RE: MSA-C, OPCA

[Guest guest]

Hi ,

I understand your confusion as I've had to sort this out for myself.

OPCA is a term used to describe what is physically wrong in the brain...

olivoponto cerebellar atrophy... the olives, pons and cerebellum are all

parts of the brain ... atrophy means shrinking. There are many, many causes

of this shrinkage... for example alcoholism can cause this shrinkage,

multiple sclerosis can cause this shrinkage, stroke, vitamin deficiencies

etc etc.

Multiple System Atrophy is a term that attempts to group disorders that have

the same underlying cause... that cause appears to be Glial Cytoplasmic

Inclusions or GCI's. These are observed in the brains of people who have

died with MSA.. this is how they know (for sure) that some people who were

diagnosed with OPCA during their lifetime actually had MSA. Think of GCI as

a clump of protein in a brain cell. These clumps either cause the brain

cell to die or they form as a cell is dying... researchers aren't sure

exactly yet but know this is an important clue.

While a person is living a physician can really only tell a person whether

they think they have " Possible MSA " or " Probable MSA " ... with probable being

more certain than possible. Again, " Definite MSA " can only be diagnosed

with an autopsy. These criteria for the diagnosis of MSA can be found in

the article at http://www.emedicine.com/neuro/topic671.htm Perhaps if you

show that to your wife's doctor you can get more clarification of what

he/she believes is happening with her.

Dr. Gilman's research says that only 25% of people with some form of OPCA

actually have MSA. The other 75% then would not have GCI's in their brain

but something else is causing their olives, pons and cerebellum to

degenerate.

---

For a diagnosis of " Probable MSA " a patient has to demonstrate the

Criterion for autonomic failure and urinary dysfunction

plus

Poorly levodopa-responsive parkinsonism OR cerebellar dysfunction

---

Autonomic failure and urinary dysfunction includes the following symptoms:

- Orthostatic hypotension (low blood pressure when standing after 3 minutes)

- Urinary incontinence

- Incomplete bladder emptying

- Impotence

Cerebellar Dysfunction includes:

- Gait ataxia (Wide-based stance with steps of irregular length and

direction)

- Ataxic dysarthria (slurred speech)

- Limb ataxia (problems coordinating the limbs)

- Sustained gaze-evoked nystagmus (the eyes seem to jump around)

MSA-C is MSA with the cerebellar dysfunction (and the autonomic/urinary

dysfunction)

MSA-P is MSA with the parkinsonism (and the autonomic/urinary dysfunction)

For your wife to be considered " Probable MSA " she needs to have the

autonomic dysfunction PLUS the cerebellar dysfunction. If she doesn't have

the autonomic dysfunction she may only be considered " Possible MSA " at the

moment. If she has only cerebellar dysfunction then the term OPCA is likely

accurate but I gather her doctor may believe she at least has " Possible MSA "

since he's already mentioned the term MSA to you.

Feel free to ask more questions, I know this is a confusing topic.

Regards,

Pam

MSA-C, OPCA

>

>

> My wife (age 50) has been diagnosed with MSA-C, (Sporadic OPCA). She began

> developing gait and balance problems about 2 and a half years ago, and

> has

> had 18 months of tests , blood tests, MRI's and scans before the

> diagnosis.

> Until a few months ago, the primary symptom was only the balance and gait

> problems. It has now progressed to include slurred speech, rigidity in

> her

> right limbs, urinary incontinence and some occasional (but rare)

> swallowing

> problems. Has any study laid out a typical progression for this

> condition?

> What's next and when? As caregiver, what should I expect in 6 months , 1

> year, 3 years etc.? I can't find any patient group studies.