What are the common signs or symptoms of multiple system atrophy (MSA)?

The initial symptoms of multiple system atrophy (MSA) are often difficult to distinguish from the initial symptoms of Parkinson's disease and include:

• Fainting or lightheadedness due to orthostatic hypotension, a condition in which blood pressure drops rapidly when rising from a seated or lying down position
• Bladder control problems, such as a sudden urge to urinate, difficulty in emptying the bladder completely, or, for men, difficulty in achieving an erection
• Clumsiness, loss of balance, and frequent falls
• Slurred speech, a croaky, quivering voice, or difficulty in swallowing
• Decreased spontaneous movement, tremors, or rigid muscles

Doctors divide MSA into two different types, depending on the most prominent symptoms at the time an individual is evaluated:

1. The parkinsonian type (MSA-P) has primary characteristics of Parkinson's disease, such as slow movements, stiff muscles, and tremors, along with problems of balance, coordination, and autonomic nervous system dysfunction.
2. The cerebellar type (MSA-C) has primary symptoms featuring difficulty in swallowing, slurred speech, or a quavering voice, along with ataxia (problems with balance and coordination).

Some people with MSA may start out with the symptoms of one type and then develop increasingly more severe symptoms of the other type as the disease progresses. Most people with MSA require an aid for walking, such as a cane or a walker, within a few years after symptoms begin.

Additional symptoms of MSA include:

• Contractures in the hands or feet that prevent the joints from moving freely
• Pisa syndrome, an abnormal posture in which the body appears to be leaning to one side, like the Leaning Tower of Pisa
• Disproportionate antecollis, in which the neck bends forward and the head drops down
• Deep, uncontrollable sighing or gasping Inappropriate laughing or crying.

This answer is based on source information from the National Institute of Neurological Disorders and Stroke.