Diagnosing multiple system atrophy (MSA) can be complex. A confirmed diagnosis ranges from possible to probable MSA, depending on clinical and imaging criteria that highlight specific motor and autonomic failures. Treatment focuses on managing symptoms to improve quality of life, addressing severe autonomic issues like OH, urinary dysfunction, and constipation, along with motor symptoms. Management of MSA involves a multidisciplinary approach, coordinating care between tertiary centers and local providers to deliver continuous, integrated care. Since there is no cure, treatments aim for symptom relief through pharmacological means such as midodrine for OH and nonpharmacological methods like physical therapy for motor symptoms. Care also extends to sleep disorders, neurogenic bladder, and sexual dysfunction, which are significant aspects of the disease. As MSA advances, care becomes increasingly complex, requiring input from neurology, palliative care, and physical medicine specialists to maintain patient autonomy and manage evolving symptoms.

Reference: Coon EA, Ahlskog JE. My Treatment Approach to Multiple System Atrophy. Mayo Clin Proc. 2021 Mar;96(3):708-719. doi: 10.1016/j.mayocp.2020.10.005. PMID: 33673922.