patient listening intently to her provider

What is multiple system atrophy?

Multiple system atrophy (MSA) is a rare, progressive neurological condition that affects the brain, interfering with how your brain communicates with the rest of your body. MSA also impacts the autonomic nervous system, which controls automatic bodily functions such as blood pressure regulation, digestion and urinary function.

Over time, MSA causes nerve cells in parts of the brain and spinal cord to break down and stop working. This leads to a range of symptoms that worsen over time.

MSA primarily affects two major systems in the body:

  • The central nervous system, which controls muscle movement, coordination and balance
  • The autonomic nervous system, which manages automatic functions like blood pressure, digestion, bladder control and breathing

Symptoms usually begin between the ages of 50 and 60, but the condition very rarely can develop in adults as young as 30. As the disease progresses, daily activities like walking, speaking and swallowing become increasingly difficult.

While there is no cure for MSA, treatments are available to help manage symptoms and improve quality of life. Early diagnosis and supportive care can make a meaningful difference.

Multiple system atrophy symptoms

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Multiple system atrophy (MSA) affects many different parts of the body. Symptoms usually appear in adulthood, typically between the ages of 50 and 60. The exact symptoms vary depending on the type of MSA, and they can worsen over time as the disease progresses.

There are two main types of MSA: parkinsonian and cerebellar. The type is determined by the specific symptoms that are most noticeable at the time of diagnosis.

Autonomic symptoms

In addition to the specific symptoms of each type, people with both types of MSA may experience other general symptoms, such as:

  • Problems with blood pressure (especially when standing up, leading to dizziness or fainting)
  • Urinary incontinence or frequent urination
  • Constipation and difficulty with bowel movements (fecal incontinence)
  • Breathing problems, such as difficulty with normal breathing during sleep and stridor (a harsh, high-pitched sound when breathing)
  • Sleep disturbances, including acting out dreams (REM Sleep behavior disorder) and sleep apnea

While everyone with MSA experiences some autonomic symptoms, not everyone with the condition develops all the symptoms. The severity of the symptoms and the speed of progression varies from person to person.

Parkinsonian type (MSA-P)

The parkinsonian type of MSA shares symptoms with Parkinson’s disease. It mainly affects movement, causing symptoms like:

  • Muscle stiffness
  • Slow movement (bradykinesia)
  • Tremors or shaking
  • Walking issues such as shuffling and walking with a stooped posture and difficulties with balance
  • Expressionless face (masked face)

This type can also involve autonomic symptoms, like low blood pressure when standing, urinary problems and difficulty swallowing. Parkinsonism is often the most prominent feature at the beginning of the condition, but other symptoms can develop as the disease progresses.

Cerebellar type (MSA-C)

The cerebellar type of MSA primarily affects coordination and balance. These symptoms include:

  • Lack of coordination (ataxia)
  • Difficulty with balance and frequent falls
  • Slurred speech (dysarthria)
  • Tremors (especially when performing tasks)
  • Trouble with fine motor skills, such as writing or buttoning a shirt

Like the parkinsonian type, the cerebellar form can also cause autonomic dysfunction. People with MSA-C may have trouble with digestion, blood pressure regulation and other automatic body functions.

When to see a doctor

If you notice early symptoms of multiple system atrophy, it’s important to talk to your primary care provider.

If you’ve already been diagnosed with Parkinson’s disease and your symptoms change, let your healthcare provider know. Follow-up visits are a chance to check how you’re doing, adjust medications, and address any new or worsening symptoms. Sometimes, people initially diagnosed with Parkinson’s may be re-diagnosed with MSA, especially if medications like levodopa don’t help as expected.

Mental health concerns, like depression or anxiety, are also common in MSA. If you’re experiencing emotional distress, talk to your healthcare provider. They can help with treatments or refer you to a specialist for mental health support.

couple taking in a health diagnosis

Multiple system atrophy causes

Experts don’t know exactly what causes multiple system atrophy, but they believe it’s connected to a protein called α-synuclein (alpha-synuclein) that can build up in different parts of the brain. This same protein is thought to play a role in the development of Parkinson’s disease.

