Diagnosis of Multiple System Atrophy (MSA)
Understanding the Diagnostic Journey
Diagnosing Multiple System Atrophy (MSA) can be challenging, particularly in the early stages of the condition.
MSA is a rare, progressive neurological disorder that can affect movement, balance, coordination and the body’s automatic functions, including blood pressure regulation and bladder control.
Many of its early symptoms can resemble those of other neurological or medical conditions.
For this reason, reaching a diagnosis may involve specialist assessments, medical investigations and monitoring changes over time.
At National MSA Research, we believe that access to reliable information can help individuals and families better understand the diagnostic process and prepare for conversations with healthcare professionals.
Why Is MSA Difficult to Diagnose?
Multiple System Atrophy shares symptoms with several other conditions, particularly Parkinson’s disease and disorders affecting coordination or the autonomic nervous system.
Early symptoms may include:
- Dizziness or faintness when standing.
- Changes in bladder control.
- Difficulties with balance or coordination.
- Slowness of movement.
- Muscle stiffness.
- Changes in speech or walking.
- Certain sleep disturbances.
These symptoms do not necessarily indicate MSA.
Many can arise from more common or potentially treatable conditions.
A healthcare professional must consider alternative explanations before making a diagnosis.
Because MSA develops differently between individuals, its characteristic features may become more apparent only after additional assessments.
Who Diagnoses Multiple System Atrophy?
A diagnosis of MSA is generally made by a neurologist.
A neurologist specialising in movement disorders may have particular experience recognising the combination of symptoms associated with MSA and distinguishing it from similar conditions.
In Australia, the diagnostic journey will often begin with a general practitioner (GP).
If a GP identifies symptoms requiring neurological investigation, they may refer the person to an appropriate specialist.
Depending on the symptoms, other healthcare professionals may also be involved, including specialists in bladder function, blood pressure disorders, sleep medicine or rehabilitation.
What Happens During a Neurological Assessment?
A neurologist will consider several aspects of a person’s health and symptoms.
Medical History
The specialist may ask when symptoms first appeared, how they have changed and whether particular difficulties are becoming more noticeable.
Information about previous medical conditions, medications and family history may also be relevant.
Neurological Examination
An examination may assess movement, muscle stiffness, walking, balance, coordination, speech and other neurological functions.
Autonomic Symptoms
The specialist may ask about symptoms involving blood pressure, bladder function, bowel function and other automatic bodily processes.
Changes Over Time
The pattern and progression of symptoms can provide important diagnostic information.
Follow-up appointments may be necessary when the clinical picture remains uncertain.
What Tests Are Used to Investigate MSA?
There is no single routine investigation that can reliably diagnose MSA in every living patient.
However, several tests may provide supporting information or help rule out other conditions.
Brain MRI
Magnetic resonance imaging (MRI) produces detailed images of the brain.
A neurologist may request an MRI to look for changes associated with certain neurological conditions.
Some people with MSA develop characteristic imaging findings involving particular brain structures.
However, these findings may not be present in the earlier stages, and a normal MRI does not necessarily rule out MSA.
MRI can also help identify alternative explanations for symptoms.
Blood Pressure and Autonomic Testing
Because MSA can affect the autonomic nervous system, blood pressure assessment is an important part of many evaluations.
This may include measuring blood pressure and heart rate while lying down and after standing.
In some circumstances, a specialist may recommend a tilt-table test or other autonomic investigations.
These tests can help assess difficulties with the body’s regulation of blood pressure and related functions.
Bladder Function Testing
Urinary symptoms can be an important feature of MSA.
Investigations may include a bladder ultrasound to measure the amount of urine remaining after emptying the bladder.
Other assessments, such as urodynamic testing, may be considered when appropriate.
Sleep Assessments
Some individuals experience unusual movements during sleep or disturbances affecting breathing.
Where clinically indicated, a specialist may recommend further assessment or a sleep study.
Blood Tests and Other Investigations
Blood tests or additional investigations may be requested to identify or exclude other medical conditions.
These tests are not, by themselves, definitive tests for MSA.
The investigations required will depend on the person’s symptoms and the specialist’s clinical judgement.
Can Parkinson’s Medication Help With Diagnosis?
Some people with MSA experience movement symptoms similar to Parkinson’s disease.
A neurologist may consider how a person responds to levodopa, a medicine commonly used to treat Parkinson’s disease.
People with MSA often have a less substantial or less sustained response than people with typical Parkinson’s disease.
However, some individuals with MSA do experience improvement.
Response to levodopa alone cannot confirm or exclude MSA.
