Treatment and Management of Multiple System Atrophy (MSA)
Managing Symptoms. Supporting Independence. Improving Quality of Life.
Living with Multiple System Atrophy (MSA) can bring significant challenges for individuals, families and carers.
MSA is a rare, progressive neurological condition that affects movement, coordination and automatic bodily functions, including blood pressure regulation, bladder control and swallowing.
Although there is currently no cure for MSA, a range of treatments, therapies and supportive care options may help manage symptoms and improve day-to-day wellbeing.
The most appropriate approach depends on each person’s symptoms, health circumstances and individual needs.
At National MSA Research, we believe access to reliable information and appropriate professional support is important for everyone affected by MSA.
Is There a Treatment for MSA?
There is currently no established treatment that can cure Multiple System Atrophy or stop its progression.
However, treatments and therapies are available to help manage particular symptoms and support quality of life.
Management may focus on:
- Improving comfort and daily functioning.
- Addressing problems with blood pressure and bladder function.
- Supporting movement, mobility and balance.
- Managing speech and swallowing difficulties.
- Recognising and treating sleep or breathing problems.
- Maintaining nutrition and hydration.
- Supporting emotional wellbeing.
- Helping individuals and families plan for changing needs.
Treatment is generally coordinated through a multidisciplinary healthcare team.
Building Your Healthcare Team
Because MSA affects several bodily systems, care may involve different healthcare professionals.
Depending on individual needs, the team may include:
Neurologist: Oversees neurological assessment, symptom management and relevant medication decisions.
General Practitioner (GP): Provides ongoing medical care, coordinates referrals and supports general health needs.
Physiotherapist: Assesses mobility, balance, posture and physical functioning.
Occupational Therapist: Helps individuals manage everyday activities and identify suitable equipment or home modifications.
Speech Pathologist: Assesses communication, speech and swallowing difficulties.
Dietitian: Provides advice about nutrition, hydration and changing dietary needs.
Continence Nurse or Urologist: Assesses and helps manage bladder-related symptoms.
Respiratory or Sleep Specialist: Investigates breathing difficulties and sleep-related problems.
Social Worker, Psychologist or Counsellor: May assist with emotional wellbeing, practical concerns and access to support services.
Palliative Care Team: Can help manage complex symptoms and support quality of life at different stages of the condition.
Not everyone will need every service. Your healthcare team can help determine which professionals may be appropriate.
Managing Movement and Muscle Stiffness
People with MSA may experience slow movement, stiffness, poor coordination and difficulties with walking.
These symptoms can affect everyday activities such as getting dressed, preparing meals and moving safely around the home.
Medication
Some individuals, particularly those with MSA-P, may experience improvement in movement symptoms with medicines such as levodopa.
However, the response is often limited or temporary, and not everyone benefits.
A neurologist can advise whether a medication trial is appropriate and monitor potential benefits and side effects.
Physiotherapy
Physiotherapy may help with maintaining strength, flexibility, mobility and safe movement.
An individualised program may include suitable exercises, posture management, mobility training and strategies to reduce the risk of falls.
Exercise should be adapted to the person’s condition, balance, blood pressure and other medical needs.
Occupational Therapy
Occupational therapists can recommend equipment and strategies that may make everyday activities safer and easier.
This may include mobility aids, adapted seating, bathroom equipment or home modifications.
Managing Low Blood Pressure
A common feature of MSA is orthostatic hypotension, where blood pressure drops when a person stands.
This can cause dizziness, light-headedness, weakness or fainting.
Low blood pressure can increase the risk of falls and injury.
Treatment may include medication and practical management strategies recommended by a healthcare professional.
Depending on individual circumstances, a clinician may discuss:
- Changing positions gradually.
- Reviewing medications that may affect blood pressure.
- Compression garments.
- Modifications to fluid or salt intake when medically appropriate.
- Adjustments to meal size or timing.
- Changes to sleeping position.
- Medicines prescribed to help manage blood pressure.
Some people with MSA also experience high blood pressure while lying down.
For this reason, measures such as increasing salt or fluid intake are not suitable for everyone and should only be undertaken with professional guidance.
