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.
Multiple system atrophy (MSA) is an orphan neurodegenerative disorder, characterized by the variable association of parkinsonism, autonomic failure, cerebellar and corticospinal symptoms [1]. Similar to patients with Parkinson's disease (PD) [2], [3], MSA patients frequently experience painful sensations.
MSA is one of a family of neurological disorders known as an atypical parkinsonian disorder. The initial symptoms can be difficult to distinguish from those of Parkinson's disease, and can include: Slowness of movement, tremor, or stiffness. Clumsiness or lack of coordination.
Appetite reduces and weight loss is apparent. Communication becomes too effortful and breathing more bubbly or shallow. Dying is very rarely a dramatic event. In the majority of cases it is an increasing winding down of all bodily functions and everything stopping, death occurring in a peaceful and dignified manner.
What are the symptoms of MSA? Most often, the first clinical symptom a patient will note will be lightheadedness, dizziness, and episodes of passing out, but the first symptoms in some patients may include difficulty initiating movement, body stiffness, urinary incontinence, and increased falls.
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. Previous studies showed that 69% to 100% of patients with MSA experience RBD.
Alongside the bladder difficulties, people with MSA also experience bowel difficulties.
Approximately 90 percent of individuals with MSA will experience parkinsonism symptoms including slowness of voluntary movements (bradykinesia), muscle stiffness (rigidity) which may make it difficult to bend the arms and/or legs, and impaired balance (postural instability).
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.
Deconditioning – having MSA means a greater effort is needed to be mobile, this can lead to deconditioning of the muscles and the cardiovascular system, which in turn can lead to fatigue.
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.
Several MRI abnormalities on conventional MRI already are included in the current diagnostic criteria for MSA along with abnormalities of functional neuroimaging, including 18F‐flurodeoxyglucose positron‐emission tomography (FDG‐PET) and presynaptic dopaminergic imaging.
In our study, we found that 6 MSA patients with pain improved their pain intensity through the use of dopaminergic medication, including levodopa and pramipexole.
Listen, listen, listen: Living with MSA can be very isolating. The family may be eager to talk about what they are going through so listening and showing empathy can be one of the most helpful things you can do. Or they may just want a light, fun evening with laughter. Pay attention to their cues and follow their lead.
People typically live about 7 to 10 years after multiple system atrophy symptoms first appear. However, the survival rate with MSA varies widely. Death is often due to respiratory problems, infections or blood clots in the lungs (pulmonary embolus).
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.
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.
Autonomic dysfunction may slow the normal, rhythmic movement of the digestive tract, known as peristalsis, resulting in bloating, decreased appetite, and constipation. Certain drugs also inhibit peristalsis.
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.
Ocular findings in MSA are less common but are less recognized. These include ophthalmoplegia, excessive square-wave jerks,blepharospasm, hypometria of saccades, impaired smooth pursuit movement, pupillary defects, nystagmus, and reduced vestibular-ocular reflex.
Autonomic Symptoms
Symptoms can include: Cold hands or feet and heat intolerance, because control of body temperature is impaired.
As already mentioned, individuals with MSA undergo motor and muscle degeneration as the disease progresses. Physiotherapists can help maintain muscle range of motion and tone by using passive range of motion in combination with an exercise program that includes resistance training and/or gait/balance training.
Our findings show that smoking history and/or heavy alcohol use is associated with younger age of onset in MSA but do not influence survival.
Inflammation in the nervous system occurs early in Parkinsonian conditions, accelerating the degeneration of dopamine-producing cells9. High levels of certain types of inflammatory molecules are often present in the early stages of MSA11.