1. Multiple System Atrophy Articel by Timothy C. Hain, MD Northwestern University Medical School, Chicago. http://www.neuro.nwu.edu/meded/MOVEMENT/msa.html

Multiple System Atrophy (MSA) Timothy C. Hain, MD Northwestern University Medical School, Chicago, USA Last update: 1/19/2001 This material is written primarily for medical students and neurology residents Please read our Multiple system atrophy is a rare neurological disorder characterized by a combination of parkinsonism, cerebellar and pyramidal signs, and autonomic dysfunction. The term "Multiple System Atrophy" is synonymous with striatonigral degeneration (SND) when Parkinsonism predominates, olivopontocerebellar atrophy (OPCA) when cerebellar signs predominate, and Shy-Drager syndrome when autonomic failure is dominant. The incidence (new case per 100,000 person years) for ages 50 to 99 years is 3.0 (Bower et al, 1997), or about half as frequent as progressive supranuclear palsy (PSP) . The mean age of onset is 54. The Parkinsonism of MSA is generally an akinetic rigid syndrome, similar to that of PSP . Rest tremor may occur but is not a predominant feature. Postural instability is common. Parkinsonism is generally the most common initial sign and eventually develops in about 90% of all patients. The cerebellar signs inlude finger-to-nose or heel-shin dysmetria, gait ataxia, intention tremor and nystagmus. Cerebellar signs are the first feature on only about 5% of patients. Cerebellar signs are observed in 50% of cases (Ben-Shlomo et al, 1997). Sporadic OPCA evolves into MSA in roughly 25% of cases within 5 years.

2. N.P.F. / The Parkinson Report VOLUME XIX ISSUE 2 / Spring 1998. multiple system atrophy. By Between 25,000 and 100,000 American have multiple system atrophy. However http://www.parkinson.org/atrophy.htm

VOLUME XIX - ISSUE 2 / Spring 1998 Multiple System Atrophy By members of the National Parkinson Foundation Center of Excellence at Vanderbilt University, including David A. Robertson, Director, Nathan S. Blaser Shy-Drager Research Laboratories; Thomas L. Davis, Director, Movement Disorder Clinic; and Ariel Y. Deutch, Director, NPF Center of Excellence A lthough the cause of idiopathic Parkinson’s disease is unknown, Parkinson’s disease is probably the best characterized of the neurodegenerative disorders. The loss of dopamine in the striatum is the major contributor to the disorder. However, there are several other neurodegenerative disorders involving several different systems in the brain, in which striatal dopamine loss is also found. Among these other neurodegenerative disorders is multiple system atrophy (MSA), in which degeneration in diverse brain regions leads to problems in the control of movement, balance, blood pressure, and sexual and urinary tract function. MSA is often accompanied by some striatal dopamine loss and in certain patients typical parkinsonian symptoms are either the first noted or the most prominent. A number of areas of the brain are involved by MSA. This has led to different varieties of MSA receiving different names, depending on which area of the brain has predominant involvement. When MSA begins with imbalance, incoordination, and difficulties in speaking (dysarthria), it is often called olivopontocerebellar atrophy; as the name suggests, this form of MSA is marked by degeneration in the cerebellum, a structure involved in balance and learned motor tasks. When a patient initially has rigidity (stiffness) and slowness in initiating movements (bradykinesia) that is out of proportion to tremor, this MSA form has been called striatonigral degeneration, involving communication between nerve cells in the striatum and midbrain. In patients in whom changes in autonomic function dominates the initial presentation, particularly changes in blood pressure regulation, the MSA form is often called Shy-Drager syndrome.

3. Autonomic Movement Disorders Program - Department Of Neurology - Mount Sinai Sch MSSM Home, multiple system atrophy. Multiple multiple system atrophy shares many of the signs and symptoms of Parkinson’s disease. Thus http://www.mssm.edu/neurology/autodis/disorders/msa/

Multiple system atrophy Multiple System Atrophy is a neurological disorder that begins in adult life and is characterized by parkinsonism, cerebellar ataxia, and autonomic dysfunction in various combinations. Cerebellar ataxia refers to impaired coordination and is caused by degeneration of the cerebellum. Autonomic dysfunction causes orthostatic hypotension (fall in blood pressure upon standing up) bladder and bowel dysfunction, and impotence. Literature on multiple system atrophy Multiple System Atrophy Hypertensive cardiovascular damage in patients with primary autonomic failure (note: Adobe acrobat is needed to read these files. You can download it here ... mssm home Questions? Contact the Web Development Office

