Multiple System Atrophy

Daniel O. Claassen, MD, MS, FAAN Movement Disorders p. 1350-1363 October 2022, Vol.28, No.5 doi: 10.1212/CON.0000000000001154
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PURPOSE OF REVIEW Patients with multiple system atrophy (MSA) can present with diverse clinical manifestations, and the clinical care required is complex and requires a thoughtful approach to emerging symptoms and treatment decisions.

RECENT FINDINGS Even though it is a rare disease, MSA is often encountered in clinical practice. New developments in biofluid biomarkers and diagnostic assessments offer potential for earlier and more accurate diagnosis. This article describes recent findings, such as the use of skin biopsies, neuroimaging, and novel treatment concepts (eg, central noradrenergic augmentation).

SUMMARY MSA is a complex disease. This article provides a summary of treatment options for diverse symptoms that include autonomic, sleep, mood, and motor manifestations of the disease to help clinicians care for patients with MSA. Providing comprehensive care for patients with MSA requires an understanding of the diverse symptomatology that patients develop over time and should include an interdisciplinary team.

Address correspondence to Dr Daniel O. Claassen, Vanderbilt Medical Center, 301 Medical Center Dr, Ste 3930, Nashville, TN 37232, [email protected].

RELATIONSHIP DISCLOSURE: Dr Claassen has received personal compensation in the range of $500 to $4999 for serving as a consultant for Spark Therapeutics, Inc and as an editor, associate editor, or editorial advisory board member for HD Insights. Dr Claassen has received personal compensation in the range of $5000 to $9999 for serving as a consultant and on a scientific advisory or data safety monitoring board for Teva Neuroscience, Inc. Dr Claassen has received personal compensation in the range of $50,000 to $99,999 for serving as a consultant for Alterity Therapeutics. The institution of Dr Claassen has received research support from AbbVie Inc; the CHDI Foundation; Genentech, Inc/R. Hoffman-La Roche Ltd; the Griffin Family Foundation; the Huntington’s Disease Society of America; the National Institutes of Health, Neurocrine Biosciences, Inc/Huntington Study Group; Prilenia Therapeutics; the US Department of Defense; and Vaccinex Inc.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Claassen discusses the unlabeled/investigational use of acarbose (α-glucosidase inhibitor) for postprandial hypotension, baclofen and gabapentin for pain/dystonia, levetiracetam for cerebellar outflow tremor, serotonin norepinephrine reuptake inhibitors (eg, duloxetine) for pain, and short-acting antihypertensives (eg, nifedipine, transdermal nitropaste) for supine hypertension.

© 2022 American Academy of Neurology.