Multiple system atrophy (MSA) is a rare condition of the nervous system that causes gradual damage to nerve cells in the brain.

This affects balance, movement and the autonomic nervous system, which controls several basic functions, such as breathing, digestion and bladder control.

Symptoms of multiple system atrophy (MSA)

Symptoms of MSA usually start when someone is between 50 and 60 years of age, but they can begin at any time after 30.

The symptoms are wide-ranging and include muscle control problems, similar to those of Parkinson’s disease.

Many different functions of the body can be affected, including the urinary system, blood pressure control and muscle movement.

Although there are many different possible symptoms of MSA, not everyone who’s affected will have all of them.

Bladder problems

Men and women with MSA will usually have one or more of the following bladder symptoms:

• constantly feeling the need to pee
• peeing more frequently
• loss of bladder control
• unable to empty the bladder properly
• unable to pee
• erection problems

Men with MSA will usually have erectile dysfunction (the inability to get and maintain an erection), although this is a common problem that many men without the condition develop.

Low blood pressure when standing up

Someone with MSA will often feel lightheaded, dizzy and faint after standing up. This is known as postural hypotension and is caused by a drop in blood pressure when you stand up or suddenly change position.

When you stand up after lying down, your blood vessels usually narrow quickly and your heart rate increases slightly to prevent your blood pressure from dropping and decreasing blood flow to your brain.

This function is controlled by the autonomic nervous system. But with MSA, this system does not work properly, so the control is lost.

Problems with co-ordination, balance and speech

In MSA, a part of the brain called the cerebellum is damaged. This can make the person clumsy and unsteady when walking, and can also cause slurred speech.

These problems are collectively known as cerebellar ataxia.

Slowness of movement and feeling stiff

A person with MSA has much slower movements than normal (bradykinesia). This can make it difficult to carry out everyday tasks. Movement is hard to initiate, and the person will often have a distinctive slow, shuffling walk with very small steps.

Some people may also have stiff and tense muscles. This can make it even more difficult to move around and cause painful muscle cramps (dystonia).

These symptoms are typical of Parkinson’s disease but, unfortunately, the medicine used to relieve them in people with Parkinson’s disease (levodopa) is not very effective for people with MSA.

Other signs and symptoms

People with MSA may also have:

• shoulder pain and neck pain
• constipation
• cold hands and feet
• problems controlling sweating
• muscle weakness in the body and limbs – it may be more pronounced in one arm or leg
• uncontrollable laughing or crying
• sleep problems – insomnia, snoring, restless legs or nightmares
• noisy breathing and unintentional sighing
• a weak, quiet voice
• swallowing problems
• blurred vision
• depression
• dementia (although this is uncommon)

Causes of multiple system atrophy (MSA)

The causes of MSA are not well understood.

It does not appear to be inherited – there’s no evidence that an affected person’s children will develop it.

Research is looking at whether family history and the environment play a role in your chances of getting MSA.

The brain cells of a person with MSA contain a protein called alpha-synuclein. A build-up of abnormal alpha-synuclein is thought to be responsible for damaging areas of the brain that control balance, movement and the body’s normal functions.

Diagnosing multiple system atrophy (MSA)

There’s no specific test to diagnose MSA.