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Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by a combination of autonomic dysfunction, parkinsonism, and cerebellar syndrome. Severe autonomic dysfunction can appear early in MSA, affecting patients’ life expectancy. Due to the difficulty of early diagnosis, rapid progression, and poor prognosis, nearly 50% of patients require a walker or assistance to walk within three years of the onset of motor symptoms. After five years, 60% of patients need a wheelchair, and by 6 to 8 years, most become completely bedridden, severely impacting quality of life.

To date, there is no approved specific and effective disease-modifying therapy for MSA. Current treatments mainly focus on symptomatic and supportive care, along with potential neuroprotective strategies. Although MSA presents prominent parkinsonian features, it typically shows a limited and short-lived response to dopaminergic drugs. Studies have shown that approximately 40% of MSA patients may experience temporary symptom improvement with levodopa; medications such as Madopar may help alleviate rigidity and bradykinesia. Other agents with potential neuroprotective effects, such as rasagiline and coenzyme Q10, are also being used clinically.

Management of non-motor symptoms is generally based on the severity and nature of the symptoms and follows a symptomatic approach. For example, orthostatic hypotension can be treated with compression stockings and medications like midodrine; urinary dysfunction is managed through catheterization and pharmacotherapy; and sleep disorders are treated with sedative-hypnotic agents.

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