From the Guidelines
The first symptoms of Multiple System Atrophy (MSA) typically include a combination of autonomic dysfunction, motor symptoms, and sleep disorders, with autonomic dysfunction such as orthostatic hypotension, urinary problems, and erectile dysfunction being common initial presentations. According to the study published in the Journal of the American College of Radiology in 2020 1, MSA can be subdivided into three distinct clinical subtypes: MSA-P (striatonigral degeneration), in which extrapyramidal/Parkinsonian features predominate, MSA-C (olivopontocerebellar atrophy), in which ataxia and cerebellar symptoms predominate, and less commonly, MSA-A (Shy-Drager syndrome), in which autonomic dysfunction predominates.
Some key initial symptoms of MSA include:
- Autonomic dysfunction, such as orthostatic hypotension, urinary problems, and erectile dysfunction
- Motor symptoms like parkinsonism, including slowness, stiffness, and tremor
- Poor balance with falls and coordination difficulties
- Sleep disorders, particularly REM sleep behavior disorder
- Voice changes, including developing a soft, quivery voice
- Respiratory issues like stridor, a high-pitched breathing sound
These symptoms appear because MSA causes progressive degeneration of nerve cells in multiple brain regions that control autonomic functions, movement, and coordination, as discussed in the study 1. The disease typically affects adults over 40, with symptoms gradually worsening over time. Early recognition of these symptoms is crucial as they can be mistaken for Parkinson's disease, but MSA progresses more rapidly and responds poorly to standard Parkinson's medications like levodopa.
From the Research
First Symptoms of MSA
The first symptoms of Multiple System Atrophy (MSA) can vary, but they often include a combination of:
- Autonomic dysfunction, such as orthostatic hypotension, urinary symptoms, and erectile dysfunction 2, 3
- Parkinsonism, including tremors, rigidity, and bradykinesia 2, 4
- Cerebellar ataxia, characterized by loss of coordination and balance 2, 5
- Pyramidal signs, such as weakness and spasticity 4
Common Initial Presentations
Some patients may initially present with:
- Severe autonomic dysfunction, including orthostatic hypotension and syncope 3
- Parkinsonian symptoms, which may respond partially to dopaminergic treatment 2, 4
- Cerebellar ataxia, which can lead to falls and loss of coordination 5
- Isolated autonomic failure or REM sleep behavior disorder, which can be premotor features of MSA 5
Diagnostic Challenges
Diagnosing MSA can be challenging, especially in early disease stages, due to the variability of symptoms and the similarity to other neurodegenerative disorders, such as Parkinson's disease 2, 5. A correct diagnosis often requires a combination of clinical evaluation, autonomic function tests, and imaging studies 2, 3.