What Causes Death In Multiple System Atrophy Patients?

Multiple system atrophy is a rare neurological disease characterized by degeneration of the autonomic nervous system.1 These degenerative changes appear in the nerve fibers located in the brain and spinal cord. These changes are similar to those that appear in the brain in Parkinson’s disease. Its causes are not clearly understood. It affects people at the age above 50 years. Its symptoms include low blood pressure, abnormal heart rate, loss of muscle coordination, balance and many more. This disease can progress to life-threatening consequences and can cause sudden death.

What Causes Death In Multiple System Atrophy Patients?

Multiple system atrophy is a rare disease that represents symptoms similar to Parkinson’s disease.2 It is a degenerative disease that slowly damages the autonomic nervous system. The autonomic nervous system is responsible to control various involuntary functions such as blood pressure, bladder function, breathing, and muscle control. It affects men and women equally belonging to all racial groups. The symptoms of multiple system atrophy represent itself in the age of 50 years that progress to life-threatening consequences in 5-10 years. In the late stages, it may lead to significant loss of motor function and limitation of the movement. It may result in pneumonia, respiratory and cardiac failure leading to death.

The prognosis of multiple system atrophy is not good. With the progress of this disease, the physical and motor functions deteriorate with time. It affects the life expectancy of the patient. Patient is likely to survive only 7 to 9 years after diagnosis. It has been reported that sudden death is quite common in the patients of multiple system atrophy. In research studies, it is found that most patients with MSA may die suddenly at night during sleep even in the early stages. Nocturnal sudden death is the common cause of death in multiple system atrophy patients. The causes of death in multiple system atrophy are-

Cardiopulmonary Arrest– due to the failure of the autonomic nervous system, brainstem cannot send impulses for the basic functions of the heart and respiratory system. This leads to cardiac arrest during sleep in multiple system atrophy resulting in sudden death in sleep.

Aspiration Pneumonia– brainstem lesions may develop due to autonomic dysfunction. It may lead to dysfunction of the lungs. Pneumonia may develop due to aspiration of foodstuffs that may cause sudden death. It happens due to passive narrowing or paralysis of glottis that prevent the movement of food into the lungs.

Acute Aspiration– asphyxia may happen due to aspiration of vomitus soon after vomiting.3 It may cause gagging and sudden death. It is also associated with stridor and acute airway obstruction i.e. blockage in the air passage.

Infectious Pneumonia– the respiratory system is more prone to catch infections in multiple system atrophy. Recurrent infections may cause complications in the respiratory system resulting in sudden death.

Sleep-Related Breathing Difficulties– sleep apnea can cause the production of harsh vibrating sound. It may lead to difficulties in breathing. It may cause sudden death during sleep.

Wasting Syndrome– wasting syndrome is represented by the loss of weight and muscle wasting occurring slowly in the body. It may lead to sudden death in multiple system atrophy. Wasting of muscles is significant in the end stage of the disease.

Urinary Tract Dysfunction– urinary tract dysfunction especially dysfunction of the lower part is common in MSA patients. It leads to urinary urgency or urinary incontinence resulting in frequent urinary tract infections. It has been reported in some cases of multiple system atrophy that recurrent urinary infections may result in many complications leading to death.

Conclusion

Multiple system atrophy is a rare neurological disorder that may progressively lead to the failure of the autonomic system. It affects motor functions of various parts of the body. It may lead to failure of the heart, lungs, and brain suddenly usually in sleep. It may lead to sudden death. The causes of sudden death at night can be a cardiopulmonary arrest, acute aspiration, sleep apnea, and others discussed above.

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