What medications are effective for treating gait disturbances in Multiple System Atrophy (MSA)?

From the Guidelines

The most effective treatment for gait problems in Multiple System Atrophy (MSA) is a multidisciplinary approach, including physical therapy and medications such as levodopa, amantadine, and midodrine, as there is no single medication that can effectively treat gait problems in MSA. According to the most recent study 1, the management of MSA symptoms, including gait problems, requires a comprehensive approach that takes into account the underlying neurodegeneration affecting multiple brain regions. While levodopa (Sinemet), typically starting at 100/25mg three times daily and gradually increasing as tolerated, is often tried first despite typically providing less benefit than in Parkinson's disease, amantadine (100mg twice daily) might help with rigidity and bradykinesia. For orthostatic hypotension contributing to gait instability, midodrine (2.5-10mg three times daily) or fludrocortisone (0.1-0.3mg daily) may be beneficial.

Some key points to consider when managing gait problems in MSA include:

• The importance of physical therapy as a non-pharmacological approach to improve mobility and balance
• The need for regular adjustment of treatment plans by a neurologist specializing in movement disorders
• The potential benefits and limitations of medications such as levodopa, amantadine, and midodrine in managing MSA symptoms
• The importance of addressing underlying neurodegeneration and its effects on multiple brain regions

It is essential to note that MSA is a progressive disease, and medication responses are often limited and diminish over time. Therefore, a comprehensive and multidisciplinary approach is necessary to manage gait problems and other symptoms associated with MSA, as suggested by the study 1.

From the Research

Medications for Gait Problems in Multiple System Atrophy

• Levodopa therapy may be effective in improving gait in patients with multiple system atrophy (MSA), particularly those with predominant parkinsonian features, with efficacy documented in about 40-60% of patients 2.
• Other antiparkinsonian compounds, such as dopamine agonists and amantadine, may also be employed, but they are not more effective than levodopa 2.

Non-Pharmacological Interventions for Gait Problems in MSA

• Physiotherapy has been shown to improve motor function, including gait, in patients with MSA, with a short-term bout of physiotherapy being feasible, safe, and effective in improving gait performance 3.
• Exercise-based interventions, such as a five-day inpatient physiotherapy program followed by a five-week unsupervised home-based exercise program, may be beneficial in improving gait in patients with MSA 3.

Management of Gait Variability in MSA

• Gait variability is higher in patients with MSA compared to those with Parkinson's disease and controls, and is associated with postural instability and a higher risk of falls 4.
• Management of gait variability in MSA may involve a team approach, including physiotherapy and other non-pharmacological interventions, as well as pharmacological treatments aimed at reducing symptoms such as orthostatic hypotension 5.

Current Treatment Options and Future Directions

• Currently, there is no cure for MSA, and treatment focuses on managing the most problematic symptoms experienced by the patient 5, 6.
• Further interventional studies of candidate disease-modifying and symptomatic therapies are essential to improve patient care and develop more effective treatment options for MSA 6.