Physical, occupational, and speech therapy are also important pillars of treatment to address many of the symptoms and challenges faced by people living with MSA, such as speaking, swallowing, balance, and daily activity performance. Home safety evaluations performed by trained physical and occupational therapists are extremely useful to help prevent falls and to recommend adaptive equipment such as grab bars, shower chairs, walkers, or wheelchairs.
Does the deep brain stimulation that is done for Parkinson’ s disease work for MSA? There have been only relatively small case series as examples of people with MSA undergoing deep brain stimulation surgery, or DBS. Only very few people with MSA who received DBS( because they were misdiagnosed as having Parkinson’ s disease) had any symptomatic improvement, and in all of those cases, the benefits were very brief. In many cases, people with MSA who underwent DBS noticed worsening of their symptoms after implantation. For these reasons, DBS is not recommended for MSA.
What is happening in the brain and spinal cord cells to cause MSA? The direct cause of MSA is not fully understood. However, we do know that it has to do with the clumps of alpha-synuclein protein. Alpha-synuclein is a protein that is normally produced in the brain. In MSA, the alpha-synuclein seems to become abnormally folded, which causes it to stick together, and become stuck inside the cell. The areas of the brain that have cells with alpha-synuclein inside of them exhibit impaired neuron function and neuronal death.
One theory of the cause of MSA is that the clumps of misfolded alpha-synuclein are toxic to the brain. There is evidence of higher levels of inflammation in the brains of people with MSA, though it remains unclear whether this is a cause of the disease or a side effect of the disease process. There are also theories related to how MSA spreads through the brain. These include the idea that the diseased cells in the brain have a faulty mechanism for getting rid of waste materials, leading to cell deterioration as well as buildup of waste products such as alphasynuclein, or that the abnormally folded alpha-synuclein protein itself“ infects” other cells.
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The same protein, alpha-synuclein, also accumulates in the brain cells in Parkinson’ s disease, but in a different pattern. In Parkinson’ s disease, the accumulation of this protein is in the neurons, which are electrically active cells, primarily in the part of the brain that produces the chemical dopamine, which helps to control movement and coordination. In MSA, the alphasynuclein accumulation and cell loss appear to mainly impact the glial cells, which are the electrically inactive supporting cells of the brain, in addition to the neurons. It is unknown why the alpha-synuclein accumulates differently in these two conditions.
Why is it called“ multiple system atrophy”? Most brain disorders affect more than one set of circuits or areas of the brain, so why does MSA deserve the term“ multiple”? It’ s because it was once three different diseases. The cerebellar type of MSA( MSA-C) used to be known as olivopontocerebellar atrophy( OPCA); the parkinsonian subtype( MSA-P) was called striatonigral degeneration( SND); and MSA with disproportion-