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What is MSA? Why am I examined for it?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hi doctor,

I have a balancing problem. I have low blood pressure in change of posture. I am on Midodrine. During a neurological examination, I was asked to tap my toes. Every time when I did that my heel involuntarily tapped several times. What is the reason? I am being examined for possible MSA.

Answered by Dr. Muhammad Majid Hanif

Education:

MBBS

Professional Bio:

Dr.Muhammad Majid Hanif is a highly skilled and established physician in the field of Cardiology. He listens to all the patient queries deliberately and is an expert in devising a proper treatment plan.

This doctor is not available for online consultations on the platform anymore.

Hi,

Welcome to icliniq.com.

I have thoroughly gone through your case and can well understand your genuine health concerns. I feel really sorry for the balance problems you have. I pray for the best of your health ahead. Yes, you have many symptoms that point my finger too towards the diagnosis of MSA (multiple system atrophy) although definitive studies are needed. Your age, balance and gait issues and postural hypotension all that concludes initially towards MSA. Your physician was actually examining the signs of cerebellar dysfunction and myoclonus (muscle twitching). Let me explain you the pathological meanings of MSA to understand more about your neurologist's intentions and your heel's presentation in doctor's office. MSA is a disease of old age. There is degeneration of neurons in brain that cause problem in relaying information passing to and from the brain and all those electrical circuits in brain's certain areas. Naming the areas of brain affected will be irrelevant here. But, it is worth mentioning that it is related to body's balance and gait controlling areas; areas that cause to keep our blood pressure normal in limits when we stand up and lie on the bed. The way your doctor tested you, he was finding the involuntary muscle contractions (specifically a group of muscles). This is then called MSA-C where C means cerebellar predominant. It is to differentiate diagnosis from MSA-P where P stands for Parkinsonism predominant type. You are taking Midodrine that is used to control postural hypotension. It means you have postural hypotension too, and this is also a feature of MSA. I need to ask some questions to assist you and prepare you more regarding knowledge about your disease, so that you may not be blank when you visit your doctor next time. You can discuss some important things with him. Please spare some time to answer few of my queries. Do you have ever felt tapping in head, palpitation or racing heart when you lie in your bed? Do you have diabetes? Are you on any medications? Have you felt dizzy and lightheaded ever after taking a meal? Have you ever felt tremors in hands, muscle rigidity and any change in your handwriting? Do you have sleep apnea diagnosed ever? Or I may ask do you get up from deep sleep due to lack of respiration and shortness of breath? Do you have observed hoarseness of voice along with these gait problems?

Answered by
Medically reviewed by Dr. Sneha Kannan
Published At January 18, 2016
Reviewed At July 24, 2025

Education:

MBBS

Professional Bio:

Dr.Muhammad Majid Hanif is a highly skilled and established physician in the field of Cardiology. He listens to all the patient queries deliberately and is an expert in devising a proper treatment plan.

This doctor is not available for online consultations on the platform anymore.

Education:

BDS

Professional Bio:

Dr. Sneha Kannan is a skilled Dental Surgeon with expertise in providing general dental care, including scaling, fillings, and preventive treatments. She does oral surgery procedures such as extractions and minor surgical interventions. She does procedures in restorative dentistry, including crowns, bridges, and dentures. She is an expert in doing endodontic treatments such as root canal therapy. She is well-versed in doing procedures in cosmetic dentistry, including teeth whitening and smile correction. She can provide pediatric dental care for children’s oral health and preventive treatments. She promotes oral hygiene awareness and preventive dental practices.  

This doctor is not available for online consultations on the platform anymore.

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Dr. Muhammad Majid Hanif

Cardiology

Education:

MBBS

Professional Bio:

Dr.Muhammad Majid Hanif is a highly skilled and established physician in the field of Cardiology. He listens to all the patient queries deliberately and is an expert in devising a proper treatment plan.

This doctor is not available for online consultations on the platform anymore.

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