Course Description:

Multiple system atrophy (MSA) is a rare progressive neurodegenerative disease that causes parkinsonism and cerebellar, pyramidal, autonomic, and urological dysfunction in any combination. The clinical presentation is variable, but two forms of the disease are recognized: a predominantly parkinsonian form (MSA-p) and a predominantly cerebellar form (MSA-c). The parkinsonian features can include tremor, rigidity, bradykinesia, and postural instability, and the cerebellar features can include ataxia and nystagmus. Orthostatic hypotension is usually present and can cause dizziness and falls. Onset of MSA is typically in late middle age. The cause is unknown. It tends to advance rapidly, with progressive loss of motor skills, eventual confinement to bed, and death. There is no remission from the disease and no established interventional therapy. Physical therapy focuses on control of orthostatic hypotension, maintaining ROM and mobility, preventing secondary complications, and optimizing functional ability. MSA-p might be difficult to differentiate from idiopathic Parkinson’s disease (PD). Many patients with pathological evidence of MSA had a clinical diagnosis of PD at one time.