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Parkinson’s Disease (PD) is an age-related disorder that primarily impairs the dopamine-producing neurons in a part of the brain, causing uncontrolled movements. If we compare Multiple System Atrophy and Parkinson’s Disease, they appear to be the same and while they can both affect the nerves, MSA can break down the myelin that surrounds and protects the nerves. Let’s take a deeper dig into understanding Multiple System Atrophy vs Parkinson’s disease.

Understanding Parkinson’s Disease

Parkinson’s Disease is a progressive motoric neurodegenerative disorder of the central nervous system (also known as the “Shaking Palsy”) that primarily affects muscle control and motor skills. Research suggests that the cause for this is a combination of genetic and environmental factors. While there aren’t any medical tests to conclusively confirm a definitive cure for Parkinson’s disease, the diagnosis is generally based on one’s symptoms, medical history, and a detailed physical examination. Parkinson Rehabilitation includes Amplitude Training, reciprocal movement patterns, balancing, stretching, and strength training. Additionally, here are some Exercises for Parkinson Disease. 

Understanding MSA

Multiple system atrophy is an atypical parkinsonian syndrome that shares a number of similarities with PD. In fact, Multiple System Atrophy-Parkinsonian type (MSA-P) is a rare condition that causes symptoms similar to Parkinson disease. Both MSA and Parkinson’s disease are degenerative diseases of the nervous system that affect movement and start to worsen over time. Overall, the early signs and symptoms are more or less similar, so it can sometimes be difficult to tell them apart, especially in the early stages. However, as MSA further progresses, it is likely to affect multiple neurologic systems, thereby leading to autonomic dysfunction, parkinsonism and/or cerebellar dysfunction

Clinical features and symptoms of MSA

While the severity of MSA worsens, the range of symptoms also vary dramatically. It is important to note that people with MSA typically have a set of symptoms of parkinsonism, such as slowness, stiffness, tremor, and problems with walking and balance that are also present in PD. They can also have dysfunction in the cerebellar system, namely, the brain system that controls accuracy of movements. Due to the variability of symptoms, MSA is often divided into two major categories: MSA-P (parkinsonian type) and MSA-C (cerebellar type). 

All the people with MSA surely have autonomic failure, or dysfunction in neurologic systems that control the automatic processes of the body such as blood pressure, urination, sweating, and bowel function. In fact, about one half of people with MSA-P have lost most of their motor skills within 5 years of onset of the disease.

Here are some of the symptoms of MSA:

  • Tremors and rigidity
  • Difficulty with movements in balance and walking
  • Muscle aches and pains, and stiffness
  • Mask-like appearance of the face, while staring
  • Difficulty chewing or swallowing (occasionally), not able to close the mouth
  • Disrupted sleep patterns 
  • Dizziness or fainting when standing up or after standing still
  • Erection problems
  • Loss of control over bowels or bladder
  • Problems with activities that require fine motor skills
  • Loss of sweating in any part of the body
  • Decline in mental function
  • Nausea and problems with digestion
  • Posture problems, such as unstable, stooped, or slumped over
  • Changes in vision, voice, and speech

Multiple System Atrophy vs Parkinson’s disease

In general, both diseases progress differently in different people. It can be challenging to differentiate between MSA vs Parkinson’s, given that MSA can manifest with mild parkinsonism and autonomic dysfunction, early in the course of the illness. 

People with MSA-P are known to have widespread damage to the part of the nervous system that controls important functions such as the heart rate, blood pressure, and sweating. However, if we have to pinpoint one difference between Parkinson’s and MSA, it would be the fact that, even though both of them seem to have some connection with environmental contaminants, the key difference continues to be that the nerve destruction in Parkinson’s tends to occur in the areas of the brain that control movement, whereas MSA affects the autonomic nervous system. That said, people normally tend to develop MSA in their 50s and 60s, and the disease often progresses faster than it does with Parkinson’s, which often emerges after the age of 60. 

MSA Treatments

The possible treatments for MSA usually focus on controlling symptoms and maximizing the quality of life. One promising approach for MSA is Stem Cell Therapy. Proven to be extremely effective, it can help to improve a person’s symptoms and slow down the progression of the disease. Stem cells are immature cells that are capable of developing into many different cell types. Mesenchymal stem cells (MSCs) are derived from the bone marrow and are used to treat several diseases, including some neurodegenerative disorders. Growth factors secreted by MSCs have been shown to protect nerve cells against MSA, conferring resistance to the MSA disease process, and also stimulating the regeneration of nerve cells.

