How quickly does MSA progress in people with Parkinson’s?

Question

Hello doctor,

I have been managing Parkinson’s disease for a few years now, and while the tremors, stiffness, and slowness of movement are challenging, I have been trying to stay active and stick to my medications. However, I was recently diagnosed with multiple system atrophy (MSA), and I am feeling overwhelmed because I read that it is a rare and more aggressive condition that can mimic or overlap with Parkinson’s.

Lately, I have noticed my balance is getting worse, and I have started having issues with blood pressure drops when I stand up, along with some bladder control problems.

Are these signs of MSA progression?
How do we know which symptoms are due to Parkinson’s and which are from MSA?
Does this mean my treatment plan has to change completely?

I am also concerned about how fast this might progress and whether physical therapy or medications will still help. Should I be seeing a neurologist who specializes in atypical Parkinsonian disorders?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Multiple system atrophy (MSA) is a rare, degenerative neurological disorder that affects adults, typically in their 50s and 60s. It is characterized by a combination of Parkinsonism, autonomic nervous system dysfunction, and cerebellar symptoms. Early symptoms can include problems with movement, such as stiffness, slowness, or tremors, similar to Parkinson's disease. Other early signs can include dizziness or fainting due to low blood pressure (orthostatic hypotension), bladder problems, erectile dysfunction (in men), and difficulties with coordination and balance.

MSA and Parkinson's disease (PD) share some symptoms like tremors, slow movement, and balance problems, but MSA typically progresses much faster and includes more severe autonomic dysfunction (like bladder problems, dizziness when standing, and erectile dysfunction).

MSA also frequently involves cerebellar symptoms (like poor coordination) and may not respond well to Levodopa medication, which is a common treatment for PD.

It is a rapidly progressive neurodegenerative disorder with no known cure. It typically advances over five to ten years, leading to significant disability and, in most cases, death within six to ten years of symptom onset. While there is no treatment to stop or reverse the progression of MSA, physical therapy and medications can help manage some symptoms and improve quality of life.

Progression:

MSA is characterized by a rapid decline in motor skills and other bodily functions.
Many individuals with MSA-P (the Parkinsonian form) lose most of their motor skills within five years of symptom onset.

Response to physical therapy:

Physical therapy plays a crucial role in managing MSA symptoms and improving quality of life.
It can help maintain muscle mass, improve strength, and prevent further decline.
Early initiation of physical therapy is ideal, ideally before significant motor disturbances occur.
Therapy may focus on strengthening exercises, balance and gait training, and improving mobility.

Response to medications:

While there is no cure for MSA, some medications used for Parkinson's disease can provide temporary relief for certain symptoms.
Levodopa, a common Parkinson's medication, may help with symptoms like slow movement and rigidity in the early stages of MSA, but its effectiveness often diminishes as the disease progresses.
Other medications may be used to manage specific symptoms like low blood pressure, urinary problems, or sleep disorders.

It is important to note that MSA generally does not respond to medications as well as Parkinson's disease. So I think you should consult a neurologist for a physical examination and follow a further treatment plan according to their direction.

I hope this information helps you.

Thank you.