Report fainting episodes or significant changes in blood pressure symptoms to your healthcare team.
Managing Bladder Problems
Bladder difficulties are common in Multiple System Atrophy.
Symptoms may include urinary urgency, frequent urination, incontinence or difficulty emptying the bladder.
These problems can affect comfort, confidence and daily activities.
A healthcare professional may assess bladder function and recommend suitable management options.
Depending on the circumstances, these may include medication, continence products, specialist bladder management or catheterisation.
It is important to distinguish between difficulty storing urine and difficulty emptying the bladder, as treatments may differ.
If you develop an inability to pass urine, seek prompt medical attention.
Managing Constipation and Digestive Problems
MSA can affect digestive and bowel function.
Constipation may occur because of changes in the autonomic nervous system, reduced mobility, medication effects or other factors.
Management may include dietary adjustments, appropriate activity, hydration guidance and medications recommended by a healthcare professional.
A GP, dietitian or continence specialist can help develop an appropriate plan.
Changes to fibre or fluid intake should take account of swallowing difficulties and other medical conditions.
Speech and Communication
Some people with MSA experience changes in their voice or speech.
Speech may become quieter, slower or less clear.
These changes can make conversations more difficult and sometimes frustrating.
A speech pathologist can assess communication needs and recommend appropriate strategies.
Depending on the person, support may involve speech exercises, communication techniques or assistive communication devices.
Introducing suitable communication options before difficulties become severe may help individuals continue expressing their preferences and participating in decisions.
Swallowing Difficulties
Swallowing problems, known as dysphagia, can develop as MSA progresses.
These may include:
- Coughing or choking when eating or drinking.
- Difficulty swallowing tablets.
- A sensation of food becoming stuck.
- A wet or gurgly voice after swallowing.
- Unexplained weight loss.
- Difficulty consuming enough food or fluids.
Swallowing difficulties can increase the risk of food or drink entering the airway, known as aspiration.
A speech pathologist can assess swallowing safety and work with the treating team and a dietitian to recommend appropriate strategies.
Where necessary, clinicians may discuss changes to food or drink consistency or alternative methods of providing nutrition.
These decisions should be based on individual assessment. Do not independently modify food or fluid consistency without appropriate professional advice.
New or worsening swallowing difficulties should be assessed promptly.
Sleep and Breathing Problems
Multiple System Atrophy can affect sleep and breathing.
Some individuals experience disturbed sleep, sleep apnoea or REM sleep behaviour disorder, in which a person may act out dreams.
MSA may also cause stridor, a high-pitched breathing sound associated with narrowing of the airway.
Stridor can occur during sleep or while awake.
New noisy breathing, suspected stridor or changes in breathing should be assessed promptly by an appropriate medical professional.
Depending on the problem, a respiratory or sleep specialist may recommend investigations such as a sleep study.
Treatment options may include breathing support, such as continuous positive airway pressure (CPAP), or other specialist interventions.
Severe breathing difficulty, serious choking or an immediate threat to life requires emergency assistance. In Australia, call Triple Zero (000).
Maintaining Mobility and Preventing Falls
Problems with balance, coordination and blood pressure can increase the risk of falls.
A physiotherapist and occupational therapist can help assess an individual’s mobility and home environment.
Depending on the circumstances, recommendations may include:
- A suitable walking aid.
- Safer transfer techniques.
- Bathroom and toilet equipment.
- Appropriate seating and posture support.
- Changes to reduce hazards around the home.
- A wheelchair or other mobility equipment when needed.
The goal is to support comfort, safety and independence wherever possible.
Mobility equipment should be selected and adjusted with appropriate professional advice.
Managing Pain, Muscle Spasms and Posture
Some individuals experience painful muscle stiffness, abnormal muscle contractions or changes in posture.
These problems may affect comfort, mobility and daily activities.
Healthcare professionals may recommend positioning strategies, suitable exercises, seating adjustments or medical treatment.
In certain circumstances, a specialist may consider treatments such as botulinum toxin injections for particular muscle problems.
Treatment decisions depend on the muscles involved and the potential risks and benefits.
