What is Multiple System Atrophy (MSA)?
MSA is a brutal illness. It is a progressive degenerative neurological disorder that affects multiple areas of the brain. The areas affected are the basal ganglia, cerebellum and brain stem and they are responsible for movement, balance and body functions such as bladder control. It is rare and very difficult to diagnose. It is thought to affect 4 in every 100,000 people and has a prognosis of between 7 and 12 years. It is not known what causes the illness and there is no cure at this point in time. Very few doctors will actually say for certain that a person has MSA because it is generally believed thatthe only way right now to know for sure that someone had MSA is to do an autopsy. Even if the symptoms all match exactly, very few doctors would say definitely. The best they are likely to do is say “probably”. (I wrote this in 2004 so it may be different now.)
For example, Progressive Supranuclear Palsy (PSP) is very similar to MSA as is Corticobasal Ganglionic Degeneration (CBGD), Lewy Body Dementia (LBD) and Fragile X-associated Tremor/Ataxia Syndrome (FXTAS)- see below.
When I first started researching MSA across the Internet, I found that there were differing schools of thought as to what MSA is. For me, an excellent description of MSA has been written by Timothy C. Hain, MD — Northwestern University Medical School, Chicago, USA. He is without doubt an authority on MSA and you can find him at:
http://www.dizziness-and-balance.com/disorders/central/movement/msa.html
In his description of MSA, Dr Hain says that MSA is synonymous with striatonigral degeneration (SND) when Parkinsonian features predominate, olivopontocerebellar atrophy (OPCA) when cerebellar signs predominate, and Shy-Drager syndrome (SDS) when autonomic failure is dominant.
Some of the key symptoms of SDS, SND and OPCA are:
SDS
Orthostatic hypotension (blood pressure)
Urinary problems (incontinence, urgency, retention, impotence in men)
Autonomic failure
SND
Resting tremor
Gait problems
Slowed movements, rigidity
OPCA
Ataxia
Intentional tremor
Balance problems
Some people believe that if a person’s symptoms fit into one of the three categories, then that is what they have. But if they can identify two symptoms from two categories, then they have MSA. Whether that is right or not, I can’t say. In Patricia’s case, she has symptoms across all three categories but clearly (in my opinion) fits into the SND category.
It is very common for people with MSA to be diagnosed initially with Parkinson’s Disease (PD).
The Sarah Matheson Trust in London, England has a fairly detailed description of MSA that can be found at http://www.msatrust.org.uk/Understanding MSA
Another good link worth checking is http://emedicine.com/NEURO/topic671.htm. It is very technical but don’t be put off by that.
A relatively new illness that appears to mimic MSA is Fragile X-associated Tremor/Ataxia Syndrome (FXTAS) and I think it is important for possible sufferers of MSA to check this out, especially if anxiety is a major factor in the illness. Go to http://www.fragilex.org/and check out the FXTAS section. A DNA test is available for FXTAS and if nothing else, it can rule out that as a possibility.
For further recommended links to other sites, go to the Links section.
People often question what causes MSA and wonder whether factors such as the environment or diet etc play a part. An MSA data survey was carried out in 2014 and you can read the report here
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