What are the treatment options and prognosis of multiple system atrophy (MSA)?

Updated: Sep 24, 2018
  • Author: Stephen M Bloomfield, MD; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Patients who develop MSA are routinely faced with a progressive disorder that eventually culminates in disability and death. Median survival in a study of 100 patients was 6.2 years, with a range of 0.5-24 years. Patients with the cerebellar subtype of MSA survived longer. Response to drug therapy is poor. The ataxia is particularly resistant to therapy. Levodopa replacement is the mainstay of therapy for the parkinsonian features (see carbidopa/levodopa). Responses tend to be less clear-cut and may be transient. Dopamine agonists are not effective and are more likely to cause hallucinations and psychosis. Blepharospasm and limb dystonia can be reduced with botulinum toxin injections.

Autonomic dysfunction, especially orthostatic hypotension, is a prominent feature of the disease. Initial treatment includes reduction of antihypertensive agents, increased salt and water intake, abdominal binders, and use of elastic stockings. Fludrocortisone and midodrine can be helpful when other measures fail. Other medications for treatment of orthostatic hypotension include droxidopa and pyridostigmine. [16]


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