A neurodegenerative condition
Multiple system atrophy (MSA) is a progressive brain condition that affects movement and balance, and body functions that are usually automatic, such as blood pressure, bladder function and digestion.
Symptoms often begin with a combination of slowness and stiffness, poor coordination or light-headedness on standing. The condition tends to progress faster than Parkinson’s disease.
Types of multiple system atrophy
Multiple system atrophy involves damage across several connected brain regions. There are two recognised subtypes, defined by which symptoms are most prominent at onset:
- MSA-parkinsonian type (MSA-P) – slowness, stiffness and reduced coordination are the main early features, resembling Parkinson’s disease but with a more limited response to Parkinson’s medication
- MSA-cerebellar type (MSA-C) – unsteady, uncoordinated movements (ataxia), particularly affecting walking, balance and sometimes speech, are the main early features.
Both subtypes share prominent automatic (autonomic body function) symptoms, which can include:
- bladder problems, such as urgency or difficulty emptying the bladder
- changes in sweating or temperature regulation
- constipation
- erectile dysfunction
- light-headedness or fainting on standing (due to a drop in blood pressure).
Over time, MSA typically affects:
- bladder and bowel function
- blood pressure regulation, particularly on standing
- movement, balance and coordination
- sleep, including vivid dreams with movement during sleep
- speech and swallowing.
What happens in the brain?
Multiple system atrophy is associated with a build-up of abnormal alpha-synuclein protein inside support cells of the brain (glial cells), a process that leads to progressive damage in areas controlling movement, coordination and autonomic function, including the basal ganglia, cerebellum and brainstem. Because MSA affects the same protein (alpha-synuclein) as Parkinson’s disease, the two conditions are grouped as ‘synucleinopathies’, even though the pattern and pace of brain involvement differ.
What increases the risk of multiple system atrophy?
MSA is rare and its exact cause isn’t fully understood, but several factors are associated with increased likelihood of developing it.
Factors that can’t be changed include:
- age – MSA typically develops in people in their 50s and 60s, and risk increases with age
- genetics – most cases occur sporadically, without a family history. Specific inherited genetic causes are rare, though research into genetic contributions is ongoing.
- sex – some studies suggest a slightly higher rate in men than women, though this isn’t fully established.
Factors that may play a role, with less well-established evidence than for conditions like vascular dementia or Alzheimer’s disease, include:
- environmental exposures – some research has explored potential links to certain environmental toxins or occupational exposures, though no specific exposure has been confirmed as a clear cause
- general brain health – cardiovascular health and lifestyle factors have drawn some research interest as possible influences on symptom severity or progression, though this hasn’t been clearly established for MSA specifically.
Common patient questions
No. MSA can resemble Parkinson’s disease, particularly the MSA-parkinsonian subtype, and both involve the same abnormal protein (alpha-synuclein). However, MSA usually:
- progresses faster
- involves more prominent automatic (autonomic) symptoms (such as blood pressure and bladder problems)
- responds poorly or only briefly to standard Parkinson’s medications.
Autonomic symptoms are a core feature of MSA and are usually present in some form, though the severity and timing can vary between people. Light-headedness on standing and bladder problems are particularly common.
No. MSA is not typically considered an inherited condition, and it usually occurs without a family history.
While there is currently no cure for MSA, care centres on managing individual symptoms and maintaining safety and quality of life, often through a multidisciplinary approach that can help patients feel supported and hopeful.