Multiple System Atrophy

Multiple system atrophy (MSA) is a rare, progressive neurodegenerative disorder characterized by degeneration of neurons in the brain regions controlling the autonomic nervous system and movement. The disease presents with combinations of parkinsonian features (rigidity, bradykinesia), cerebellar ataxia (incoordination, gait disturbance), and autonomic failure (orthostatic hypotension, urinary incontinence, sexual dysfunction). Pathological hallmark is neuronal inclusions containing alpha-synuclein protein. The disease progresses relentlessly, with median survival of about 10 years from symptom onset. Early symptoms are often autonomic dysfunction and sleep problems; motor symptoms develop progressively. Currently, there is no disease-modifying treatment, so management is symptomatic, focusing on blood pressure management, movement disorder treatment, and supportive care.