Multiple system atrophy is a progressive disorder of the nervous system.1 MSA leads to degeneration of multiple areas of brain, mainly, basal ganglia, brain stem and cerebellum. The particular areas affected in the brain can lead to symptoms related to the function of these parts, which include coordination, balance, movement and control of autonomic functions in the body. Autonomic functions are functions that are beyond our control and done involuntarily by the body.
Is Multiple System Atrophy A Form Of Parkinson?
Although, multiple system atrophy is a very rare disease and affects, it’s progression is rapid over a course of 5-10 years causing disability. In the past, it was popularly known as Shy Drager syndrome.1 It usually affects individuals in their 30-50s, although, it can affect older individuals too. The cause of it still remains unknown and mostly it is a random disorder. It is characteristic of accumulation of alpha-synuclein protein in oligodendroglia (type of cells that make up myelin sheath in the CNS). What differentiates MSA from Parkinson’ disease is the accumulation of alpha-synuclein protein. In Parkinson’s disease it accumulates in nerve cells.2
Therefore, multiple system atrophy and Parkinson’s do share some of the symptoms as both are neurodegenerative disease with movement disorders. Multiple system atrophy is not a form of Parkinson’s disease, but since they share some of the symptoms, the clinical diagnosis between the two poses some amount of difficulty. Multiple system atrophy can be wrongly diagnosed as Parkinson’s as it is rarer.
Similar Symptoms Between Multiple System Atrophy And Parkinson’s
Initially, it is difficult to differentiate multiple system atrophy from Parkinson’s. The similar symptoms that present in both the diseases include, tremors, rigidity and slowing of movements, incoordination and lack of balance, speech problems with difficulty speaking, orthostatic hypotension leading to spells of lightheadedness and fainting especially from seated position to standing position, bladder problems including both urinary urgency and urinary hesitancy and difficulty emptying bladder.
Signs And Symptoms Of Multiple System Atrophy
Multiple system atrophy is classified under two categories based on the presenting symptoms at the time of evaluation. These include:
MSA-P or parkinsonian type. It consists of primary characters of Parkinson’s disease, such as slow, shuffling gait, stiffness of muscles, and mild tremors, along with imbalance, incoordination and autonomic nervous system dysfunction.3
The progression of multiple system atrophy symptoms is usually rapid and eventually requires walking assistance such as cane, walker or wheelchair, within years of initiation of symptoms as compared to Parkinson’s in which the progression is slow.
Diagnosis Of Multiple System Atrophy
The diagnosis of multiple system atrophy poses a challenge because there is no specific test to diagnose the condition. Parkinsonism can be confused with Parkinson’s disease, whereas cerebellar ataxia can be confused with different forms of cerebellar ataxia, acquired or inherited. A definitive diagnosis can only be made on autopsy to find the characteristic pattern of degeneration. A probable diagnosis is made based on the exhibiting autonomic failure with either parkinsonism or cerebellar ataxia.
Autonomic system testing can be done, such as assessing for orthostatic hypotension, polysomnogram for sleep apnea, along with neurological examination, neuroimaging, including PET scan or MRI and DaTscan. MRI can help in identifying changes that may help rule out other causes or suggest multiple system atrophy. PET is used to check for metabolic functioning in specific parts of brain. DaTscan helps in assessing whether the disease is caused by dopamine system disorder, although the test is insufficient in differentiating between MSA and Parkinson’s disease.
Levodopa is usually used for the treatment of Parkinson’s as it is caused due to decrease in dopamine levels. However, levodopa when given to patients with multiple system atrophy do not benefit from it, although may transiently see improvement with it. Long term improvement is not seen with it in patients with MSA as the disease progresses, which can help in differentiating multiple system atrophy from Parkinson’s disease. Another differentiating feature is that MSA progression is rapid than Parkinson’s.
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