Diseases which look like Parkinson’s disease, but have additional features are called “Parkinson’s Plus” syndromes.

Multiple System atrophy (MSA) is a “Parkinson’s Plus” syndrome in which a component of our nervous system called the “Autonomic Nervous System” is also affected.

The Autonomic Nervous System helps us do things that we don’t think about consciously. Thus, it helps us in:

  • Preventing a drop in blood pressure when we stand up from a chair or bed.

    The Autonomic Nervous System helps us maintain our Blood Pressure.

  • Maintaining heart rhythm
  • Having an erection
  • Sweating
  • Passing urine and stool

The following symptoms can be seen because of this system dysfunction:

  • A sudden drop in blood pressure can cause sudden dizziness, blurred vision, or loss of consciousness if you stand up abruptly.

    In MSA, patients may feel lightheaded, have blurred visions, or experience loss of consciousness if they stand up suddenly.

  • Heart rhythm problems (these are uncommon).
  • Impotence
  • Reduced sweating
  • Loss of bladder or bowel control or severe constipation

There is a form of MSA called MSA-C: The C stands for cerebellum. The cerebellum is the part of the brain that helps with coordination while walking or doing something physical. Therefore, these patients may have difficulty coordinating their movements and may sway from side-to-side while walking.

What Causes Multiple System Atrophy (MSA)?

MSA is caused by the accumulation of the same waste material as in Parkinson’s disease (synuclein).

We don’t know why the accumulation of synuclein causes Parkinson’s disease in some and Multiple System Atrophy in others.

What is the Treatment of Multiple System Atrophy (MSA)?

Like all Parkinson’s Plus syndromes, the mainstay treatment is Levodopa. As noted before, the patient’s response to Levodopa is unpredictable and sometimes may not be excellent.

Just like all Parkinson’s Plus syndromes, and Parkinson’s disease itself, many MSA symptoms are treatable. For example:

  • Drop in blood pressure: Maintaining a proper fluid balance and taking medications such as pyridostigmine, fludrocortisone, midodrine may be helpful.
  • Heart rhythm problems: We can control these with medications. In rare cases, a pacemaker may be needed.

    Very rarely, a pacemaker may be needed to make sure the heart beats regularly.

  • Impotence: There are many effective medications for impotence.
  • Bladder & bowel control: A mixture of behavioral changes, physical supports (diapers), and medications are usually helpful.


Dr. Siddharth Kharkar

Dr. Kharkar is a Neurologist, Epilepsy specialist & Parkinson’s disease specialist in Mumbai, Maharashtra, India. He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

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