4. The Parkinson's Institute Movement Disorders Short article on clinical presentation and treatment. http://www.parkinsonsinstitute.org/movement_disorders/multiple_system.html

Treatment Center PD Dystonia ET ... TS People with Multiple System Atrophy (MSA) can exhibit a wide variety of symptoms, including: postural instability, slowed movements, muscle rigidity, orthostatic hypotension (a fall in blood pressure when standing), and urinary and sexual problems. As the term "multiple system atrophy" implies, MSA can vary in its affect on the nervous system, resulting in a range of symptoms. Thus, MSA is generally separated into three main categories depending on the predominant symptoms. Pharmacological treatment is much the same as Parkinson's disease, although as the disease progresses the benefits of these drugs diminish and often complicate the autonomic dysfunction, particularly orthostatic hypotension (low blood pressure). Orthostatic hypotension is often treated with fludrocortisone (Florinef ), midodrine (ProAmatine), or other drugs that raise blood pressure. Male impotence may be treated with penile implants or drugs. Incontinence may be treated with medications or catheterization. Constipation may improve with increased dietary fiber or laxatives. A speech-language pathologist may be able to offer strategies for improving swallowing and speaking. Use of softer foods may improve the ability to swallow. A gastrostomy tube, which delivers foods directly to the stomach, may be required at some time during the course of the disease. [return to top]

5. WE MOVE - Multiple System Atrophy Symptoms, complications and treatment of MSA. http://www.wemove.org/msa.html

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6. MSA multiple system atrophy. Originally called the ShyDrager Syndrome this complex syndrome is currently referred to as multiple system atrophy or MSA. http://www.ndrf.org/MSA.htm

NDRF National Dysautonomia Research Foundation 1407 W Fourth Street, Suite 160, Red Wing, MN 55066-2108 Phone: (651) 267-0525 Fax: (651) 267-0524 Be sure to visit the NDRF Reference Page where you can learn more about the NDRF Patient Handbook, Videos and other reference materials. Multiple System Atrophy In 1960, two researchers, Dr. Milton Shy at the National Institutes of Health, and Dr. Glen Drager at Baylor College of Medicine in Houston, Texas, described a common set of neurological manifestations associated with autonomic failure. Originally called the "Shy-Drager Syndrome" this complex syndrome is currently referred to as "Multiple System Atrophy" or MSA. The American Autonomic Society has defined MSA in the following manner: "MSA is a sporadic, progressive, adult onset disorder characterized by autonomic dysfunction, Parkinsonism, and ataxia (a failure of muscular coordination) in any combination. The features of the disorder include: Parkinsonism Cerebellar or Corticospinal Signs Orthostatic Hypotension, Impotence, Urinary Incontinence or Retention, usually preceding or within two years after the onset of the motor symptoms

7. Multiple System Atrophy Horacio Kaufmann multiple system atrophy. Horacio KaufmannAlthough the precise definition of multiple. system atrophy (MSA) has been difficult, a. recent consensus in diagnostic criteria for. MSA has been achieved . http://www.mssm.edu/neurology/autodis/disorders/msa/msapaper.pdf

8. EMedicine - Multiple System Atrophy : Article By André Diedrich multiple system atrophy The concept of multiple system atrophy (MSA) as a unitary diagnosis encompassing several clinical syndromes has a long history (see Table 1).In 1996 and 1998, the A, Colosimo C, Lees AJ The clinical diagnosis of multiple system atrophy presenting as pure parkinsonism Aiba I, Yasuda T Cerebral atrophy in multiple system atrophy by MRI http://www.emedicine.com/neuro/topic671.htm

(advertisement) Home Specialties Resource Centers CME ... Patient Education Articles Images CME Patient Education Advanced Search Consumer Health Link to this site Back to: eMedicine Specialties Neurology Movement And Neurodegenerative Diseases Multiple System Atrophy Last Updated: January 16, 2002 Rate this Article Email to a Colleague AUTHOR INFORMATION Section 1 of 10 Author Information Introduction Clinical Differentials ... Bibliography Author: André Diedrich , Research Assistant Professor of Medicine, Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University School of Medicine Coauthor(s): David Robertson, MD , Director of Clinical Research, Professor, Departments of Internal Medicine, Pharmacology, and Neurology, Vanderbilt University André Diedrich, is a member of the following medical societies: American Autonomic Society , and American Heart Association Editor(s): Christopher C Luzzio, MD , Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison; Francisco Talavera, PharmD, PhD