Proteins are important for how your body works. They help different body systems communicate with each other, carry chemical compounds throughout the body, and more. But when proteins become damaged and build up in the wrong areas, they can become unhealthy and can lead cells to stop functioning properly. Experts believe this damage leads to the progressive breakdown of brain tissue in MSA.

Scientists are still trying to figure out why α-synuclein builds up in certain areas of the brain. They think it could be linked to genetic mutations that affect how some cells use this protein. There’s also some evidence that MSA-C may run in families. However, researchers haven’t found any strong genetic connection with MSA-P yet.

How is multiple system atrophy diagnosed?

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Diagnosing multiple system atrophy can be challenging because its symptoms often look like other neurological conditions, especially Parkinson’s disease. There is no single test that can confirm MSA, so doctors use a combination of tools to evaluate symptoms, rule out other conditions and monitor how the disease progresses over time.

If your primary care provider suspects MSA, they may refer you to a neurologist for further evaluation. A detailed medical history, physical exam and specialized testing can help support an accurate diagnosis.

Medical history and exam

A thorough medical history is an important first step in diagnosing multiple system atrophy. Your doctor will ask about when your symptoms started, how they’ve changed over time and whether you’ve experienced issues with movement, balance, blood pressure, bladder control or sleep.

You may also be asked about:

  • Motor symptoms like tremors, stiffness or falls
  • Autonomic symptoms such as dizziness when standing, urinary problems or constipation
  • Sleep issues, including acting out dreams or breathing problems at night
  • How well you’ve responded to Parkinson’s medications, if applicable
  • Any family history of neurological conditions

Your doctor will also do a physical and neurological exam to check your reflexes, coordination, muscle strength and balance. These findings help guide next steps and rule out other conditions.

Imaging tests

Brain imaging helps doctors look for patterns of brain damage that may be linked to MSA. These tests can also help rule out other causes of your symptoms.

Common imaging tests include:

  • Magnetic resonance imaging (MRI) scan: An MRI uses powerful magnets and radio waves to create detailed images of the brain. In people with MSA, an MRI may show signs of brain tissue shrinkage or specific changes in areas like the cerebellum or brainstem.
  • Positron emission tomography (PET) scan: A PET scan shows how different parts of the brain are functioning. It can help identify areas that aren’t using glucose or oxygen properly, which may suggest nerve cell damage.
  • Dopamine transporter scan (DaTscan): This scan can show whether you’re losing neurons in an area of the brain called the substantia nigra, which is sometimes related to multiple system atrophy.

Autonomic testing

Because MSA affects the autonomic nervous system, your doctor may run tests that measure how well your body regulates automatic functions. These can include:

  • Blood pressure testing when lying down and standing up
  • Heart rate variability testing
  • Sweat tests
  • Bladder function testing

These tests help identify problems like orthostatic hypotension (a sudden drop in blood pressure when standing), urinary difficulties or reduced ability to sweat—all common in MSA.

Skin biopsy

Since MSA leads to the buildup of α-synuclein in nerve cells, a skin biopsy test can be used to identify the presence of this protein in the nerves within the inner layers of the skin.

Genetic testing

Although most cases of MSA are not inherited, your doctor may consider genetic testing in certain situations. This is especially true if there’s a family history of neurological symptoms or if you’re diagnosed with MSA-C, which may have a genetic component. While there is currently no known gene that causes MSA, genetic testing can help rule out other conditions that may have similar symptoms.

Multiple system atrophy treatment

While there’s currently no cure for multiple system atrophy, treatment focuses on helping you manage symptoms and maintain the best possible quality of life. Because MSA affects different systems in the body, treatment plans are often personalized and may include medication, lifestyle changes and supportive therapies.

