Multiple System Atrophy - Procedures, Side effects, Recovery time, Costs and alternatives

Multiple system atrophy is one of the rare diseases. This disease can be classified as a degenerative neurological disorder. Multiple system atrophy affects both the movement and autonomic nervous system (a part of the nervous system that is responsible for controlling the involuntary actions like digestion and blood pressure. The symptoms which are exhibited in this disease showcase a progressive loss of functions along with the death of certain nerve cells in the brain and spinal cord. Some of the symptoms of this disease are usually observed after the person has passed the age of 50 years.

The multiple system atrophy advances rapidly in the next 5 to 10 years after the appearance of initial symptoms. A few of the features of this disease are similar to that of Parkinson’s disease. Multiple system atrophy and Parkinson’s disease are difficult to differentiate as in the early stages multiple system atrophy exhibits similar symptoms to Parkinson’s disease. People that develop multiple system atrophy usually suffering pneumonia in their later stages and die suddenly either due to respiratory issues or cardiac issues. The reason or cause as to why a person suffers from multiple system atrophy is unknown.

The majority of the cases of patient suffering from multiple system atrophy are sporadic and any random person can suffer from this disease. Multiple system atrophy, a protein by the name of alpha-synuclein get accumulated in the glia. These deposits of the protein occur specifically in oligodendroglia whichis responsible for making myelin. It is very difficult to diagnose this disease as the symptoms of this disease are somewhat similar to those of Parkinson’s disease. However, a doctor prescribes some tests like bladder function assessment, autonomic testing, and PET or MRI scan for diagnosing multiple system atrophy. There is no permanent cure available for the multiple system atrophy. The treatment that is given in this disease is governed by the symptoms which are exhibited.

For treating the particular signs and symptom of the multiple system atrophy a doctor may recommend the following medications and therapies:

• Medicines for increasing the blood pressure: A doctor may prescribe corticosteroid fludrocortisone along with other medicines to increase the level of blood pressure in the patient.This medicine attains the desired result assisting the body in retaining more water and salt. A drug by the name of pyridostigmine is prescribed for increasing the blood pressure whilestanding without raising the blood pressure when the patient is lying down. A doctor may advise Midodrine but it must be used with caution as it suddenly increases the blood pressure evenwhen patients are lying down.
• Medicines for reducing signs and symptoms similar to Parkinson’s: For treating the symptoms similar to Parkinson’s a doctor may advise levodopa and carbidopa in combination which is generally used for treating Parkinson’s disease. The symptoms which this medicine treats are the slowness of movement, stiffness, and problems with balancing. These medicines usually enhancethe overall well-being of the patient. However, it is not a compulsion that every patient who is suffering from multiple system atrophy responds to the treatment given in Parkinson’s disease.
• Bladder problems: If a patient is experiencing problems associated with the bladder control then a doctor may advise medicines like Anticholinergic drugs for the initial management of the disease. However, as the disease of multiple system atrophy advances, these medicines would not work and the patient would need a catheter to be inserted permanently for draining the bladder.
• Pacemaker: A pacemaker would be implanted in the patient on the advice of the doctor for keeping the heart beats faster and improving the blood pressure.
• Sleeping problems: For treating the sleeping problem a doctor may prescribe medicines such as clonazepam.
• Mobility: For treating the mobility related problems in multiple system atrophy the doctor may advise physical therapy to the patient.
• Speech and swallowing: For treating the problem of speech and swallowing which may develop a doctor may prescribe speech therapy. However, as the disease would progress the patient would need a feeding tube.

• Tremors, rigidity, and slowness of movement.
• Bladder control disorder, for instance, urgent need to urinate or problem in emptying the bladder
.
• Impaired speech and voice quivering.
• Incoordination problem
• The problem of lightheadedness or fainting due to the occurrence of orthostatic hypotension.
• A patient may experience contractures in their limbs and hands.
• Sleep disorders like abnormal breathing at night.
• A patient may exhibit the bending forward of the neck and head dropping down also known as antecollis.

Doctors usually divide multiple system atrophy into two types the first one is known as Parkinsonian multiple system atrophy and other is called cerebellar multiple system atrophy. The patients belonging to either category of the condition are also eligible for the treatment.

The decision on deciding the eligibility or ineligibility of a patient for treatment is taken by the doctor. A person that is not suffering from the problem of multiple system atrophy is not eligible for the treatment. If a doctor mistakenly diagnoses a patient suffering from multiple system atrophy with Parkinson’s then that patient is also not eligible for treatment.

Side effects are a part of any treatment that is given to a patient irrespective of the treatment being oral, injectable or surgical. Every treatment has some minor side effects and some major side effects however; the occurrence of either minor or major side effect varies from patient to patient. Minor effects experienced usually goes away after sometime while if a serious side effect is experienced by any patient then the doctor is required to be informed quickly. A patient suffering from multiple system atrophy may exhibit some side effects of the treatment as well. The side effects associated with the use of corticosteroid are weight gain, glaucoma, and bruising.

The side effects of fludrocortisone are bloating, a headache, a spinning sensation, and mood changes. The side effects of pyridostigmine include muscle cramps, blurred vision, and increased sweating. The use of midodrine for treatment can cause goosebumps, nervousness, and stomach pain as the side effects. When a patient is given levodopa and carbidopa he/she may experience vomiting, uncontrolled shaking, and uncontrolled muscle movements like tongue movement. The side effects experienced by a patient while using anticholinergic drugs for bladder control are confusion, hallucination, and dry mouth. The side effects associated with the use of pacemaker includes swelling or bruising at the site of the implant, and infection at the implant site. If a patient has to undergo physical therapy then he/she may experience pain, fatigue, and muscle soreness as the side effects.

The post-treatment guidelines is a set of to-do list which is given by the doctor after the completion of the treatment so that a patient may have to suffer from the disease again in the future. But, in case of multiple system atrophy, a doctor may prescribe some self-care measures since the treatment for this disease continues for whole life. The self-care measures that must be followed by the patients are

• The head of the bed must be elevated to about 30-degrees as it helps in reducing the blood pressure while the patient is asleep.
• Some dietary changes must be made to the diet of the patient. Small and low- carbohydrate meals must be taken. Foods containing fiber must be added to the diet.
• Support stockings must be worn up to the waist as it can help in preventing the blood pressure to fall suddenly.
• In hot days the patient must stay in an air-conditioned room.
• A patient must also avoid bathing with warm water.
• Some extra salt must be added to the food of the patient along with drinking more fluids.

The patients suffering from the problem of multiple system atrophy have a very poor prognosis. After the appearance of the first symptom the median survival age of the patient suffering from multiple system atrophy ranges from 5 to 10 years. If the disease occurs in older patients then the survival time gets shorter.

The price of the treatment for multiple system atrophy can be gauged since the treatment lasts until the lifetime of a patient. The cost of the treatment would include all the medicines that would be prescribed by the doctor for reducing the symptoms associated with the disease. The cost of a pacemaker in India ranges in between 45,000 to 1.5 lakh rupees. The price of physical therapy per session would depend on the location and experience of the therapist.

There is no cure for multiple system atrophy. The treatment given is based on the symptoms exhibited by the patient. The results of the treatment are immediate and they only reduce the symptoms for some time duration as multiple system atrophy is a progressive disease.

Apart from the treatment described above for multiple system atrophy, a patient may opt for some herbal treatment to reduce the effect of the symptoms on the body. A patient can use herbs like Boswellia serrate and Curcuma longa for the treatment.