Any medication trial should be managed by the treating healthcare professional.
Understanding Diagnostic Terminology
Specialists may use terminology based on recognised international diagnostic criteria.
Two important categories are:
Clinically Established MSA
This classification is used when a specific combination of symptoms, examination findings, supporting features and characteristic MRI findings meets established diagnostic criteria.
Clinically Probable MSA
This classification is used when clinical findings support an MSA diagnosis but the full requirements for clinically established MSA are not met.
Characteristic MRI findings are not required for clinically probable MSA.
Both are recognised clinical diagnostic categories.
Your neurologist can explain what the terminology means in your individual circumstances.
These levels of diagnostic certainty are different from MSA-P and MSA-C, which describe the predominant movement symptoms.
Can an MSA Diagnosis Change?
Yes. Sometimes a diagnosis is reconsidered as additional symptoms or investigation results become available.
A person may initially receive a diagnosis of Parkinson’s disease or another neurological condition before MSA is considered.
In other cases, a neurologist may suspect MSA but require further observation before reaching a more confident conclusion.
It is reasonable to ask your specialist what findings support the diagnosis, what remains uncertain and whether any further assessment is needed.
Preparing for Your Neurology Appointment
Preparing information beforehand can help you make the most of an appointment.
Consider bringing:
- A list of current medications and doses.
- Details of symptoms and when they began.
- Notes about changes in walking, balance or coordination.
- Information about dizziness, fainting or falls.
- Details of bladder, bowel or sleep difficulties.
- Copies of relevant previous investigations, if available.
- Questions you would like to discuss.
You may also wish to have a trusted family member, friend or support person attend the appointment with your consent.
Questions You Might Ask Your Neurologist
Some useful questions include:
- What conditions could explain my symptoms?
- What findings suggest MSA or another neurological disorder?
- Do I need further investigations?
- Would a movement disorders specialist assessment be helpful?
- How will changes in my symptoms be monitored?
- What can be done to manage my current symptoms?
- Which symptoms should prompt urgent medical attention?
- What support services or allied health professionals might help?
Your healthcare team can help you understand which questions and investigations are most relevant to you.
What Happens After Diagnosis?
If MSA is diagnosed, the treating team can discuss available symptom management, ongoing assessments and support needs.
Although there is currently no cure for MSA, appropriate medical and allied health care can help address particular symptoms and difficulties.
Depending on individual circumstances, this may include physiotherapy, occupational therapy, speech pathology, bladder management and assistance with blood pressure problems.
People whose diagnosis remains uncertain may also benefit from appropriate symptom management while investigations continue.
New or worsening swallowing difficulties, unusual breathing sounds, repeated fainting or significant changes in functioning should be discussed promptly with a healthcare professional.
For severe breathing difficulties or another medical emergency in Australia, call Triple Zero (000).
Explore Treatment and Management of MSA
Support for Patients and Families
Receiving a diagnosis of MSA, or waiting for a diagnosis to become clearer, can raise many practical and emotional questions.
Individuals and families may wish to seek support from their treating healthcare team, reputable community organisations and appropriate support services.
National MSA Research provides information intended to help visitors understand MSA and locate relevant resources.
We do not provide clinical diagnosis, personalised treatment advice or emergency medical services.
Explore Patient & Family Support
Research Into Earlier and More Accurate Diagnosis
Improving the diagnosis of Multiple System Atrophy remains an important area of scientific research.
Researchers are investigating biological markers, imaging techniques and other approaches that may help distinguish MSA from similar conditions.
Progress in diagnostic research could contribute towards earlier identification and improved opportunities for evaluating potential treatments.
National MSA Research is committed to raising awareness of these challenges and encouraging scientific progress.
Learn More About MSA Research
Understanding the Journey Together
Every person’s experience of Multiple System Atrophy is different.
For some, symptoms and clinical findings may lead to a diagnosis relatively quickly. For others, the process may involve repeated assessments and uncertainty.
Access to clear information, qualified medical advice and appropriate support can help individuals and families navigate this process.
At National MSA Research, we remain committed to increasing awareness, improving understanding and encouraging progress towards better diagnosis, more effective treatments and ultimately a cure.
Combatting MSA Together — Through Awareness, Alleviation and Advancement.
Further Information and Enquiries
National MSA Research
Rare Neurological Disease Research Ltd
ABN: 55 681 229 032
Email: info@nationalmsaresearch.org.au
Website: www.nationalmsaresearch.org.au
Medical disclaimer: This information is provided for general educational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Anyone concerned about symptoms or their health should consult an appropriately qualified healthcare professional.