Occupational therapy adds value to the lives of people with MSA by improving self-perceived performance in daily activities. Occupational therapy aims to make day to day life easier by increasing knowledge around symptom management and by supporting decisions around the choice and timing of equipment, home adaptations and care until the end of life.

There are other courses of treatment similar to PD as well:

  • Parkinsonism: Physical therapy (PT) can be vital to maximize functions
  • Orthostatic hypotension can be treated in the same ways that it is treated when it is a symptom of PD. These measures include:
  • Implementing dietary changes to increase fluid and salt intake 
  • Avoiding foods that lower blood pressure  
  • Changing head position slowly to allow more time for blood pressure to adapt
  • Elevating the head of the bed at night
  • Wearing compression stockings or an abdominal binder
  • Urinary dysfunction can also be treated (as with PD) by strengthening the muscles that control the bladder through PT and pelvic floor exercises, and occasionally using medications for an overactive bladder. 
  • Bowel dysfunction can also be treated (as with PD) by optimizing the diet so that it helps with constipation, exercising, and daily activity. 
  • Speech and swallow difficulties can be improved by implementing the relevant therapy.

FAQs

What is MSA disease?

MSA is a rare neurodegenerative disorder without too many known treatments in slowing down or stopping the disease progression. It is characterized by poor levodopa-responsive Parkinsonism, cerebellar ataxia, pyramidal signs and autonomic failure in any combination.

Is MSA a Parkinson’s disease?

Multiple System Atrophy-Parkinsonian type (MSA-P) is surely the type, yes. On the whole, MSA is often mistaken for Parkinson’s, as it tends to present similar initial symptoms. Many patients are diagnosed with Parkinson’s disease first, but over time, the extent, severity, and type of symptoms change, making a diagnosis of MSA more likely.

What is the difference between PSP and MSA?

Multiple System Atrophy (MSA) and Progressive Supranuclear Palsy (PSP) are sporadic, atypical parkinsonian disorders, wherein the nerve destruction in PSP tends to occur in the areas of the brain that control movement, whereas MSA affects the autonomic nervous system. 

What are the first signs of multiple systems atrophy?

Most often, the first clinical symptom a patient will note will be lightheadedness, dizziness, and episodes of passing out, however, the first symptoms in some patients may include difficulty initiating movement, body stiffness, urinary incontinence, and increased falls.

Can MSA be misdiagnosed?

Its symptoms often mimic those of Parkinson’s disease and ataxia, so the chances of MSA being misdiagnosed are quite high. However, the symptoms can be managed, which is why it’s important to be evaluated and treated by physicians who have experience dealing with MSA.

What are the two types of atrophy?

Muscle atrophy (the wasting or thinning of muscle mass) has three types: physiologic, pathologic, and neurogenic.

In a nutshell, even though Parkinson’s Disease and MSA, are both characterized by deposits of alpha-synuclein in the nervous system, and b

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oth these conditions specifically affect cells that produce dopamine thereby causing many of the same motor dysfunctions, PD and MSA affect people very differently. Often, these diseases don’t even progress to advanced stages. However, it is always helpful to do your research and know about the various symptoms and treatments, to know what to expect and lead fulfilling lives.

Reference links

https://parkinsonsdisease.net/answers/multiple-system-atrophy-vs-pd

https://www.apdaparkinson.org/article/planning-for-the-what-ifs-multiple-system-atrophy/

https://jnnp.bmj.com/content/73/5/51

Dr Na'eem Sadiq is a respected stem cell specialist at Plexus, and a prominent neurologist in Bangalore. He studied neurology and clinical neurophysiology in London, and worked with some of the most prestigious medical institutions in England, and the Middle East. He completed his MBBS at Bellary Government Medical College, and a postgraduate degree in psychiatry from NIMHANS in Bangalore.

Dr Na'eem has perfected his knowledge and expertise in Continuing medical education (CME), and training in tissue culture, Stem Cell Therapy, and neurology. Dr Na'eem Sadiq possesses an undying passion to improve people’s lives. This led to the creation of Plexus, a neuro and Stem Cell Research centre in Bangalore in neurosurgery, and neurorehabilitation.