Managing MSA 

The cause of multiple system atrophy (MSA) remains unknown, and no current therapy can reverse or halt progression of the disease. The extra-pyramidal and cerebellar aspects of the disease are debilitating and difficult to treat.

Nonpharmacologic treatment

  • Constipation – A high-fiber diet, bulk laxative, lactulose, and suppositories can prevent constipation
  • Stridor- Speech therapy is often useful to improve swallowing and communication
  • Deconditioning- Physical therapy and an aquatic exercise program (hypotension does not occur while patients are in water) prevent physical deconditioning of the patient unless the movement disorder aspect of the illness so impairs balance that this is not advisable
  • Urinary incontinence – Intermittent self catheterization or suprapubic or urethral catheterization can improve symptoms of urinary incontinence
  • Falls – As the disease progresses, the risk of falls increases; proper gait instruction and precautions are critical to prevent falls and resultant injury

Pharmacologic treatment

Drug therapy is directed mainly toward alleviation of symptoms of the movement disorder and orthostatic hypotension. Urinary incontinence, constipation, erectile dysfunction, and supine hypertension can also be addressed through pharmacologic therapy.

Surgical care 

An atrial pacemaker may be used in patients with profound bradycardia in addition to orthostatic hypotension as a means of preventing the hypotension. However, this treatment is rarely undertaken and is rarely helpful. Consider tracheostomy with the utmost care for intermittent respiratory stridor. Cricopharyngeal myotomy or gastrostomy has been used in patients with severe dysphagia, but its value is uncertain.

Consultations 

Physical therapists, occupational therapists, speech therapists, psychologists, nutritionists and social workers can offer considerable practical help.

Diet

An essentially normal diet is recommended, with the following guidelines:
  • Increased salt and fluid intake maintains plasma volume
  • Small, frequent meals may help patients for whom postprandial hypotension is a significant problem
  • A high – fiber diet, bulk laxatives, and suppositories prevent constipation

Activity

Exercise of muscles of the lower extremities and abdomen, water aerobics at hip level (not swimming, as it causes polyuria), and postural training, in combination with drug therapy, are useful. Inpatient evaluation and tailoring of therapy are often important, However, if patients are restricted to bed rest, their functional mobility can decrease rapidly. Therefore, extensive physical therapy is strongly encouraged. [Reference: www.emedicine.medscape.com]