From the Research
The management of multisystem atrophy (MSA) should focus on symptomatic treatment, as there is currently no cure or disease-modifying therapy available, and a multidisciplinary approach is essential to improve the patient's quality of life 1. The treatment should be individualized based on the predominant symptoms, which typically include autonomic dysfunction, parkinsonism, and cerebellar ataxia.
- For orthostatic hypotension, first-line measures include increasing salt and fluid intake, wearing compression stockings, and elevating the head of the bed.
- Pharmacologic options include fludrocortisone (0.1-0.3 mg daily), midodrine (2.5-10 mg three times daily), and droxidopa (100-600 mg three times daily) 2.
- Parkinsonism symptoms may respond to levodopa therapy (starting at 100 mg three times daily, with titration as needed), though the response is often limited and short-lived compared to Parkinson's disease.
- Urinary symptoms can be managed with anticholinergics like oxybutynin (5 mg two to three times daily) for urgency and incontinence, while intermittent catheterization may be necessary for retention.
- For constipation, a high-fiber diet, adequate hydration, and laxatives such as polyethylene glycol (17 g daily) are recommended.
- Sleep disorders, particularly REM sleep behavior disorder, may respond to clonazepam (0.5-2 mg at bedtime). Multidisciplinary care involving neurologists, physical therapists, speech therapists, and palliative care specialists is essential as the disease progresses, as stated in the most recent study 1. Patient and caregiver education about the progressive nature of MSA is crucial, and early discussions about advanced care planning should be initiated. The median survival from symptom onset is typically 6-10 years, with respiratory complications being a common cause of death 1.