Editing Multiple system atrophy (section)

==Management==

===Supervision===
Ongoing care from a [[neurologist]] specializing in [[movement disorders]] is recommended,{{by whom|date=March 2014}} because the complex symptoms of MSA are often not familiar to less-specialized neurologists. [[Hospice care|Hospice]]/homecare services can be very useful as disability progresses.{{citation needed|date=December 2020}}

===Drug therapy===

[[Levodopa]] (L-Dopa), a drug used in the treatment of Parkinson's disease, improves parkinsonian symptoms in a small percentage of MSA patients. A recent trial reported that only 1.5% of MSA patients experienced any improvement at all when taking levodopa, their improvement was less than 50%, and even that improvement was a transient effect lasting less than one year. Poor response to L-Dopa has been suggested as a possible element in the differential diagnosis of MSA from Parkinson's disease.<ref name="Calandra-BuonauraDoria2015">{{cite journal | vauthors = Calandra-Buonaura G, Doria A, Lopane G, Guaraldi P, Capellari S, Martinelli P, Cortelli P, Contin M | display-authors = 6 | title = Pharmacodynamics of a low subacute levodopa dose helps distinguish between multiple system atrophy with predominant Parkinsonism and Parkinson's disease | journal = Journal of Neurology | volume = 263 | issue = 2 | pages = 250–256 | date = February 2016 | pmid = 26566913 | doi = 10.1007/s00415-015-7961-7 | s2cid = 189866517 }}</ref>

The drug [[riluzole]] is ineffective in treating MSA or PSP.<ref name="Bensimon"/>

===Rehabilitation===
Management by rehabilitation professionals including [[physiatrist]]s, physiotherapists, occupational therapists, speech therapists, and others for difficulties with walking/movement, daily tasks, and speech problems is essential.{{citation needed|date=December 2020}}

[[Physiotherapist]]s can help to maintain the patient's mobility and will help to prevent [[contractures]].<ref name=Wenning04>{{cite journal | vauthors = Wenning GK, Colosimo C, Geser F, Poewe W | title = Multiple system atrophy | journal = The Lancet. Neurology | volume = 3 | issue = 2 | pages = 93–103 | date = February 2004 | pmid = 14747001 | doi = 10.1016/S1474-4422(03)00662-8 | s2cid = 10162139 }}<br />{{cite journal |vauthors=Wenning GK, Colosimo C, Geser F, Poewe W |title=Erratum |journal=Lancet Neurol |volume=3 |issue=3 |pages=137 |date=March 2004 |doi=10.1016/S1474-4422(04)00695-7 |s2cid=208782339 }}</ref> Instructing patients in [[gait training]] will help to improve their mobility and decrease their risk of falls.<ref name="Hardy">{{cite journal | vauthors = Hardy J | title = Multiple system atrophy: pathophysiology, treatment and nursing care | journal = Nursing Standard | volume = 22 | issue = 22 | pages = 50–6; quiz 58 | date = 2008 | pmid = 18333558 | doi = 10.7748/ns2008.02.22.22.50.c6359 }}</ref> A physiotherapist may also prescribe [[mobility aid]]s such as a cane or a walker to increase the patient's safety.<ref name="Hardy"/>

[[Speech therapist]]s may assist in assessing, treating and supporting speech (dysarthria) and swallowing difficulties (dysphagia).  Speech changes mean that alternative communication may be needed, for example, communication aids or word charts.{{citation needed|date=December 2020}}

Early intervention of swallowing difficulties is particularly useful to allow for discussion around tube feeding further in the disease progression.{{citation needed|date=May 2018}}  At some point in the progression of the disease, fluid and food modification may be implemented.{{citation needed|date=December 2020}}

===Avoidance of postural hypotension===
One particularly serious problem, the [[Orthostatic hypotension|drop in blood pressure upon standing up]] (with risk of [[Syncope (medicine)|fainting]] and thus injury from falling), often responds to [[fludrocortisone]], a synthetic [[mineralocorticoid]].<ref name="MayoMSA" /><ref name=":2">{{cite journal | vauthors = Palma JA, Kaufmann H | title = Management of Orthostatic Hypotension | language = en-US | journal = Continuum | volume = 26 | issue = 1 | pages = 154–177 | date = February 2020 | pmid = 31996627 | pmc = 7339914 | doi = 10.1212/CON.0000000000000816 }}</ref> Another common drug treatment is the [[alpha-agonist]] [[midodrine]].<ref name=MayoMSA>[https://www.mayoclinic.org/diseases-conditions/multiple-system-atrophy/symptoms-causes/syc-20356153 Multiple system atrophy (MSA)] ''mayoclinic.org'', accessed 20 May 2018</ref>

Non-drug treatments include "head-up tilt" (elevating the head of the whole bed by about 10 degrees), salt tablets or increasing salt in the diet, generous intake of fluids, and pressure (elastic) stockings. Avoidance of triggers of low blood pressure, such as hot weather, [[alcohol (drug)|alcohol]], and dehydration, are crucial.<ref name=":2" /> The patient can be taught to move and transfer from sitting to standing slowly to decrease risk of falls and limit the effect of [[postural hypotension]].<ref name="Hardy"/> Instruction in ankle pumping helps to return blood in the legs to the [[systemic circulation]].<ref name=Hardy /> Other preventative measures are raising the head of the bed by 8&nbsp;in (20.3&nbsp;cm), and the use of compression stockings and abdominal binders.<ref name="pmid10331752"/>

====Supine hypertension====

In addition to orthostatic hypotension, supine hypertension, where the BP is excessively high lying down, is a frequent problem in multiple system atrophy. Treatment of one symptom can easily aggravate the other, and supine hypertension in such patients has been linked to the same cardiovascular complications as [[essential hypertension]].<ref>{{Cite journal |last1=Palma |first1=Jose-Alberto |last2=Redel-Traub |first2=Gabriel |last3=Porciuncula |first3=Angelo |last4=Samaniego-Toro |first4=Daniela |last5=Millar Vernetti |first5=Patricio |last6=Lui |first6=Yvonne W. |last7=Norcliffe-Kaufmann |first7=Lucy |last8=Kaufmann |first8=Horacio |date=June 2020 |title=The impact of supine hypertension on target organ damage and survival in patients with synucleinopathies and neurogenic orthostatic hypotension |journal=Parkinsonism & Related Disorders |language=en |volume=75 |issue=75 |pages=97–104 |doi=10.1016/j.parkreldis.2020.04.011 |pmc=7415666 |pmid=32516630}}</ref>

===Support===
Social workers and occupational therapists can also help with coping with disability through the provision of equipment and home adaptations, services for caregivers and access to healthcare services, both for the person with MSA as well as family caregivers.{{citation needed|date=September 2020}}