Working closely with your care team—which may include a neurologist, physical therapist, speech therapist and other specialists—can help you find strategies that make everyday life more manageable.

Lifestyle modifications

Simple lifestyle changes can make a big difference in managing some of the daily challenges of MSA. Your doctor may recommend:

  • Eating small, frequent meals to help with digestion and blood pressure regulation
  • Using extra pillows or an adjustable bed to ease breathing and prevent nighttime blood pressure drops
  • Wearing compression garments or using support stockings to help with blood pressure
  • Adding grab bars, ramps or mobility aids at home to reduce the risk of falls
  • Staying hydrated and eating fiber-rich foods to prevent constipation

Planning ahead and adjusting your routine as symptoms progress can help you stay as independent as possible.


Medication

Medications used for Parkinson’s disease may offer some relief for MSA symptoms, especially in the early stages. The most common option is levodopa, which helps boost dopamine levels in the brain to improve movement. However, the benefit is often temporary and not as effective for people with MSA as it is for those with Parkinson’s disease.

Other medications may be used to target specific symptoms, such as:

  • Medicines to help control bladder urgency or incontinence
  • Medications for sleep disturbances or acting out dreams
  • Drugs that support blood pressure if you experience lightheadedness or dizziness when standing

Your doctor will work with you to find the right combination of medications based on your symptoms and how they change over time.

Therapy

Supportive therapies can improve comfort, function and safety as symptoms progress. These therapies may include:

  • Physical therapy: Helps improve strength, posture and balance, and can reduce muscle stiffness or spasms
  • Occupational therapy: Teaches new ways to perform daily tasks, like dressing or bathing, to support independence
  • Speech therapy: Helps with speech clarity, swallowing and communication tools if speaking becomes difficult

Therapy plans are often adjusted as the condition changes. Ongoing support from rehabilitation specialists can help you adapt and maintain your daily activities for as long as possible.



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Baylor Scott & White Dallas Diagnostic Association - Garland (Satellite)

Baylor Scott & White Dallas Diagnostic Association - Garland (Satellite)

5220 W University Dr POB II, Ste 250, McKinney, TX, 75071
888.6 mi Directions
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Baylor Scott & White Neurology - McKinney

Baylor Scott & White Neurology - McKinney

5236 W University Dr Ste 3700, McKinney, TX, 75071
888.7 mi Directions
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Baylor Scott & White Medical Center - McKinney

Baylor Scott & White Medical Center - McKinney

5252 W University Dr Highway 380 at Lake Forest Drive, McKinney, TX, 75071
888.7 mi Directions
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Baylor Scott & White Medical Center - Lake Pointe

Baylor Scott & White Medical Center - Lake Pointe

6800 Scenic Dr , Rowlett, TX, 75088
892.9 mi Directions
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Baylor Scott & White Neurology - Lake Pointe

Baylor Scott & White Neurology - Lake Pointe

7600 Lakeview Pkwy Ste 150, Rowlett, TX, 75088
894.1 mi Directions
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Baylor Scott & White Medical Center - Frisco at PGA Parkway

Baylor Scott & White Medical Center - Frisco at PGA Parkway

7600 Better Way , Frisco, TX, 75033
895.5 mi Directions
Call 945.339.1000
Baylor Scott & White Medical Center - Centennial

Baylor Scott & White Medical Center - Centennial

12505 Lebanon Rd , Frisco, TX, 75035
897.2 mi Directions
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Baylor Scott & White Dallas Diagnostic Association - Garland

Baylor Scott & White Dallas Diagnostic Association - Garland

7217 Telecom Pkwy Ste 300, Garland, TX, 75044
897.5 mi Directions
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Baylor Scott & White Orthopedic Associates of Dallas - Sports Concussion Program at The Star

Baylor Scott & White Orthopedic Associates of Dallas - Sports Concussion Program at The Star

3800 Gaylord Pkwy Ste 810, Frisco, TX, 75034
900.0 mi Directions
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Baylor Scott & White Medical Center - Sunnyvale

