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Currently there is no cure for MSA and no known means to slow progression. Treatment aims to reduce the disabling effect of the symptoms so that as full a life as possible can be led. The treatment is aimed at controlling symptoms such as postural hypotension and parkinsonian movements.
The fluctuating blood pressure makes the condition difficult to treat. Dietary changes, such as increasing salt and fluid intake, may help elevate blood pressure.
A number of drugs can be used to treat the various symptoms of MSA, although they become less effective as the disease progresses.
A breathing or feeding tube may have to be surgically inserted to manage swallowing and breathing difficulties.
- Levodopa and dopamine agonists used to treat Parkinson's disease are sometimes effective for the slowness and rigidity of MSA.
- Orthostatic hypotension can be improved with fludrocortisone, midodrine, or other drugs that raise blood pressure.
- Male impotence may be treated with penile implants or drugs.
- Incontinence may be treated with medications or catheterization.
- Constipation may improve with increased dietary fiber or laxatives.
- A speech-language pathologist may be able to offer strategies for improving swallowing and speaking. Use of softer foods may improve the ability to swallow.
- A gastrostomy tube, which delivers foods directly to the stomach, is occasionally needed later in the disease course.
Levodopa may improve movement and balance. MSA patients either do not respond or respond poorly to levodopa. Doses of 1 to 1.5 gram per day must be used before unresponsiveness is declared, but generally only about 1/3 of patients respond.
Carbidopa may reduce the side effects of Levodopa and make the Levodopa work better. The response to medications may be disappointing. Many affected individuals respond poorly to treatment with anticholinergics or Levodopa.
Autonomic failure can be treated with salt supplements, florinef, and midodrine. It has been suggested that MSA patients may benefit from replacement of central norepinephrine or epinephrine with precursors such as dihidroxyphenylserine. There is no effective treatment for the cerebellar disturbance.
Anticholinergic medications may be used to reduce early or mild tremors.
Sympathomimetics, vasoconstrictors, beta-blockers, MAO inhibitors, vasopressin, 9-fluohydrocortisone, or other medications may be used to treat low blood pressure (postural hypotension).
A heart pacemaker programmed to stimulate the heart to beat at a rapid rate (faster than 100) may increase the blood pressure for some people.
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