Multiple System Atrophy

Multiple system atrophy (MSA; also known as Shy-Drager syndrome) is a rare degenerative disorder that keeps your body's involuntary functions from working properly. It affects such functions as blood pressure, heart rate, bladder function and digestion. This condition also demonstrates many of the symptoms of Parkinson’s disease such as slow deliberate movements, rigid muscles and poor balance.

The symptoms of MSA affect multiple systems in your body and it is classified by two types:
  • The parkinsonian type exhibits such symptoms as rigid muscles and difficulty bending your arms and legs, slow movement, tremors (but not as much as with Parkinson’s disease) and impaired balance and posture.
  • The cerebellar type exhibits such symptoms as impairment of movement and coordination (unsteady gait, loss of balance), speech impediments (slurred, slow or whispered), visual disturbances (blurred or double vision) and difficulty in swallowing or chewing.

Multiple system atrophy produces postural or orthostatic hypotension, a form of low blood pressure that makes you dizzy when you change positions from sitting or lying down to standing. Conversely, you may also develop dangerously high blood pressure while lying down. Your heartbeat may become irregular.

You may experience constipation, incontinence, reduced perspiration, reduced tears and saliva, cold hands and feet and intolerance to heat. Certain sleep disorders may also affect you, such as “acting out” your dreams and abnormal breathing; you may experience impotence and loss of libido.

Multiple system atrophy develops in adulthood, usually in the 50s or 60s. It has no known cause or cure and is associated with deterioration and shrinkage of your brain’s cerebellum, basal ganglia and brainstem; they regulate internal body functions, digestion and motor control. Examination of the brain tissue of people with MSA shows nerve cells containing an abnormal amount of a protein called alpha-synuclein.

Diagnosis  of Multiple System Atrophy
If our team suspects multiple system atrophy, we will obtain a medical history, perform a physical examination and usually order blood tests and brain-imaging scans to determine whether brain lesions are present. Some of the tests we may perform include a tilt table test (you are strapped to a tilting table and your blood pressure is monitored in various positions), other blood pressure tests, a perspiration test, an eye exam, tests for bladder and bowel function, an EKG and nerve and muscular tests. We may also have you evaluated in a sleep lab to see if you have any disorders such as sleep apnea.

Treatment Options  for Multiple System Atrophy
Treatment for multiple system atrophy includes medications and lifestyle changes to help manage your symptoms and maintain your body functions and capabilities.

We may recommend medications to raise your blood pressure (like the corticosteroids fludrocortisone, pyridostigmine and midodrine) and treat hypotension (droxidopa) and drugs to reduce the Parkinson’s disease symptoms (levodopa and carbidopa). Not everyone responds to Parkinson’s drugs, though.

Our team may also recommend you get a pacemaker to help keep your heartbeat regular. 

We may make several other recommendations to try to restore or stabilize your condition:  
  • Impotence medications
  • Sleeping in a heads-up position
  • Catheterization for bladder control
  • Physical and speech therapy
  • Softer foods for swallowing problems or a feeding tube
  • Breathing tube for breathing difficulties


Our physicians at Houston Methodist specialize in managing multiple system atrophy at the following convenient locations: