Multiple System Atrophy in the Elderly
February 28, 2013 Health

What is multiple system atrophy?

Multiple system atrophy is a rare condition leading to impaired neurological functions of the body characterized by a fall in blood pressure during standing, lightheadedness, fainting, impaired movement, abnormal speech and visual disturbance. It is a degenerative condition that usually affects older people, around 50 and 60 years. Men are more commonly affected in comparison to women. In most patients death usually occurs in 5 to 10 years after appearance of first symptom. Treatment options include drugs to stabilize blood pressure, swallowing or breathing problems and physical therapy to improve the quality of the life.

Types and Symptoms

As the name suggests the disease leads to different symptoms involving different organs of the body. There are two main types of multiple system atrophy depending upon the presenting symptoms. The common types are :

  • Parkinsonian types characterized by symptoms like Parkinson’s disease. These are rigidity and stiffness of the muscle of the arms and legs leading to impaired movement, slowness of movement (bradykinesia), involuntary movements of the fingers (tremor) although this symptom is more common in patients of Parkinson’s disease and abnormality in maintaining normal gait and balance.
  • Cerebellar type where poor muscle co-ordination is the principal symptom leading to unsteady gait, imbalance, slurring of speech (dysarthria), visual problems like blurring of vision, difficulty in focusing and painful swallowing or chewing.

Other symptoms common to all types of multiple system atrophy patients are fall in blood pressure during standing leading to dizziness, sudden blackouts and excessive rise in blood pressure during lying down. Some patients with multiple system atrophy may experience one or more of the following :

  • Impotence and loss of libido in males.
  • Inability to control bowel or bladder movements.
  • Decreased sweating.
  • Reduced production of tears and other body secretions.
  • Poor maintenance of normal body temperature leading to cold limbs and inability to tolerate heat.
  • Difficulty in passing stool (constipation).
  • Irregularity in heart beat.
  • Inability to control emotions leading to sudden emotional outburst.
  • Abnormal breathing during sleep and interrupted sleep.

The rate at which symptoms develop and progress varies from person to person but the symptoms never improve. Common complications are respiratory problems, injury due to unsteady gait and repeated falls, patients gradually become immobile leading to appearance of stress ulcer, weakening and ultimately paralysis of the vocal cords leading to speech and breathing problem, progressive difficulty in swallowing and ultimately the patient becomes so much incapacitated that they even cannot perform simple day to day activities like brushing of teeth or bathing. Death usually occurs due to respiratory failure.

Causes of Multiple System Atrophy

The exact cause of multiple system atrophy is not known but exposure to different environmental toxisn may play an important role. In multiple system atrophy the brain tissue gradually shrinks and becomes degenerated. This mainly affects the brainstem, cerebellum and the basal ganglia. Some researchers suggest that abnormal expression of the protein alpha-synuclein may be responsible for brain damage.

Treatment and Cure

There is no cure for multiple system atrophy, however, aim of treatment is to relieve the symptoms as much as possible to improve quality of life.
Treatment options include drugs to :

  • Stabilize the low blood pressure.
  • Anti-parkinsonian drugs like levodopa to treat rigidity and stiffness of the muscles.
  • Implanting a pacemaker to ensure normal beating of heart.
  • Improve bladder function.
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