RESEARCH: The symptomatic treatment of multiple system atrophy.

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Eur J Neurol 2002 May;9(3):195-9

The symptomatic treatment of multiple system atrophy.

Colosimo C, Pezzella FR.

Dipartimento di Scienze Neurologiche, Universita La Sapienza, Rome, Italy.

Multiple system atrophy (MSA) is a neurodegenerative disease of undetermined

aetiology that occurs sporadically and manifests itself as a combination of

parkinsonian, autonomic, cerebellar and pyramidal signs. Despite the lack of

any effective therapy to reverse this condition, some of the symptoms may

be, at least temporarily, improved with adequate symptomatic therapies.

Medical treatment is largely aimed at mitigating the parkinsonian and

autonomic features. The therapeutic results of levodopa therapy in cases of

MSA are difficult to interpret because of their variability. Nevertheless,

the statement that patients with MSA are non or poorly levodopa-responsive

is misleading. Clinical and pathologically proven series document about

40-60% levodopa efficacy in patients with MSA presenting with predominant

parkinsonian features. Unfortunately, other antiparkinsonian compounds

(dopamine agonists, amantadine) are not more effective than levodopa.

Orthostatic hypotension (OH) can be suspected from the patient's history and

subsequently documented in the clinic by measuring lying and standing blood

pressure. The diagnosis ideally should be confirmed in the laboratory with

additional tests to determine the cause and evaluate the functional deficit,

so as to aid treatment. A variety of pharmacological agents with different

mechanisms of action have been used in MSA to reduce OH when this is

symptomatic. OH can also be alleviated by avoiding aggravating factors, such

as the effects of food, micturition, exposure to a warm environment and

physiological diurnal changes and by using other non-pharmacological

strategies. The treatment of the very common genito-urinary symptoms

(incontinence, retention, impotence) should also be considered in order to

improve the quality of life of these patients.

PMID: 11985626 [PubMed - in process]