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Neurology

Multiple system atrophy (MSA): symptoms, causes, diagnosis and treatment

Multiple system atrophy (MSA) is a rare, progressive condition in which nerve cells in the brain are lost, causing problems with movement, balance, blood pressure and bladder control. It cannot currently be cured or slowed, but treatments and a care team can manage symptoms. See a GP if you have symptoms; diagnosis is usually made by a neurologist.

Last checked: 2026-10-11

Key facts

At a glance.

  • What it is

    The NHS describes MSA as a rare condition caused by a loss of nerve cells in the brain, leading to problems with muscle control and movement. NHS inform calls it a progressive neurological condition affecting adults.

  • Main symptoms

    Bladder problems, dizziness or fainting on standing, erectile dysfunction, slow, clumsy or unsteady movement, slurred speech and stiff muscles, according to the NHS.

  • Who gets it

    The NHS says symptoms most often begin in people over 50 and it does not usually affect people under 30. NHS inform says symptoms often start between 50 and 60.

  • Is it Parkinson's disease?

    No. The symptoms can look similar early on, but MSA often progresses faster. NHS inform says it is more likely if symptoms progress quickly, there are early falls and levodopa does not work well.

  • Cause

    Not known. The NHS says there is no evidence it can be passed on to children, and NHS inform says it appears to occur at random and is unconnected with multiple sclerosis.

  • Diagnosis

    There is no single test. A neurologist diagnoses MSA from your symptoms, how long you have had them and how quickly they worsen, and may use tests including an MRI scan.

  • Treatment

    The NHS says there is no cure and no treatment that stops it getting worse, but symptoms can be managed with medicines, therapy and equipment.

  • Outlook

    The NHS says MSA affects how long someone lives and can sometimes get worse quickly. Most people eventually need help with daily living.

What are the symptoms of multiple system atrophy?

The NHS says the main symptom is losing control of muscles in the body, which happens gradually in some people and quickly in others. MSA affects people in different ways. NHS inform adds that you are likely to have muscle control and balance problems like those of Parkinson's disease or ataxia, and that symptoms get worse over time.

Symptoms of MSA grouped by body system (NHS and NHS inform)
AreaSymptoms
Movement and balanceSlow, clumsy or unsteady movement; stiff, tense and sometimes painful muscles; tremor; problems with co-ordination and balance (cerebellar ataxia)
Blood pressureDizziness or fainting on standing up (postural hypotension), cold hands and feet, blurred vision
Bladder and bowelNeeding to pee more often, loss of bladder control or being unable to pee; constipation
Sexual functionErectile dysfunction, which NHS inform says is often the first symptom
Speech and swallowingSlurred, weak or quiet voice; difficulty chewing or swallowing, choking episodes
Sleep and breathingInsomnia, restless legs, nightmares, noisy breathing, unintentional sighing, snoring, sometimes stridor or sleep apnoea
Mood and otherUncontrollable laughing or crying, feeling too hot or cold, problems controlling sweating, shoulder and neck pain

What is multiple system atrophy?

In MSA, nerves in the area of the brain that controls things like balance and movement become damaged and lost over time. It can affect movement, balance, blood pressure and bladder control, which is why symptoms are so varied.

The NHS describes it as rare, and says the cause is not known. NHS inform says it is not thought to be inherited, that having it appears to be random, that it is not due to anything the person has done, and that it has no connection to multiple sclerosis.

MSA or Parkinson's disease?

In the early stages the symptoms of MSA can be very similar to other conditions such as Parkinson's disease, which is why diagnosis can take time. NHS inform says there are features that make MSA more likely:

  • Symptoms have progressed quickly.

  • There have been falls in the early stages.

  • You do not respond well to the medicine levodopa.

  • Speech has been severely affected.

  • You gasp and breathe noisily.

How is multiple system atrophy diagnosed?

The NHS says that if a GP thinks you have symptoms of MSA or a similar condition they will usually refer you to a neurologist, who may diagnose MSA based on your symptoms, how long you have had them and how quickly they are getting worse. It can be difficult to diagnose because there is no specific test.

NHS inform says your doctor will test your reflexes and bodily functions such as bladder control and blood pressure, and you might have a brain scan, like an MRI, to detect loss of brain cells. It might take some time to get a diagnosis.

How is multiple system atrophy treated?

There is currently no cure for MSA and no treatment that can stop it getting worse, according to the NHS. But treatment and support are available to manage symptoms and help you stay comfortable and independent for as long as possible, and you will be supported by a team of healthcare professionals who create a care plan.

NHS inform says treatment involves a combination of medication, specialist equipment and therapists, and that it might take time to find the right combination. The table summarises what it describes.

