Multiple System Atrophy (MSA)

Medically Reviewed by Christopher Melinosky, MD on August 24, 2022
4 min read

Multiple system atrophy (MSA) is a nervous system disease that causes problems with how your body works, such as the way you move and keep your balance. There's no cure, but medicine and changes in your everyday habits can help you manage the symptoms.

If you get MSA, you usually start to see symptoms when you're in your 50s or 60s.

The first signs you may notice are:

  • Slow movement, stiffness, and tremors (uncontrolled, repeated movements)

  • Clumsiness

  • Speech problems, like a shaky voice

  • Fainting or dizziness when you stand up

  • Bladder problems, like the sudden need to pee or trouble emptying your bladder

You may also have problems with some of the basic actions your body does. For instance, you may find you make less sweat, tears, and spit. You could lose bladder and bowel control or become constipated.

Some other problems you might notice are:

  • Can't handle heat well

  • Erectile dysfunction (ED)

  • Sleep apnea

  • Sleep disturbances, including acting out vivid dreams

  • Noisy breathing

  • Cold or discolored hands and feet 

  • Finding it hard to control your emotions

  • Anxiety or depression

There are two types of MSA. Your doctor will tell you which one you have based on your major symptoms.

Parkinsonian or MSA-P. The main symptoms look like Parkinson's disease. You may have problems like stiff muscles, slow movement, tremors, and trouble with balance. This is the most common type of MSA.

Cerebellar or MSA-C. The main symptoms you may get are loss of coordination and trouble keeping your balance. You may also have problems with your speech, trouble swallowing, and eye issues like blurred vision or finding it hard to focus.

Your doctor may find it hard at first to diagnose you with MSA. Many of the early symptoms look like Parkinson's disease, which is more common. You may need to see a neurologist, a doctor who specializes in movement disorders.

To see if you have MSA, your doctor will examine you, talk about your symptoms, and look for changes in your brain and nervous system. To figure out if you have MSA or Parkinson's disease, you may need to get "autonomic testing," a type of nervous system test.

You may need to get an MRI of your brain. Your doctor might also check your blood pressure while you're sitting and standing. They may also test how your body sweats. And you might need a test called an electrocardiogram that looks at the electrical signals in your heart.

When you have MSA, a specific protein builds up in the cells that support the nerve cells in your brain. This causes parts of the brain and spinal cord to break down. Experts don't know why this happens.

For most people, symptoms become serious problems over a few years. You are likely to have:

  • More and more trouble with day-to-day activities

  • Breathing problems including sleep apnea

  • Falls

  • Trouble moving, to the point of needing a wheelchair, and over time not being able to get out of bed

  • Paralysis of the vocal cords

  • Not being able to swallow

  • Pneumonia

  • Urinary tract infections

  • Blood clots

The outlook for people with this disease can vary. It’s possible to live 15 years or longer with multiple system atrophy. Death for people who have this condition is often from respiratory problems.


MSA has no cure. Treatment is aimed at managing the symptoms.

The Parkinson's drug levodopa can help manage shaking, stiffness, and slow movement. Stretching and exercise can keep your muscles strong and flexible. Physical, occupational, and speech therapists can help with walking and talking.

To control your blood pressure, your doctor may prescribe you drugs like droxidopa, fludrocortisone, or midodrine. You could need a pacemaker to regulate your heart rate and increase your blood pressure.

For bladder control, drugs including oxybutynin, mirabegron, tamsulosin, and tolterodine might help. You might use a catheter as well, which you can learn to use on your own. Catheters or medication can also help if you're unable to empty your bladder.

Softer foods can help with swallowing. You might need a breathing or feeding tube for more serious problems.

Medications can help with erectile dysfunction if that becomes a problem for you.

Steps you can take to make yourself more comfortable include:

  • Eat more salt, drink more water, and have caffeine to raise your blood pressure

  • Wear compression stockings 

  • Avoid standing up too quickly

  • Sleep with the head of your bed raised

  • Eat more fiber, take stool softeners, or try enemas for constipation

  • Keep yourself from getting overheated

  • Move around as much as you can to keep blood clots from forming