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Multiple System Atrophy (MSA)

Multiple System Atrophy (MSA)

Multiple System Atrophy (MSA) is a progressive neurological illness (an illness of the nervous system). It is caused by an overproduction of a protein in the brain called alpha synuclein which causes degeneration (atrophy) of nerve cells in several areas of the brain (multiple systems). The three main areas affected are the basal ganglia, the cerebellum and the brain stem. This cell loss can result in a number of problems, particularly related to movement, balance and other autonomic (unconscious) body functions (such as bladder function). These symptoms are very similar to Parkinson’s, but MSA progresses faster and does not respond as well to medication.

What causes MSA?

Both men and women can be affected by MSA. It usually starts between the ages of 30 and 60 years, although it can also affect older people. MSA is not infectious nor contagious.

At present the cause is unknown and MSA seems to occur randomly. It does not appear to be inherited, although it may be that some people are genetically more predisposed to developing it. What triggers the process of atrophy is the subject of ongoing research.


Symptoms vary according to which part of the brain is affected by loss of nerve cells. Not everyone will experience all symptoms. Deterioration is very individual. Some of the most common symptoms include:

  • slowed movements
  • rigidity or stiffness
  • difficulty turning in bed
  • difficulty in initiating a movement
  • difficulty writing; writing may become small and spidery
  • loss of balance and poor coordination or clumsiness (ataxia)
  • speech difficulties
  • difficulty with fine motor skills such as doing up buttons
  • problems with erection or male impotence
  • loss of bladder control, including urgency, frequent urination or incomplete emptying, often getting up several times at night to pass urine
  • bowel problems, including constipation
  • inability to sweat
  • cold hands and feet
  • drop in blood pressure when standing (postural hypotension), leading to dizziness, fainting or blurred vision
  • coat hanger pain’ (pain in neck or shoulders) as a result of low blood pressure
  • problems with swallowing
  • emotions that are easily aroused or tend to change quickly
  • depression, anxiety or a feeling of being overwhelmed
  • soft voice, particularly when tired, which over time becomes slurred, then incomprehensible
  • restless sleep
  • noisy breathing, including snoring when sleeping.


MSA can be difficult to diagnose, especially early on when symptoms appear very similar to Parkinson’s. This can mean it takes some time for a diagnosis to be reached.

There is no specific test to confirm MSA. However, brain scans and blood tests may help to rule out other possible causes. A neurologist or a movement disorder specialist, will make careful observations over a period of time in order to reach an accurate diagnosis, using a set of criteria, so several visits may be needed in order to give a possible or probable diagnosis.

MSA and Parkinson’s

MSA is often mistaken for Parkinson’s as it initially tends to present similarly. It is important that a doctor experienced in movement disorders is consulted so that she or he can reach an accurate diagnosis. The focus of treatment in MSA is different to Parkinson's; whilst there is some overlap , it is helpful to get the diagnosis clarified to ensure the best management of symptoms.

Treatment and management

Currently there is no cure for MSA, nor any treatments to delay the degeneration of nerve cells. However, medications and treatments can help to manage some of the symptoms. As the illness progresses, increasing help will be needed with everyday activities. Because MSA is a complex illness, a combination of approaches will probably be suggested.


A specialist doctor or neurologist may prescribe medicines, often including Parkinson’s medicines, to treat movement symptoms, regulate blood pressure and improve bladder control. She or he will tailor your medication to suit your symptoms and adjust the dose as necessary.

Specialist equipment

In many countries, an occupational therapist, physiotherapist and speech and language therapist will be able to advise on specialist equipment and strategies to overcome everyday difficulties, for example turning in bed, personal hygiene or eating. Your doctor will be able to refer you to the right healthcare professional, so it is important to tell him or her about symptoms and any difficulties you experience.

Complementary therapies

So far there is no actual evidence that complementary therapies can alleviate the symptoms of MSA, but some people find them helpful, for example in relaxing stiffness and rigidity in muscles and relieving stress.

Who can help?

Healthcare professionals who may be able to help include physiotherapists, speech and language therapists, occupational therapists, specialist nurses, continence advisors, dieticians and social workers. Each specialist will be able to advise on specific difficulties and will work with you to find solutions and strategies to make life easier.

In some countries there are MSA organisations that provide help, advice and support for both people with MSA and their carers. Your doctor or specialist nurse may be able to provide you with contacts, or you can ask at your local library or search using the Internet. 

Content last reviewed: April 2020


We would like to thank the MSA Trust for help in reviewing this information.

Related reading

  • Discriminating α-synuclein strains in Parkinson’s disease and multiple system atrophy – research paper
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