Multiple System Atrophy: Difference between revisions
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== Definition/Description<br> == | == Definition/Description<br> == | ||
Multiple System Atrophy (MSA) is defined as a sporadic, progressive, neurodegenerative adult-onset disorder that can affect the autonomic system, basal ganglia causing parkinsonism, and/or cerebellum causing ataxia in any combination.(Lundy-Eckman)<ref name="Lundy Eckman">Lundy-Eckman, L. Neuroscience: Fundamentals for Rehabilitation. 3rd ed. St. Louis: Saunders Elsevier, 2002.</ref> | Multiple System Atrophy (MSA) is defined as a sporadic, progressive, neurodegenerative adult-onset disorder that can affect the autonomic system, basal ganglia causing parkinsonism, and/or cerebellum causing ataxia in any combination.(Lundy-Eckman)<ref name="Lundy Eckman">Lundy-Eckman, L. Neuroscience: Fundamentals for Rehabilitation. 3rd ed. St. Louis: Saunders Elsevier, 2002.</ref> | ||
This disorder is called Multiple System Atrophy, because there is a combination of symptoms arising from each system just mentioned (autonomic system, basal gangila, and cerebellum). In order for a patient to be diagnosed with MSA, there have to be at least two systems involved. There can be any combination of symptoms present from the three systems. (Swan)<ref name="Swan">Swan L, Dupont J. Multiple System Atrophy. Journal of Physical Therapy 1999;79:488-94.</ref> | This disorder is called Multiple System Atrophy, because there is a combination of symptoms arising from each system just mentioned (autonomic system, basal gangila, and cerebellum). In order for a patient to be diagnosed with MSA, there have to be at least two systems involved. There can be any combination of symptoms present from the three systems. (Swan)<ref name="Swan">Swan L, Dupont J. Multiple System Atrophy. Journal of Physical Therapy 1999;79:488-94.</ref> | ||
*In MSA, patients often have symptoms that are characteristic of autonomic dysfunction, parkinsonism, or cerebellar dysfunction. As the disease progresses, additional symptoms emerge (Swan).<ref name="Swan" /> | *In MSA, patients often have symptoms that are characteristic of autonomic dysfunction, parkinsonism, or cerebellar dysfunction. As the disease progresses, additional symptoms emerge (Swan).<ref name="Swan" /> | ||
*Some patients may initially have autonomic features and may be diagnosed with pure autonomic failure. (Swan)<ref name="Swan" /><br>o Patients who are initially misdiagnosed with PAF may later be correctly diagnosed with MSA as the neurological symptoms of parkinsonism and/or cerebellar ataxia appear. (Swan).<ref name="Swan" /> | *Some patients may initially have autonomic features and may be diagnosed with pure autonomic failure. (Swan)<ref name="Swan" /><br>o Patients who are initially misdiagnosed with PAF may later be correctly diagnosed with MSA as the neurological symptoms of parkinsonism and/or cerebellar ataxia appear. (Swan).<ref name="Swan" /> | ||
There are three different categories or types of MSA, based upon what areas of the nervous system or autonomic system are affected and to what degree: | There are three different categories or types of MSA, based upon what areas of the nervous system or autonomic system are affected and to what degree: | ||
*Clinically, MSA is dominated by autonomic failure (MSA-A subtype) (also referred to as ''Shy Drager Syndrome''), which may be associated with either: | *Clinically, MSA is dominated by autonomic failure (MSA-A subtype) (also referred to as ''Shy Drager Syndrome''), which may be associated with either: | ||
*the movement dysfunction of parkinsonism (MSA-P subtype) (also referred to as ''Striatonigral degeneration'') in 80% of cases. 2,3 | *the movement dysfunction of parkinsonism (MSA-P subtype) (also referred to as ''Striatonigral degeneration'') in 80% of cases. 2,3<ref name="Wenning">Wenning GK, Braune S. Multiple System Atrophy: Pathophysiology and Management. CNS Drugs 2001;15:839-48.</ref>,<ref name="Wedge">Wedge F. The Impact of Resistance Training on Balance and Functional Ability of a Patient with Multiple System Atrophy. Journal of Geriatric Physical Therapy 2008;31:79-83.</ref> | ||
*or with cerebellar ataxia (MSA-C subtype) (also referred to as ''Sporadic Olivopontocerebellar atrophy OPCA''), which will result in difficulty with postural control and coordination in 20-50% of cases. 2,3,<ref name="Wenning" />,<ref name="Wedge" /> | *or with cerebellar ataxia (MSA-C subtype) (also referred to as ''Sporadic Olivopontocerebellar atrophy OPCA''), which will result in difficulty with postural control and coordination in 20-50% of cases. 2,3,<ref name="Wenning" />,<ref name="Wedge" /> | ||
Revision as of 22:54, 3 March 2010
Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.
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Definition/Description
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Multiple System Atrophy (MSA) is defined as a sporadic, progressive, neurodegenerative adult-onset disorder that can affect the autonomic system, basal ganglia causing parkinsonism, and/or cerebellum causing ataxia in any combination.(Lundy-Eckman)[1]
This disorder is called Multiple System Atrophy, because there is a combination of symptoms arising from each system just mentioned (autonomic system, basal gangila, and cerebellum). In order for a patient to be diagnosed with MSA, there have to be at least two systems involved. There can be any combination of symptoms present from the three systems. (Swan)[2]
- In MSA, patients often have symptoms that are characteristic of autonomic dysfunction, parkinsonism, or cerebellar dysfunction. As the disease progresses, additional symptoms emerge (Swan).[2]
- Some patients may initially have autonomic features and may be diagnosed with pure autonomic failure. (Swan)[2]
o Patients who are initially misdiagnosed with PAF may later be correctly diagnosed with MSA as the neurological symptoms of parkinsonism and/or cerebellar ataxia appear. (Swan).[2]
There are three different categories or types of MSA, based upon what areas of the nervous system or autonomic system are affected and to what degree:
- Clinically, MSA is dominated by autonomic failure (MSA-A subtype) (also referred to as Shy Drager Syndrome), which may be associated with either:
- the movement dysfunction of parkinsonism (MSA-P subtype) (also referred to as Striatonigral degeneration) in 80% of cases. 2,3[3],[4]
- or with cerebellar ataxia (MSA-C subtype) (also referred to as Sporadic Olivopontocerebellar atrophy OPCA), which will result in difficulty with postural control and coordination in 20-50% of cases. 2,3,[3],[4]
Prevalence[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
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Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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- ↑ Lundy-Eckman, L. Neuroscience: Fundamentals for Rehabilitation. 3rd ed. St. Louis: Saunders Elsevier, 2002.
- ↑ 2.0 2.1 2.2 2.3 Swan L, Dupont J. Multiple System Atrophy. Journal of Physical Therapy 1999;79:488-94.
- ↑ 3.0 3.1 Wenning GK, Braune S. Multiple System Atrophy: Pathophysiology and Management. CNS Drugs 2001;15:839-48.
- ↑ 4.0 4.1 Wedge F. The Impact of Resistance Training on Balance and Functional Ability of a Patient with Multiple System Atrophy. Journal of Geriatric Physical Therapy 2008;31:79-83.