Description

Multiple system atrophy (MSA) is an uncommon neurological disorder that frequently mimics Parkinson’s disease. It is characterised by selective and progressive neuronal degeneration in various neuronal systems including the extrapyramidal, autonomic, cerebellar and pyramidal tracts. Any combination of these systems can be affected in a patient with MSA. Autonomic failure is present in the majority of MSA patients. MSA patients are classified clinically into two subgroups depending on the presence of parkinsonism or cerebellar features. Parkinsonism is present in 80% of MSA patients (MSA-P), while cerebellar features dominate in 20% of patients (MSA-C). The parkinsonism of MSA can be very similar to Parkinson’s disease, although MSA patients are less likely to have a pill-rolling rest tremor and respond poorly to levodopa. The most common autonomic features include postural hypotension, urinary incontinence, and impotence. The management of patients with MSA requires the skills of the multidisciplinary team.