Commonly reported findings on iron‐sensitive MRIs from patients with MSA include iron deposition in subcortical structures, including the putamen (especially the posterior putamen), globus pallidus, caudate nucleus, substantia nigra, and thalamus, observed as hypointensity on T2* and SWI images.
Diagnosing MSA
Magnetic resonance imaging (MRI) may identify changes that suggest MSA or rule out other causes of the symptoms. Positron emission tomography (PET) scans can be used to monitor metabolic function in specific parts of the brain.
Conventional MRI may be useful for differentiating MSA from other mimic diseases. Olfactory function tests and autonomic function tests can provide important information for differentiating Lewy body disease from MSA, PSP, and CBD.
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.
MSA causes deterioration and shrinkage (atrophy) of portions of your brain (cerebellum, basal ganglia and brainstem) that affect internal body functions and motor control.
Its symptoms often mimic those of Parkinson's disease and ataxia. There is no cure, and many physicians are not familiar with the condition – meaning MSA is often misdiagnosed. However, symptoms can be managed, which is why it's important to be evaluated and treated by physicians who have experience dealing with MSA.
Red flags supporting the diagnosis of MSA include the following: Orofacial dystonia. Disproportionate antecollis. Severe anterior flexion of the spine (camptocormia)
MSA damages the nervous system. The disease tends to progress rapidly. About one half of people with MSA-P have lost most of their motor skills within 5 years of onset of the disease.
Sleep disorders in patients with MSA include rapid eye movement sleep behavior disorder (RBD), excessive daytime sleepiness (EDS), and nocturnal sleep disturbances.
The diagnostic accuracy was 71% in probable MSA and 60% in possible MSA. Correctly diagnosed patients with MSA had a younger age at onset and age at death than patients with PD or PSP, but duration of symptoms did not differ.
The first symptoms of MSA are frequently autonomic and may predate recognition of motor manifestations. Orthostatic hypotension and, in men, erectile failure are among the first symptoms that, when evaluated in the context of associated clinical findings, may facilitate accurate and earlier diagnosis.
At this time, there are no specific symptoms, blood tests or imaging studies that distinguish MSA. Instead, doctors rely on a combination of symptom history, physical examination, and laboratory tests to evaluate the motor system, coordination, and autonomic function to arrive at a probable diagnosis.
Multiple System Atrophy (MSA) is a rare neurodegenerative disorder that can cause a multitude of symptoms in any combination including impairments to balance, difficulty with movement, poor coordination, bladder dysfunction, sleep disturbances and poor blood pressure control.
The presence of α-syn within oligodendrocytes in the form of glial cytoplasmic inclusions is the diagnostic hallmark of MSA.
We found that 30 MSA patients (46.15%) suffered from pain. There was a trend towards a higher prevalence in MSA-P compared to MSA-C patients although the difference was not significant, which might be due to the small sample size. Few studies have investigated the pain mechanism in MSA patients.
The incidence of MSA is 3:100,000 in adults aged over 50 years, and the course of illness lasts 5 to 10 years. There are 2 known groups: MSA-P (parkinsonian) and MSA-C (cerebellar) that have clinical presentations associating them closely with more common movement disorders (eg, Parkinson's disease [PD] and ataxia).
Higher H-Y stage indicates a more severe neuromuscular state in MSA-P and is considered to be related to higher energy expenditure and decrease of BMI. Patients with MSA-P lose weight as the disease progresses.
This explains why some symptoms of MSA such as a tremor or speech difficulty can seem temporarily worse in stressful situations. Feeling anxious and worried is a familiar feeling for many people affected by MSA and it can easily become an unhelpful cycle.
Attention, execution, verbal and visual memory, verbal fluency, and new learning were impaired in patients with MSA. MSA-P had more impairment in motor and mental speed, working memory, executive functions, and focused attention compared to MSA-C.
MSA Life Expectancy (Prognosis)
Prognosis is currently guarded, with most MSA patients passing away from the disease or its complications within 6-10 years after the onset of symptoms.
The progression of MSA varies, but the condition does not go into remission. As the disorder progresses, daily activities become more difficult. Possible complications include: Breathing problems during sleep.
Alongside the bladder difficulties, people with MSA also experience bowel difficulties.
In MSA they can all go awry and produce a complicated picture of bladder problems – the need to go suddenly, feeling you need to go then can't, needing to go frequently, passing tiny amounts sometimes and large amounts other times, needing to get up frequently in the night etc.
In MSA there may be several stages -- alpha-synuclein accumulates in the oligodendroglial cells, then there is failure of mitochondrial function as well as loss of trophic factor support. Then the oligodendroglia degenerate, followed by microglia and astroglial activation. alpha-synuclein misfolds in MSA.
Though dementia is not considered a common characteristic of MSA, cognitive impairment occurs in some patients in the form of loss of verbal memory and verbal fluency1.