Managing MSA symptoms (NHS inform)
ProblemPossible help
Stiffness and slownessMedicines (benefits are limited and they can worsen blood pressure problems), physiotherapy exercises, walking frame or shoes to reduce falls
Balance and fallsPhysiotherapy and occupational therapy advice, handrails, strategies to avoid falls
Bladder problemsUrology and continence specialists, intermittent catheterisation, medicines for night-time urine
Dizziness on standingMore fluids and salt, calf exercises, avoiding sudden changes in position, medicines if needed
ConstipationPlenty of fluids and a balanced diet, regular medication, suppositories to avoid straining
Speech and swallowingSpeech and language therapy, dietitian advice on food consistency, communication aids, a feeding tube if needed
Breathing problemsRespiratory team and overnight non-invasive ventilation such as CPAP

Outlook and living with MSA

The NHS says MSA affects how long someone lives and can sometimes get worse quickly. Most people eventually need some help and support with daily living, but the type of support and how quickly it is needed vary, because MSA affects everyone differently. Your care team can discuss how it may affect you and your family.

NHS inform says you can choose palliative care at any stage of MSA, alongside other treatments, to relieve pain and other symptoms and provide psychological, spiritual and social support at home, in a hospice or care home, or in hospital. You may also want to consider future care planning, which it describes as helpful if you become unable to communicate later on.

Support for people with MSA and their carers

The NHS suggests contacting the MSA Trust, a charity that provides a range of support and information for people affected by MSA, including support for carers and information on the emotional impact of the condition. NHS inform says the charity has dedicated MSA nurses who can help.

If you need help with day-to-day living because of illness or disability, the NHS says to find out about social care and support options through your local authority.

When to see a doctor

See a GP if you think you have symptoms of MSA. The NHS stresses that some symptoms are very common and can be caused by many other conditions, so having them does not mean you have MSA, but they should be checked.

NHS and private pathways

On the NHS the route is your GP, then a neurologist, with ongoing care from a team that may include physiotherapists, occupational therapists, speech and language therapists, dietitians, continence and urology specialists and palliative care.

Private neurology appointments can speed up a first assessment, but because there is no single test and the picture changes over time, ongoing care is best coordinated with one specialist team. Ask who will be your main point of contact.

Frequently asked

Questions people ask.

Quick, plain-English answers to the questions we hear most.

  • What is multiple system atrophy?

    Multiple system atrophy (MSA) is a rare condition caused by a loss of nerve cells in the brain, leading to problems with movement, balance, blood pressure and bladder control. It is progressive and cannot currently be cured, but symptoms can be managed.

  • What are the first symptoms of MSA?

    They vary. NHS inform says erectile dysfunction is often the first symptom, and common early signs include bladder problems, dizziness or fainting when standing, slow or clumsy movement, unsteadiness and slurred speech. Symptoms most often begin after the age of 50.

  • What is the difference between MSA and Parkinson's disease?

    They can look similar early on. MSA is more likely if symptoms progress quickly, there are falls early on, levodopa works poorly, speech is severely affected, or there is noisy breathing and gasping. A neurologist makes the distinction.

  • What causes MSA?

    The cause is not known. Nerve cells in areas controlling balance and movement are damaged and lost over time. The NHS says there is no evidence it can be inherited, and NHS inform says it appears random and is unconnected to multiple sclerosis.

  • Is there a cure for MSA?

    No. The NHS says there is currently no cure and no treatment that can stop MSA getting worse. Treatment aims to control symptoms and help people stay comfortable and independent, using medicines, therapy and equipment.

  • How is MSA diagnosed?

    A neurologist diagnoses it from your symptoms, how long you have had them and how quickly they worsen, ruling out similar conditions. There is no specific test, but reflex and blood pressure checks and an MRI brain scan may be used.

  • What is the life expectancy for MSA?

    The NHS says MSA affects how long someone lives and can sometimes get worse quickly, but it does not give a figure because it affects everyone differently. Your care team can discuss what to expect for you.

  • Is MSA hereditary?

    There is no evidence that it is passed from parents to children, according to the NHS, and NHS inform says it is not thought to be inherited. Research continues into whether some people are more at risk.

  • How can dizziness on standing in MSA be managed?

    NHS inform suggests drinking more fluids, eating more salt, doing calf exercises and avoiding sudden changes in position, with medication if practical measures are not enough. Always check with your doctor before changing salt intake.

  • Where can I get support for MSA?

    The MSA Trust is a charity supporting people with MSA and carers, with nurses available. Your NHS team, including therapists and a palliative care service, can also help, and local authorities can assess social care needs.

Where this comes from

Sources and checking.

This guide is for information, not medical advice.

Your GP or consultant knows your history and can tell you which parts apply to you. If your symptoms are severe, rapidly worsening, or come with red-flag features, seek urgent medical care. Figures and availability change, so treat them as a guide and confirm with the provider.

Published 2026-10-11, next review 2027-10-11.

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