People with multiple system atrophy (MSA) generally have a very poor prognosis. Their median survival is 6.2 to 9.5 years after the first symptoms appear. Patients who are older at the time of onset tend to have a shorter survival time. There are no therapies that cure or alter the disease or slow its progress, but there are many treatments available which may alleviate the symptoms of MSA.
In the early stages of the Parkinsonian variant of the disease, termed MSA-P, drugs used to treat Parkinson's disease may bring relief from slow movements and muscle rigidity. However, the same drugs may also lower the blood pressure. This side effect may exacerbate the primary symptom of MSA, namely, orthostatic hypotension, which results in fainting spells or dizziness. Botulinum toxin injections have also been used to relieve abnormal muscle postures.
Therapy for autonomic symptoms, including orthostatic hypotension relies either on medications that raise the blood pressure, or on comfort measures such as a CPAP (continuous positive airway pressure) machine. A new drug has recently been approved for the treatment of orthostatic hypotension in MSA.
Lifestyle adjustments are recommended to help patients manage orthostatic hypotension (OH). These include moving more slowly and carefully, eating smaller meals, avoiding extremes of temperature, and avoiding activities in the morning, when OH symptoms are at their worst.
Compression stockings may help by preventing the pooling of blood in the legs. They force the blood into the systemic circulation instead, which helps to maintain a steady blood pressure. Other simple measures like staying properly hydrated and eating a diet with increased salt content may also help to support normal blood pressure levels. Raising the head of the bed by 10 to 30 degrees is also sometimes recommended.
Drugs that increase the levels of the neurotransmitter gamma-amino butyric acid (GABA) can reduce cerebellar ataxia in some patients. Cerebellar ataxia is also treated with certain anti-anxiety drugs, antidepressants, pituitary hormone extract, and a drug used in multiple sclerosis, that improves the walking ability of the patient.
Botulinum toxin injections have been used to relieve the abnormal muscle postures associated with MSA. This treatment is most effective for dystonias of the mouth, jaw and tongue, as well as dystonias of the trunk muscles. Other drugs used to relieve this set of symptoms include medications used in Parkinson's disease, anticholinergics, and muscle relaxants, among others.
A number of medications are available to treat erectile dysfunction.
Anticholinergic drugs can be used to treat urinary incontinence. Sleep problems are sometimes managed with sleep aids or antidepressants. In advanced disease, a catheter is often used to drain the bladder.
Swallowing and Breathing Difficulties
Comfort care measures like softer foods can help patients who have trouble swallowing. For more severe swallowing and breathing difficulties, a breathing tube or feeding tube may be necessary.
Physical therapy, speech therapy, and occupational therapy can also offer some relief as well as maintain adequate function for essential daily activities for as long as possible, even as the disease progresses.
In addition to medications and symptomatic treatment, some physicians recommend a neuroprotective diet. Calorie restriction is claimed to boost the levels of glutamate in the brain. Glutamate is an amino acid and neurotransmitter which improves motor control.
A low protein diet may potentiate the actions of certain drugs prescribed for Parkinson's-like symptoms. Again, an anti-inflammatory diet may reduce the risk and progression of degenerative diseases, including not only MSA, but heart disease, diabetes, and autoimmune disease. This kind of diet is high in fruits and vegetables, healthy fats, fish, and beneficial micronutrients like quercetin and flavonoids.
Reviewed by Dr. Liji Thomas, MD