Therapeutic strategies in multiple system atrophy.
This review provides an update on therapeutic principles and their implications for practical management in multiple system atrophy (MSA), a sporadic neurodegenerative disorder characterized clinically by various combinations of dysautonomia, Parkinsonism, or cerebellar ataxia, often associated with other warning features (red flags), and pathologically by cell loss, gliosis, and glial cytoplasmic inclusions in selected multiple regions of the brain and spinal cord. Because of the small number of randomized controlled trials, the management of MSA is largely based on empirical or open-label evidence. Parkinsonism often shows a poor or unsustained response to chronic levodopa therapy, although more patients than previously recognized may experience an initial moderate-to-good dopaminergic response. There is no effective drug treatment for cerebellar ataxia. However, features of dysautonomia such as orthostatic hypotension, urinary retention or incontinence, constipation, and impotence, may often be relieved if recognized by the treating physician. Because no drug treatment consistently benefits patients with this disease in the long-term, palliative therapies are all the more important. Novel symptomatic and neuroprotective therapies are urgently required.
Wenning
Gregor K
GK
Innsbruck Medical University, Clinical Department of Neurology, Austria. gregor.wenning@uibk.ac.at
Geser
Felix
F
Poewe
Werner
W
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D001342:Autonomic Nervous System Diseases / Q000628:therapy; D018678:Cholinergic Agents / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D019578:Multiple System Atrophy / Q000628:therapy*; D016202:N-Methylaspartate / Q000037:antagonists & inhibitors; D010166:Palliative Care; D020734:Parkinsonian Disorders / Q000628:therapy
D000317:Adrenergic alpha-Antagonists; D000893:Anti-Inflammatory Agents; D000927:Anticonvulsants; D018678:Cholinergic Agents; D018491:Dopamine Agonists; D016202:N-Methylaspartate