Current Treatment of Multiple System Atrophy

Treatment of patients with multiple system atrophy (MSA) is complex and purely symptomatic to date. No disease-modifying treatment is available so far, leaving a survival time of usually less than 10 years after diagnosis is made. Clinically, two forms of movement disorders characterize this disease, either a hypokinetic rigid parkinsonian movement disorder in MSA of the parkinsonian type or ataxia in MSA of the cerebellar type. In both variants of the disease, autonomic symptoms are mandatory for establishing the diagnosis of MSA. While hypokinetic rigid symptoms of patients with MSA of the parkinsonian type can respond to some extent to dopaminergic treatment, no effective symptomatic treatment for the cerebellar symptoms is available so far. Particular attention should be paid to autonomic symptoms, as these symptoms are known to strongly affect the patients' quality of life. Here, we discuss the current state of the art in MSA treatment.