Nutrition and Hydration
Maintaining adequate nutrition and hydration is important for overall health.
However, MSA-related symptoms can make eating and drinking more difficult.
Swallowing changes, reduced mobility, fatigue and blood pressure problems may all influence nutritional needs.
A dietitian can provide advice tailored to the person’s circumstances and work with a speech pathologist where swallowing safety is a concern.
Unexpected weight loss, dehydration or increasing difficulty eating and drinking should be discussed with the healthcare team.
Emotional Wellbeing and Mental Health
Living with a progressive neurological condition can have emotional and psychological effects.
Individuals may experience anxiety, frustration, sadness or uncertainty about the future.
Family members and carers may also face significant emotional and practical pressures.
Psychological support, counselling, appropriate medical care and connections with trusted people or community organisations may be helpful.
Seeking emotional support is an important part of overall wellbeing.
Supporting Families and Carers
Families and carers often play an important role in assisting someone living with MSA.
Their responsibilities may include helping with appointments, daily activities, medications, mobility and care coordination.
As needs change, caring responsibilities may also increase.
It is important that carers have access to information, practical assistance and opportunities to look after their own wellbeing.
Depending on eligibility and circumstances, Australian disability, aged care and community support services may provide assistance.
Explore Patient & Family Support
Palliative Care and Future Planning
Palliative care focuses on improving quality of life for people living with serious illness.
It can include symptom management and emotional, social and practical support for individuals and families.
Palliative care is not limited to the final stages of life and may be provided alongside other treatments.
Some people may also wish to discuss future care preferences, advance care planning and the support they would want as their needs change.
These conversations are personal and should take place with appropriate healthcare guidance.
Keeping Track of Symptoms and Care
Because MSA can affect several bodily systems, keeping organised information may assist communication with healthcare professionals.
You may find it useful to maintain:
- An updated medication list.
- Notes about symptoms and significant changes.
- A record of falls, fainting or other concerning events.
- Details of medical appointments and investigations.
- Contact information for treating professionals.
- Questions for upcoming appointments.
- Relevant care plans and support arrangements.
Our Patient & Family Toolkit contains resources intended to help with organisation and appointment preparation.
Explore the Patient & Family Toolkit
Clinical Trials and Emerging Treatments
Researchers are investigating potential treatments for Multiple System Atrophy.
Clinical studies are exploring approaches to better understand the condition, improve symptom management and potentially slow its progression.
However, an experimental treatment is not necessarily safe or effective simply because it is being studied.
Participation in clinical trials is voluntary and subject to eligibility, informed consent and appropriate ethical oversight.
Anyone considering a clinical trial should discuss the potential risks, benefits and alternatives with their treating healthcare team.
National MSA Research encourages continued scientific investigation and responsible collaboration.
Explore MSA Research and Clinical Trials
Our Commitment to the MSA Community
National MSA Research was established in October 2024 following the loss of Adrian Klep to Multiple System Atrophy.
His family’s experience inspired a commitment to increasing awareness of this rare condition and encouraging research towards better diagnosis, more effective treatments and ultimately a cure.
We recognise that individuals living with MSA and their families need reliable information, appropriate healthcare and practical support.
Through awareness, education and the advancement of research, we aim to contribute towards a future of better understanding and meaningful progress.
Find Further Information and Support
Explore our resources covering:
- Understanding Multiple System Atrophy.
- Types of MSA.
- Diagnosis of MSA.
- Patient & Family Support.
- Australian Support Services.
- Research and Clinical Trials.
National MSA Research provides general information and links to resources. We do not provide medical diagnosis, personalised clinical treatment or emergency services.
General Enquiries
National MSA Research
Rare Neurological Disease Research Ltd
ABN: 55 681 229 032
Email: info@nationalmsaresearch.org.au
Website: www.nationalmsaresearch.org.au
Combatting MSA Together — Through Awareness, Alleviation and Advancement.
Medical disclaimer: This page provides general educational information only. It is not a substitute for professional medical advice, diagnosis or treatment. Medical decisions should be made in consultation with appropriately qualified healthcare professionals.