Running head: (GAGTAN,ANDREI RAPHAEL L.

Multisystem Problems

Gagtan,Andrei Raphael L.

Union Christian College

(SURNAME, NAME, M.I.) 2

Multiple system atrophy (MSA) is a rare, degenerative neurological disorder affecting your

body's involuntary (autonomic) functions, including blood pressure, breathing, bladder function

and motor control.

Formerly called Shy-Drager syndrome, olivopontocerebellar atrophy or striatonigral

degeneration, MSA shares many Parkinson's disease-like symptoms, such as slow movement,

rigid muscles and poor balance.Treatment includes medications and lifestyle changes to help

manage symptoms, but there is no cure. The condition progresses gradually and eventually leads

to death. Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by a

combination of symptoms that affect both the autonomic nervous system (the part of the nervous

system that controls involuntary action such as blood pressure or digestion) and movement. The

symptoms reflect the progressive loss of function and death of different types of nerve cells in the brain

and spinal cord.

Symptoms of autonomic failure that may be seen in MSA include fainting spells and problems

with heart rate, erectile dysfunction, and bladder control. Motor impairments (loss of or limited

muscle control or movement, or limited mobility) may include tremor, rigidity, and/or loss of

muscle coordination as well as difficulties with speech and gait (the way a person walks). Some

of these features are similar to those seen in Parkinson’s disease, and early in the disease course

it often may be difficult to distinguish these disorders.

MSA is a rare disease, affecting potentially 15,000 to 50,000 Americans, including men and

women and all racial groups. Symptoms tend to appear in a person’s 50s and advance rapidly

over the course of 5 to 10 years, with progressive loss of motor function and eventual

confinement to bed. People with MSA often develop pneumonia in the later stages of the disease

and may suddenly die from cardiac or respiratory issues.

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While some of the symptoms of MSA can be treated with medications, currently there are no

drugs that are able to slow disease progression and there is no cure.

MSA includes disorders that historically had been referred to as Shy-Drager syndrome,

olivopontocerebellar atrophy, and striatonigral degeneration.

Symptoms

Multiple system atrophy (MSA) affects many parts of your body. Symptoms typically develop in

adulthood, usually in the 50s or 60s.

MSA is classified by two types: parkinsonian and cerebellar. The type depends on the symptoms

you have at diagnosis.

Parkinsonian type

This is the most common type of MSA. The signs and symptoms are similar to those of

Parkinson's disease, such as:

 Rigid muscles

 Difficulty bending your arms and legs

 Slow movement (bradykinesia)

 Tremors (rare in MSA compared with classic Parkinson's disease)

 Problems with posture and balance

Cerebellar type

The main signs and symptoms are problems with muscle coordination (ataxia), but others may

include:

 Impaired movement and coordination, such as unsteady gait and loss of balance

 Slurred, slow or low-volume speech (dysarthria)

 Visual disturbances, such as blurred or double vision and difficulty focusing your eyes
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 Difficulty swallowing (dysphagia) or chewing

General signs and symptoms

In addition, the primary sign of multiple system atrophy is:

 Postural (orthostatic) hypotension, a form of low blood pressure that makes you feel

dizzy or lightheaded, or even faint, when you stand up from sitting or lying down

You can also develop dangerously high blood pressure levels while lying down (supine

hypertension).

MSA might cause other difficulties with involuntary (autonomic) body functions, including:

Urinary and bowel dysfunction

 Constipation

 Loss of bladder or bowel control (incontinence)

Sweating abnormalities

 Reduced production of sweat, tears and saliva

 Heat intolerance due to reduced sweating

 Impaired body temperature control, often causing cold hands or feet

Sleep disorders

 Agitated sleep due to "acting out" dreams

 Abnormal breathing at night

Sexual dysfunction

 Inability to achieve or maintain an erection (impotence)

 Loss of libido

Cardiovascular problems

 Color changes in hands and feet caused by pooling of blood

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 Cold hands and feet

Psychiatric problems

 Difficulty controlling emotions, such as laughing or crying inappropriately

When to see a doctor

If you develop any of the signs and symptoms associated with multiple system atrophy, see your

doctor for an evaluation and diagnosis. If you've already been diagnosed with the condition,

contact your doctor if new symptoms occur or if existing symptoms worsen.

Causes

There's no known cause for multiple system atrophy (MSA). Some researchers are studying a

possible inherited component or involvement of an environmental toxin in the disease process,

but there's no substantial evidence to support these theories.

MSA causes deterioration and shrinkage (atrophy) of portions of your brain (cerebellum, basal

ganglia and brainstem) that regulate internal body functions, digestion and motor control.

Under a microscope, the damaged brain tissue of people with MSA shows nerve cells (neurons)

that contain an abnormal amount of a protein called alpha-synuclein. Some research suggests that

this protein may be overexpressed in multiple system atrophy.

Complications

The progression of MSA varies, but the condition does not go into remission. As the disorder

progresses, daily activities become increasingly difficult.

Possible complications include:

 Breathing abnormalities during sleep

 Injuries from falls caused by poor balance or fainting

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 Progressive immobility that can lead to secondary problems such as a breakdown of your

skin

 Loss of ability to care for yourself in day-to-day activities

 Vocal cord paralysis, which makes speech and breathing difficult

 Increased difficulty swallowing

People typically live about seven to 10 years after multiple system atrophy symptoms first

appear. However, the survival rate with MSA varies widely. Occasionally, people can live for 15

years or longer with the disease. Death is often due to respiratory problems.
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References

Hodder J. Shy Drager syndrome. Axone. 1997;18:75-79.

http://www.ncbi.nlm.nih.gov/pubmed/9295481

Litvan I, Goetz CG, Jankovic J, et al. What is the accuracy of the clinical diagnosis of multiple

system atrophy? A clinicopathologic study. Arch Neurol. 1997;54:937-44.

http://www.ncbi.nlm.nih.gov/pubmed/9267967

Wenning GK, et al. Clinical features and natural history of multiple system atrophy. An analysis

of 100 cases. Brain. 1994;117:835-45. http://www.ncbi.nlm.nih.gov/pubmed/7922469

Quinn N. Multiple system atrophy – the nature of the beast. J Neurol Neurosurg Psychiatry.

1989;Suppl:78-89. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1033311/

INTERNET

Diedrich A, Robertson D. Multiple System Atrophy. Emedicine Journal, April 6, 2012. Available

at: http://emedicine.medscape.com/article/1154583-overview Accessed on: September 1, 2012.

Mayo Clinic for Medical Education and Research. Multiple System Atrophy. July 2, 2011.

Available at: http://www.mayoclinic.com/health/shy-drager-syndrome/DS00989 Accessed On:

September 1, 2012.

Kruger R. Multiple System Atrophy. Orphanet Encyclopedia, November 2004. Available at:

http://www.orpha.net/ Accessed on: September 1, 2012.