Multiple System Atrophy

Multiple System Atrophy (MSA) is a rare, progressive neurological condition that affects:

• Movement and balance
• Coordination
• Automatic (autonomic) functions such as blood pressure, bladder and bowel control

MSA can look similar to Parkinson’s disease but usually progresses more quickly and causes more severe autonomic symptoms. There is no cure, but specialist rehabilitation can help maintain function, safety and quality of life.

At The Royal Buckinghamshire Hospital, we provide inpatient neurorehabilitation for adults with neurological conditions.

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Symptoms of Multiple System Atrophy

Symptoms vary between individuals and may change over time.

Movement and balance

• Slowness and stiffness of movement
• Shuffling or unsteady walking
• Poor balance and frequent falls
• Reduced arm swing and difficulty with fine hand movements

Autonomic symptoms

• Dizziness or fainting on standing (low blood pressure)
• Urinary urgency, frequency, difficulty emptying or incontinence
• Constipation and occasional bowel incontinence
• Erectile dysfunction and reduced libido
• Changes in sweating and temperature control

Speech, swallowing and breathing

• Quiet, slurred or monotone speech
• Hoarse or strained voice
• Swallowing difficulties, with coughing or choking on food or drink
• Noisy or disturbed breathing at night

Fatigue, sleep disturbance, pain, muscle cramps and changes in mood are also common.

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How is MSA diagnosed?

There is no single test for MSA. Diagnosis is usually made by a neurologist or movement disorder specialist based on:

• Clinical history and examination
• Brain imaging (commonly MRI) to look for characteristic changes and exclude other causes
• Blood pressure and autonomic testing
• Additional tests, such as blood tests, bladder investigations or sleep studies, if needed

Early in the disease, MSA can be difficult to distinguish from Parkinson’s disease and other atypical parkinsonian syndromes. The diagnosis often becomes clearer as symptoms and treatment responses are monitored over time.

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Treatment and management

Although MSA is not curable, many symptoms can be managed.

Medication

• Parkinson’s medications (e.g. levodopa) may give limited benefit for stiffness and slowness
• Medicines and lifestyle measures to support blood pressure
• Treatments for bladder, bowel and sleep problems
• Medication for pain, mood or anxiety if required

Medication plans need careful review because people with MSA can be sensitive to side effects and blood pressure changes.

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Rehabilitation at The Royal Buckinghamshire Hospital

Our specialist multidisciplinary team (MDT) works together to help people with MSA maximise independence and comfort.

Multidisciplinary team

Your rehabilitation programme may involve:

• Consultants in Rehabilitation Medicine and Neurology
• Specialist rehabilitation doctors and nurses
• Physiotherapists
• Occupational therapists
• Speech and language therapists
• Neuropsychologists
• Dietitians and other allied health professionals

Physiotherapy

• Gait and balance training to reduce falls
• Strength and mobility exercises
• Advice on safe transfers and use of walking aids and equipment

Occupational therapy

• Support with everyday activities such as washing, dressing and toileting
• Assessment for equipment and home adaptations
• Wheelchair and seating assessments
• Education on energy conservation and pacing

Speech and language therapy

• Assessment and management of speech and voice changes
• Swallowing assessments and strategies to reduce choking risk
• Advice on modified food and fluid textures where appropriate
• Communication support if speech becomes more difficult

Nutrition, psychology and family support

• Dietetic advice to maintain nutrition and hydration
• Help with weight loss, constipation or swallowing-related issues
• Psychological support with adjustment, coping and mood
• Education and support for family members and carers

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Who may benefit from inpatient rehabilitation?

Admission to The Royal Buckinghamshire Hospital may be suitable for adults with confirmed or suspected MSA who have:

• Reduced mobility or frequent falls
• Significant balance or coordination problems
• Complex bladder, bowel or autonomic symptoms affecting independence
• New or worsening speech and swallowing difficulties
• Increased care needs following a hospital stay or health setback

We accept referrals from neurologists, rehabilitation consultants, GPs, hospitals, case managers and solicitors.

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Referrals and further information

To discuss a potential referral for Multiple System Atrophy rehabilitation or to find out more about our services:

• Visit our Neurological Rehabilitation and Inpatient Rehabilitation pages

Early access to a specialist multidisciplinary team can help people living with MSA, and those who support them, plan ahead and maintain the best possible quality of life.