Thanks to Jesse Fitzpatrick for presenting a great case of a 75 yo M with h/o HTN, BPH and numerous falls at home, ultimately diagnosed with Multiple Systems Atrophy (MSA.)
- Key Points
- Fatal neurodegenerative dz – progressive autonomic failure, parkinsonian features, and cerebellar/pyramidal features
- onset usually in 60s
- mean survival is 6-10yrs
- Natural History of MSA
- No effective dz-modifying or neuroprotective tx is available currently
- For Motor Sx – PT, Botox injections (for focal dystonia), speech therapy & assessing dysphagia, CPAP/BiPAP/tracheostomy
- Levodopa & Dopaminergic Tx – generally diagnostic, and can trial on it therapeutically (but sustained/effective response in the long term is rarely observed in patients w/ MSA)
- Orthostatic Hypotension – 1st line fludrocortisone, 2nd line alpha-1 adrenoreceptor agonists (ephedrine, pseudo ephedrine, phenylephrine, midodrine); also behavior modifications!
- Depression – common problem in MSA; pharmacotherapy AND support groups!
- See UpToDate for more specific treatments for other manifestations
- Multiple System Atrophy – NEJM 2015