9. NINDS Multiple System Atrophy Information Page Information sheet on multiple system atrophy compiled by NINDS. What is multiple system atrophy? Is there any treatment What is multiple system atrophy? multiple system atrophy (MSA) refers http://www.ninds.nih.gov/health_and_medical/disorders/msa.htm

National Institute of Neurological Disorders and Stroke Accessible version Science for the Brain The nation's leading supporter of biomedical research on disorders of the brain and nervous system Browse all disorders Browse all health organizations More about Multiple System Atrophy Studies with patients Research literature Press releases Search NINDS... (help) Contact us My privacy NINDS is part of the National Institutes of Health NINDS Multiple System Atrophy Information Page Reviewed 9-23-2003 Get Web page suited for printing Email this to a friend or colleague Table of Contents (click to jump to sections) What is Multiple System Atrophy? Is there any treatment? What is the prognosis? What research is being done? ... Related NINDS Publications and Information What is Multiple System Atrophy? Multiple system atrophy (MSA) refers to three slowly progressive related disorders that affect the central and autonomic nervous systems. The disorders are characterized by their foremost symptoms: olivopontocerebellar atrophy (OPCA), which primarily affects balance, coordination, and speech; a parkinsonian form (

10. European Multiple System Atrophy Study Group Study group for multiple system atrophy. http://www.emsa-sg.org

11. WE MOVE - Multiple System Atrophy multiple system atrophy (MSA) is a neurodegenerative disease marked by a combination of symptoms affecting movement, blood pressure, and other body functions http://www.wemove.org/msa/

WE MOVE 204 West 84th Street New York, NY 10024 Tel: 800-437-MOV2 Fax: 212-875-8389 E-mail: wemove@wemove.org Multiple System Atrophy Multiple System Atrophy Information for Patients and Caregivers (see table of contents below) Multiple System Atrophy Information for Medical Professionals at MDVU Multiple System Atrophy Information for Patients and Caregivers Table of Contents Overview of Multiple System Atrophy Symptoms and Complications of Multiple System Atrophy Treatment of Multiple System Atrophy Multiple System Atrophy Discussion Forum ... Additional Resources WE MOVE makes every effort to present medical information that is up-to-date and accurate. The material provided has undergone rigorous medical review. Information regarding the authors, editors, publisher, and medical reviewers of this material of the WE MOVE Web site is listed below. Medical science is constantly changing. Therefore, the authors, editors, and publisher do not warrant that the information in this text is complete, nor are they responsible for omissions or errors in the text or for the results of the use of this information. This information does not replace consultation with a physician. All medical procedures, drug doses, indications, and contraindications should be discussed with your personal physician. Medical Editor: Richard Robinson Medical Review: Horacio Kaufmann, MD; Niall Quinn, MD

12. WE MOVE - Treatment Of Multiple System Atrophy Treatment of multiple system atrophy. A number of drugs can be used to treat the various symptoms of MSA, although they become less http://www.wemove.org/msa/msa_tre.html

WE MOVE 204 West 84th Street New York, NY 10024 Tel: 800-437-MOV2 Fax: 212-875-8389 E-mail: wemove@wemove.org Treatment of Multiple System Atrophy A number of drugs can be used to treat the various symptoms of MSA, although they become less effective as the disease progresses. Levodopa and dopamine agonists used to treat Parkinson's disease are sometimes effective for the slowness and rigidity of MSA. Orthostatic hypotension can be improved with fludrocortisone, midodrine, or other drugs that raise blood pressure. Male impotence may be treated with penile implants or drugs. Incontinence may be treated with medications or catheterization. Constipation may improve with increased dietary fiber or laxatives. A speech-language pathologist may be able to offer strategies for improving swallowing and speaking. Use of softer foods may improve the ability to swallow. A gastrostomy tube, which delivers foods directly to the stomach, is occasionally needed later in the disease course. Additional Resources Our Mission Board of Directors Funders ... WE MOVE

13. Shy-Drager Syndrome (multiple system atrophy)A look at this disorder, its treatment, prognosis, research and organizations. http://www.ninds.nih.gov/health_and_medical/disorders/shydrger_doc.htm