Baylor Scott & White Medical Center - Sunnyvale

231 S Collins Rd , Sunnyvale, TX, 75182
901.5 mi Directions
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Baylor Scott & White - Plano Brain and Spine Center

Baylor Scott & White - Plano Brain and Spine Center

4708 Alliance Blvd Pavilion I, Ste 810, Plano, TX, 75093
902.2 mi Directions
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Baylor Scott & White Neuro-Oncology Associates - Plano

Baylor Scott & White Neuro-Oncology Associates - Plano

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Baylor Scott & White Neurology - Plano

Baylor Scott & White Neurology - Plano

4708 Alliance Blvd Pavilion I, Ste 550, Plano, TX, 75093
902.2 mi Directions
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Baylor Scott & White Dallas Diagnostic Association - Plano

Baylor Scott & White Dallas Diagnostic Association - Plano

4716 Alliance Blvd Pavilion II, Plano, TX, 75093
902.3 mi Directions
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Baylor Scott & White Medical Center - Plano

Baylor Scott & White Medical Center - Plano

4700 Alliance Blvd , Plano, TX, 75093
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Baylor Scott & White Neurology Hospitalist Group - Plano

Baylor Scott & White Neurology Hospitalist Group - Plano

4700 Alliance Blvd , Plano, TX, 75093
902.3 mi Directions
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The Headache Center at Baylor University Medical Center

The Headache Center at Baylor University Medical Center

9101 N Central Expy Ste 400, Dallas, TX, 75231
907.1 mi Directions
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Baylor Scott & White Diagnostic Imaging Center at North Dallas

Baylor Scott & White Diagnostic Imaging Center at North Dallas

9101 N Central Expy Ste 100, Dallas, TX, 75231
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Baylor Scott & White Neuroscience Center

Baylor Scott & White Neuroscience Center

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907.1 mi Directions
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Baylor Scott & White Cognitive and Behavioral Neurology Associates

Baylor Scott & White Cognitive and Behavioral Neurology Associates

9101 N Central Expy Ste 230, Dallas, TX, 75231
907.1 mi Directions
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Baylor Scott & White Headache Medicine Specialists of North Texas - Dallas

Baylor Scott & White Headache Medicine Specialists of North Texas - Dallas

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907.1 mi Directions
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Baylor Scott & White Institute for Rehabilitation - Dallas

Baylor Scott & White Institute for Rehabilitation - Dallas

909 N Washington Ave , Dallas, TX, 75246
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Baylor University Medical Center, part of Baylor Scott & White Health

Baylor University Medical Center, part of Baylor Scott & White Health

3500 Gaston Ave , Dallas, TX, 75246
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Baylor Scott & White Charles A. Sammons Cancer Center - Dallas

Baylor Scott & White Charles A. Sammons Cancer Center - Dallas

3410 Worth St , Dallas, TX, 75246
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Baylor Scott & White Neuro-Oncology Associates

Baylor Scott & White Neuro-Oncology Associates

3410 Worth St Ste 820, Dallas, TX, 75246
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Baylor Scott & White Neurology - Dallas

Baylor Scott & White Neurology - Dallas

3434 Swiss Ave Ste 400, Dallas, TX, 75204
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Baylor Scott & White Charles A. Sammons Cancer Center - Irving

Baylor Scott & White Charles A. Sammons Cancer Center - Irving

2001 N MacArthur Blvd Ste 120, Irving, TX, 75061
917.4 mi Directions
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Baylor Scott & White Medical Center - Irving

Baylor Scott & White Medical Center - Irving

1901 N MacArthur Blvd , Irving, TX, 75061
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Baylor Scott & White Neurology - Irving

Baylor Scott & White Neurology - Irving

2021 N MacArthur Blvd Ste 210, Irving, TX, 75061
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Baylor Scott & White Medical Center - Grapevine

Baylor Scott & White Medical Center - Grapevine

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Baylor Scott & White Medical Center - Waxahachie

