Multiple system atrophy is a progressive disorder of the nervous system.1 It leads to degeneration of the parts of the brain and spinal cord with time. It was formerly known as the Shy-Drager syndrome. It also has many symptoms similar to Parkinson’s disease such as slow movements of the body, tensed muscles with rigid body parts and difficulty in maintaining balance. The body’s voluntary activities are affected due to the involvement of the autonomic nervous system.
Prevention Of Multiple System Atrophy
Multiple system atrophy cannot be prevented, but only progresses with time. It can be controlled with medications and lifestyle changes, but at present there is no cure for multiple system atrophy. The condition progresses with time and ultimately leads to death. It affects multiple parts of the body and the symptoms usually develop in the late 50s. The symptoms affecting the person will either be Parkinson’s type or cerebellar type. It mostly manifests as Parkinsonism’s type and lead to rigidity or stiffness of muscles and slow body movements that are poorly balanced and difficult to initiate. There will also be presence of tremors in some cases although in multiple system atrophy these are rare as compared to Parkinson’s disease. The person will have a stooped posture and he will have difficulty in standing in a position and will have jerky movements with loss of balance. The person will also walk with a shuffling gait and the normal movements of the arm while walking is lost. The person feels he is not able to make balance and has an unsteady appearance and falls while initiating activities that require instant movement. The limbs are jerky and it is difficult to stand still in a certain posture without falling or making trembling movements. The person’s articulation is also disturbed and he is unable to speak clearly and the tone is changed to a higher pitch and his voice may be shaky.2
The cerebellar type will present as loss of coordination of movements and inability to maintain balance. He will walk with small irregular steps that are not properly spaced. Fine day to day activities are also affected like holding a pen, turning a door knob and reaching out for objects. The person will also have orthostatic hypotension as his blood pressure might abnormally decrease on standing because the autonomic nervous system is degenerated. It leads to malfunctioning of the internal body processes that are involuntary. Bladder dysfunction, urinary incontinence and erectile dysfunction in males are other symptoms associated with loss of involuntary movements.
Management Of Multiple System Atrophy
The diagnosis is made on the basis of the presenting symptoms. It is however difficult to differentiate it with Parkinsonism’s as they present with almost similar symptoms and with certain clinical examination and tests the physician can make a probable diagnosis then the disease progression is faster involving multiple systems. MRI of brain and scans showing lesions in the brain are positive towards the diagnosis of multiple system atrophy.
The treatment mainly is aimed at managing the symptoms and making the life easier for the patient since there is no cure for the disease. It cannot also be prevented but only progresses with time. Medications are used to treat Parkinson’s symptoms that include the combination of levodopa and carbidopa. They reduce symptoms of rigidity and stiffness in muscles. The bradykinesia is also resolved although not very effectively. These medications have shown different results in different patients and not everybody responds to the medication the same way. Pacemaker might be used to regulate the heartbeat. Difficulty in breathing due to stiffness of respiratory muscles can be controlled with surgical insertion of feeding tube or a gastrostomy tube that will pass the food directly into the stomach. For bladder dysfunction a sift tube catheter is permanently used to drain the bladder.
The doctors can recommend speech therapy and physical therapy to maintain the motor function when the disease progression is there. It can allow the person to lead a near normal life for the time being and help with the severe disability.
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