14. Shy-Drager Syndrome multiple system atrophy with autonomic failure An article about this disorder giving an explanation, the types, treatment and prognosis. http://healthlink.mcw.edu/article/921961623.html

Search Articles: search tips Please Take the HealthLink Survey Email this article Print this article Find related articles: By topic: Neurology By keywords: Receive Health Link via email! Subscribe now >> Shy-Drager Syndrome Shy-Drager is often difficult totreat because of the fluctuations in blood pressure. The general treatment course is aimed at controlling symptoms. Anti-Parkinson medication, such as L-dopa, may be helpful but should be used with caution because it can lower blood pressure, causing blackouts. To relieve low blood pressure, dietary increases of salt and fluid may be beneficial. Medications to elevate blood pressure such as corticosteroids may cause side effects and should be carefully monitored by a physician. Alpha-adrenergic medications, metoclopramide, ergotamine derivatives, and indomethacin are useful in many cases. Sleeping in a head-up position at night may reduce headaches and morning dizziness. An artificial feeding tube or breathing tube may be surgically inserted for management of swallowing and breathing difficulties. In rare cases, a pacemaker may be implanted to correct heart irregularities. Shy-Drager usually ends in death 7 to 10 years after the onset of symptoms. Pneumonia is the most common cause of death, although irregularities in heart beat may be responsible for death in some patients.

15. Multisystem Atrophy - Neurologychannel Good article on MSA including MSA anatomy. http://neurologychannel.com/msa/

Home Search SiteMap Ask the Dr. ... Medical Store advertisement MULTISYSTEM ATROPHY Overview Anatomy of MSA Diagnosis Treatment CONDITIONS ADHD ALS Alzheimer's Disease Autism ... Carpal Tunnel Syndrome Cephalic Disorders Cerebral Palsy Charcot-Marie-Tooth Disease Chronic Pain Dementia Encephalitis Epilepsy ... Guillain-Barre Syndrome Headache Huntington's Disease Hydrocephalus Lou Gehrig's Disease ... Traumatic Brain Injury Vertigo TREATMENT OPTIONS Botulinum Toxin Therapy Epidural Injection Trigger Point Injection Vagus Nerve Stimulation RESOURCES neurologychannelMD Clinical Trials Links MDLocator ... What Is a Neurologist? Videos ABOUT US Healthcommunities.com Pressroom Testimonials Overview Multisystem atrophy (MSA) is a group of rare, multisystem degenerative diseases that have several clinical features of Parkinson’s and are sometimes referred to as the "Parkinsonism-plus syndromes." When MSA was first identified in 1960 it was named "Shy-Drager Syndrome" after the two physicians who first described its symptoms. Now, Shy-Drager Syndrome is recognized as only one of three manifestations of multisystem atrophy. The other two are Striatonigral Degeneration and Olivopontocerebellar Atrophy (OPCA) . The three are lumped together as MSA because of their clinical overlap and neuroanatomical similiarities. Multisystem atrophy has three cardinal features: Parkinsonism (see Parkinson’s Autonomic failure (including orthostatic hypotension

16. MedlinePlus Medical Encyclopedia: Multiple System Atrophy multiple system atrophy. Definition Return to top. multiple system atrophy is a degenerative disorder characterized by the following http://www.nlm.nih.gov/medlineplus/ency/article/000757.htm

@import url(http://www.nlm.nih.gov/medlineplus/images/advanced.css); Skip navigation Medical Encyclopedia Other encyclopedia topics: A-Ag Ah-Ap Aq-Az B-Bk ... Z Multiple system atrophy Contents of this page: Illustrations Alternative names Definition Causes, incidence, and risk factors ... Calling your health care provider Illustrations Central nervous system Alternative names Return to top Shy-Drager syndrome; Neurologic orthostatic hypotension; Shy-McGee-Drager syndrome; Parkinson's plus syndrome Definition Return to top Multiple system atrophy is a degenerative disorder characterized by the following: Progressive damage to the autonomic nervous system (the portion of the nervous system that controls involuntary functions such as blood pressure, heart rate, digestion, and sexual function) Muscle tremor and rigidity Slow movement Causes, incidence, and risk factors Return to top Multiple system atrophy (MSA) is a rare degenerative condition. Its symptoms are similar to those of Parkinson's disease in that patients may move slowly, be tremulous, and have a shuffling gait. However, in MSA there is more widespread neurologic damage and damage to the autonomic nervous system (the portion of the nervous system that controls involuntary functions). There is progressive degeneration of the nervous system, with damage to all parts of the nervous system, including the brain.

