Multiple system atrophy (MSA) is a progressive neurological condition that affects movements and involuntary functions, such as blood pressure and digestion.

The first symptoms of MSA resemble those of Parkinson’s disease and may include a lack of coordination, stiffness, and tremors.

MSA onset typically occurs when a person is in their 50s, advancing quickly over the following 5–10 years. In its early stages, doctors may prescribe the Parkinson’s disease drug levodopa, but the benefits are usually temporary. However, medications are available to ease symptoms, such as sleep and bladder difficulties.

Keep reading to learn more about MSA, including the symptoms, causes, diagnosis, treatment, and life expectancy.

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MSA is a progressive condition that causes the death and loss of function of nerve cells in the brain. It affects parts of the brain that control movements, certain types of learning and memory, and emotions.

MSA also affects the autonomic nervous system, which regulates involuntary functions, such as digestion, temperature, and blood pressure.

People start with more prominent symptoms in one of the following areas, before the disease eventually causes symptoms in all of these areas:

  • balance and coordination
  • temors and stiffness
  • autonomic symptoms

This condition affects fewer than 50,000 individuals in the United States, making MSA relatively rare.

MSA symptoms usually begin during a person’s 50s. Initially, the symptoms may resemble those of Parkinson’s disease. They include:

The symptoms worsen quickly over the course of 5–10 years.

Other effects include:

  • a long-term shortening of tendons and muscles around joints, which limits their range of motion
  • anterocollis, which is when muscle contractions cause the neck to bend forwards
  • involuntary leaning to one side
  • sleep disorders, such as vivid dreams, restless leg syndrome, or sleep apnea
  • a tendency to act out dreams
  • depression or anxiety

In the later stages, swallowing difficulties develop, which can result in pneumonia.

Healthcare professionals do not know what causes MSA. Additionally, most cases occur at random, with no family history of the disease.

Despite the lack of knowledge about what causes it, researchers believe a combination of environmental and genetic factors may play a role in the condition’s development and progression.

Researchers have not identified a specific gene that causes MSA, but some gene variants with links to Parkinson’s disease, inflammation, and oxidative stress may raise the risk. Oxidative stress is an imbalance between antioxidants and unstable molecules known as free radicals, which can lead to tissue damage.

Currently, there is no definitive evidence of any environmental factors that may raise the risk of MSA.

Because MSA can be similar to Parkinson’s disease, diagnosing it can be challenging, particularly in the early stages.

To begin with, a doctor will ask about a person’s symptoms and may take their personal and family medical history. They may order tests, such as:

  • a neurological exam
  • bladder function assessment
  • autonomic tests, such as heart rate control and blood pressure
  • medical imaging, including:
    • an MRI to find changes that indicate MSA or to rule out other causes
    • a dopamine transporter to measure the distribution and activity of dopamine in the brain
    • a PET scan to observe metabolic function in certain brain areas

If the diagnosis is uncertain, a person’s response to Parkinson’s disease medications may reveal more, as people with MSA typically do not experience long-term benefits from them.

There is no cure for MSA, and medications do not slow or stop the progression of the condition. However, doctors may recommend the following treatments to reduce symptoms.


Medications for MSA include:

  • Levodopa: This Parkinson’s disease drug may help improve movement symptoms, but the benefits are often temporary.
  • Botox: Botox injections may reduce atypical muscle postures and contractions.
  • Medications for other symptoms: This could include drugs to improve sleep, reduce anxiety, improve bladder control, or regulate blood pressure.

Non-drug treatments

Other treatments that may help with MSA include:

  • Physical therapy: This may promote mobility and could help decrease muscle spasms, contractures, and atypical posture. Encouraging mobility is important for lowering the risk of a pulmonary embolism, which is a blood clot in an artery to the lungs.
  • Occupational therapy: This can help people learn new ways of doing daily tasks, such as eating and dressing, and can help adapt the home to make it more suitable for a person’s needs.
  • Strategies for lightheadedness and fainting: This may involve wearing compression stockings, drinking more water, eating more salt, and avoiding large meals.
  • Mobility devices: Sticks, walkers, wheelchairs, and other devices can help a person move independently for as long as possible.
  • Speech therapy: This may help with managing swallowing difficulties. Some individuals may also require nutritional support or a feeding tube so they can eat enough.

For most people with MSA, death occurs from complications of the disease within 6–10 years following symptom onset. Complications that may lead to death include:

  • pulmonary embolism
  • pneumonia
  • apnea
  • difficulties in regulating blood pressure
  • urinary infections, which can lead to sepsis

Coming to terms with an MSA diagnosis and experiencing its symptoms may be difficult, both for the person with MSA and their loved ones.

Anyone experiencing symptoms of anxiety or depression following their diagnosis may benefit from speaking with a therapist with experience supporting those with chronic conditions.

People may also find it helpful to join support groups and connect with others sharing their experiences. The following organizations can connect people to resources and support options:

Multiple system atrophy (MSA) is a rare, progressive condition that occurs when nerve cells in certain parts of the brain die or lose functionality. The initial symptoms are similar to Parkinson’s disease and can include tremors, muscle stiffness, and lack of coordination.

MSA also affects the autonomic nervous system, which can result in lightheadedness or fainting and difficulty with bladder control. Researchers do not know what causes it.

Levodopa may help with movement symptoms in the early stages of MSA. Medications and other therapies are available to help with other symptoms.