Baylor Scott & White Medical Center - Waxahachie

2400 N Interstate 35E , Waxahachie, TX, 75165
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Baylor Scott & White All Saints Medical Center - Fort Worth

Baylor Scott & White All Saints Medical Center - Fort Worth

1400 8th Ave , Fort Worth, TX, 76104
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Baylor Scott & White McClinton Cancer Center - Waco

Baylor Scott & White McClinton Cancer Center - Waco

150 Hillcrest Medical Blvd , Waco, TX, 76712
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Baylor Scott & White Neurosciences Clinic - Waco

Baylor Scott & White Neurosciences Clinic - Waco

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Baylor Scott & White Medical Center - Hillcrest

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Baylor Scott & White Clinic - College Station Rock Prairie

Baylor Scott & White Clinic - College Station Rock Prairie

800 Scott and White Dr , College Station, TX, 77845
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Baylor Scott & White Cancer Center - College Station

Baylor Scott & White Cancer Center - College Station

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Baylor Scott & White Medical Center - College Station

Baylor Scott & White Medical Center - College Station

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Baylor Scott & White Medical Center - Temple

Baylor Scott & White Medical Center - Temple

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Baylor Scott & White Clinic - Temple

Baylor Scott & White Clinic - Temple

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1012.0 mi Directions
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Baylor Scott & White McLane Children's Medical Center - Temple

Baylor Scott & White McLane Children's Medical Center - Temple

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Baylor Scott & White McLane Children's Specialty Clinic - Temple

Baylor Scott & White McLane Children's Specialty Clinic - Temple

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Baylor Scott & White Medical Center - Brenham

Baylor Scott & White Medical Center - Brenham

700 Medical Pkwy , Brenham, TX, 77833
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Baylor Scott & White Specialty Clinic - Killeen Hemingway

Baylor Scott & White Specialty Clinic - Killeen Hemingway

2405 S Clear Creek Rd , Killeen, TX, 76549
1030.1 mi Directions
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Baylor Scott & White Medical Center - Taylor

Baylor Scott & White Medical Center - Taylor

305 Mallard Ln , Taylor, TX, 76574
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Baylor Scott & White Clinic - Round Rock 300 University

Baylor Scott & White Clinic - Round Rock 300 University

300A University Blvd , Round Rock, TX, 78665
1049.9 mi Directions
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Baylor Scott & White Medical Center - Round Rock

Baylor Scott & White Medical Center - Round Rock

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Baylor Scott & White Cancer Center - Round Rock

Baylor Scott & White Cancer Center - Round Rock

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Baylor Scott & White Clinic - Pflugerville Medical Center

Baylor Scott & White Clinic - Pflugerville Medical Center

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1051.1 mi Directions
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Baylor Scott & White Clinic - Pflugerville Medical Center Building 2

Baylor Scott & White Clinic - Pflugerville Medical Center Building 2

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When it comes to the care and treatment of multiple system atrophy, Baylor Scott & White offers several locations close to home, including neurology centers in North and Central Texas. From diagnosis to treatment plans personalized for you, we’re with you every step of the way.

Frequently Asked Questions

  • Is MSA the same as Parkinson's disease?

    No, multiple system atrophy is not the same as Parkinson’s disease. But symptoms of multiple system atrophy, including slow movement and stiffness, can be similar to those of Parkinson’s, especially in early stages.

  • Is multiple system atrophy hereditary?

    No. Scientists have not found any evidence that multiple system atrophy is a hereditary condition.

  • How long can you live with multiple system atrophy?

    Most people with multiple system atrophy live for six to 10 years. However, in less severe cases, some people live up to 15 years.

  • Can you exercise with multiple system atrophy?

    Yes. People with MSA can benefit from working with a physical therapist to help maintain mobility and improve posture.

  • Does multiple system atrophy cause pain?

    Yes, MSA can cause painful muscle cramps as well as pain in the shoulders and neck.