17. Medical Encyclopedia: Multiple System Atrophy (Print Version) Medical Encyclopedia multiple system atrophy. Definition. multiple system atrophy is a degenerative disorder characterized by the following http://www.nlm.nih.gov/medlineplus/print/ency/article/000757.htm

To print this page, use the print option from your browser. To close this window, click on the "x" in the upper right hand corner of the window. Medical Encyclopedia: Multiple system atrophy URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/000757.htm Alternative names Shy-Drager syndrome; Neurologic orthostatic hypotension; Shy-McGee-Drager syndrome; Parkinson's plus syndrome Definition Multiple system atrophy is a degenerative disorder characterized by the following: Progressive damage to the autonomic nervous system (the portion of the nervous system that controls involuntary functions such as blood pressure, heart rate, digestion, and sexual function) Muscle tremor and rigidity Slow movement Causes, incidence, and risk factors Multiple system atrophy (MSA) is a rare degenerative condition. Its symptoms are similar to those of Parkinson's disease in that patients may move slowly, be tremulous, and have a shuffling gait. However, in MSA there is more widespread neurologic damage and damage to the autonomic nervous system (the portion of the nervous system that controls involuntary functions). There is progressive degeneration of the nervous system, with damage to all parts of the nervous system, including the brain. The cause is unknown. MSA develops gradually and is most often diagnosed in men older than 60.

18. NORD - National Organization For Rare Disorders, Inc. General Discussion. multiple system atrophy (MSA) is a rare progressive neurological disorder characterized by a varying The exact cause of multiple system atrophy is unknown http://www.rarediseases.org/search/rdbdetail_abstract.html?disname=Multiple Syst

19. Multi System Atrophy And My Story, Multiple System Atrophy, Multisystem Atrophy multiple system atrophy, multisystem atrophy or Multi System Atrophy (MSA) is a neurological disorder marked by a combination of symptoms affecting movement http://msainfo.tripod.com/

var cm_role = "live" var cm_host = "tripod.lycos.com" var cm_taxid = "/memberembedded" Multi System Atrophy Shy Drager Syndrome Olivoponticerebellar Atrophy Striatal Nigral Degeneration ... Send Email Multi System Atrophy and My Story was designed to provide a better understanding of this rare disorder. Everyday someone asks me what Multi System Atrophy (or MSA or Multiple System Atrophy) is and it's hard to explain. In my case I started off with symptoms of Parkinson's Disease, which progressed more rapidly as the months went on. I left work on Long Term Disability in late July 2000 after being Diagnosed with PD (Parkinson's Disease) on February 20, 2000. The stage that many Parkinson's patients reach over many years I had managed to "achieve" in a short period of time. Even very few folks with PD understand MSA. Journal Page and click on the BLOG button I am constantly amazed at the number of people that visit this site. I am adding new information as I am physically able and as I find it. I have updated the

20. Vanderbilt University Autonomic Dysfunction Center - Multiple System Atrophy multiple system atrophy Introduction In multiple system atrophy, there is widespread autonomic failure associated with impairment http://www.mc.vanderbilt.edu/gcrc/adc/msa.html

Overview History Faculty Research ... Patient Information Multiple System Atrophy Introduction: In multiple system atrophy, there is widespread autonomic failure associated with impairment in other neurological systems. The other neurological systems may be cerebellar, extrapyramidal, neuromuscular, or pyramidal. The pathological hallmark of MSA is neuronal loss and gliosis within multiple sites in the brain. Clinical Manifestations: The average age of onset is in the sixth decade of life. Men are affected twice as frequently as women are. In some patients, chronic glial cytoplasmic inclusion has been found to occur intracellularly in both glial cells and neurons of involved portions of the brain. This has been seen in patients carrying the clinical diagnosis of Shy-Drager syndrome, sporadic oligopontocerebellar atrophy, striatonigral degeneration, and corticobasal degeneration. These inclusions contain ubiquitin , but are quite distinct from Lewy bodies , which also contain ubiquitin. The glial cytoplasmic inclusions tend to be irregular in outline in contrast to the target-shaped concentric circular Lewy bodies. Some investigators have suggested a relationship between the Shy-Drager syndrome and Parkinson's disease, although this is not supported by the pathologic data accumulated to date.

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