Multiple System Atrophy - Cerebellar Type: Clinical Picture and Treatment of an Often-Overlooked Disorder

Juan Fernando Ortiz; Sagari Betté; Willians Tambo; Feiyang Tao; Jazmin Carolina Cozar; Stuart Isaacson

doi:10.7759/cureus.10741

Multiple System Atrophy - Cerebellar Type: Clinical Picture and Treatment of an Often-Overlooked Disorder

Cureus. 2020 Sep 30;12(9):e10741. doi: 10.7759/cureus.10741.

Authors

Juan Fernando Ortiz¹, Sagari Betté², Willians Tambo³, Feiyang Tao⁴, Jazmin Carolina Cozar^{5

6}, Stuart Isaacson²

Affiliations

¹ Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
² Neurology, Parkinson's Disease and Movement Disorder Center of Boca Raton, Boca Raton, USA.
³ Neurology, Universidad San Francisco de Quito, Quito, ECU.
⁴ Neurology, School of Medicine, University of California, Irvine, Irvine, USA.
⁵ Medicine, Universidad de las Américas, Quito, ECU.
⁶ Family Medicine, Open Door Family Medical Center, Portchester, USA.

Abstract

Multiple system atrophy (MSA) is a rare, progressive, fatal, neurodegenerative disorder. There are two main types: the parkinsonian type (MSA-P) and cerebellar type (MSA-C). The disease usually presents with genitourinary dysfunction, orthostatic hypotension, and rapid eye movement (REM) sleep behavior disorder. Patients rapidly develop balance, speech, and coordination abnormalities. We present a review of the clinical picture and the actualized treatment modalities of the MSA cerebellar type. For the study methods, a PubMed search was done using the following medical subject headings (MeSH) terms: "multiple system atrophy/therapy". Inclusion criteria included studies in English, full papers, human studies, and publications in the last 30 years. Case reports and series were excluded. A total of 157 papers were extracted after applying the inclusion and exclusion criteria, and 41 papers were included for the discussion of this review. This review underlines the therapeutic strategies as well as the clinical picture of multiple system atrophy, and how MSA-C and MSA-P differ from each other. We discussed this review in four topics: ataxia, autonomic dysfunction (neurogenic orthostatic hypotension and urinary disorders), parkinsonism, and REM sleep disorder. In conclusion, the treatment of MSA-C is mainly symptomatic; there are not many studies on MSA-C. The ataxic component and fewer parkinsonian symptoms are the main difference of MSA-C as opposed to MSA-P.

Keywords: ataxia; autonomic dysfunction; multiple system atrophy; parkinsonism; sleep-wake disorder.

Publication types

Review