Types & Symptoms of MSA

MSA is broken down into two main subtypes based on the predominant symptom: MSA-predominant Parkinsonism (MSA-P), and MSA-predominant cerebellar ataxia (MSA-C). A patient diagnosed with MSA-P may over time appear to have MSA-C and vice versa, so these categorizations are not always set in stone.


MSA-P is more common than MSA-C. The most common symptoms seen with MSA-P are those that are more similar to Parkinson’s disease, hence the designation. These symptoms may include slowness or difficulty moving, increased falls due to walking problems associated with shuffling of gait, resting tremor, rigidity, slurred speech, voice changes, drooling, difficulty swallowing, and lack of facial expression. The tremor usually disappears when the patient is moving and is more prominent at rest, thus the term “resting tremor.”

In the early stages, this form of MSA may respond to medications used for Parkinson’s disease; however, MSA-P tends to progress more rapidly than Parkinsonism. As patients pass through the initial stages, they no longer respond to Parkinson’s medications. Individual variation with regard to the course of the disease varies widely. Some MSA-P patients require assistance with daily activities as early as 5 years after diagnosis and others are able to remain independent for as long as 20 years.



MSA-C patients present with symptoms that affect the cerebellum, which plays a role in synchronizing motor movement. As a result of the disease, people with MSA-C have difficulty coordinating walking, hand movements, speech, and eye movements. Sometimes they look intoxicated without having had an alcoholic beverage, so it can be useful to carry a medical card should anyone ask.


Dysautonomia (dysfunction of the autonomic nervous system) in MSA leads to problems regulating heart rate, blood pressure, breathing, digestion, and other internal organ functions. Patients may become dizzy or faint when they sit up or stand up – a condition known as neurogenic orthostatic hypotension (NOH). Conversely, blood pressure may be excessively high when lying down. Loss of bladder or bowel control, constipation, abnormal sweating, difficulty with heat, sexual impotence in men, and sleep disturbances as mentioned above are also a result of dysautonomia.

Depression, anxiety, panic attacks, and suicidal ideation may present in MSA. Some patients express inappropriate laughing or crying. Cognitive impairment, particularly seen in executive function, may occur in up to 75% of patients. Dementia is thought to be rare in MSA but may affect 12% to 18% of patients.