The second most common form of atypical parkinsonism is Multiple System Atrophy or MSA.  At one time MSA was also known as Shy-Drager Syndrome to acknowledge early contributions of two physicians; Dr. Milton Shy (National Institues of Health) and Dr. Glenn Drager (Baylor College of Medicine).
In terms of affecting particular parts of the brain, MSA is characterized by an abnormal accumulation of alpha-synuclein protein in brain cells (synucleinopathy) that affects the autonomic nervous system (the part of the nervous system that controls internal functions such as heartbeat, blood pressure, urination and digestion), substantia nigra and at times the cerebellum.

The Facts

  • Average onset is 50/60
  • Prevalence is 4 or 5/100,000

Symptoms Include

  • A significant drop in blood pressure when standing (postural hypotension) that can cause dizziness or fainting
  • Bowel and bladder issues
  • Parkinsonian symptoms including: slowness, stiffness, rigidity and balance issues
  • Speech and swallowing issues
  • Erectile dysfunction
  • Dry mouth and skin
  • Color and temperature changes in hands and feet



There is no specific medication to treat MSA directly, rather current treatment options focus on attending to the symptoms most prevalent (ie: blood pressure and bowel/bladder issues).  Some may find limited and/or temporary relief from levodopa when addressing Parkinsonian issues.


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