic hypotension, is a type of low blood pressure that occurs when individuals stand up from a sitting or lying position. This condition often makes patients feel lightheaded and dizzy, and in serious cases can even lead to fainting. Patients may also experience blurry vision and overall weakness. They may feel nauseous and exhibit confusion.
If an individual's systolic blood pressure falls by twenty mmHg or more, or their diastolic blood pressure falls by ten mmHg or more upon standing, they are considered to have postural hypotension. Isolated episodes can occur when an individual is dehydrated or fatigued. These aren't related to an overarching condition. However, chronic episodes may be a sign an individual has multiple system atrophy or another underlying condition.