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Multiple System Atrophy - Treatment

clinical neurology hypotension journal therapy

The parkinsonian features in multiple system atrophy respond poorly or, at best, have modest response to dopaminergic agents. Anti-cholinergic agents and amantadine sometimes give mild benefit. The cerebellar signs in multiple system atrophy do not respond to any medical treatment. For postural hypotension, a high salt diet, head up-tilt of the bed at night, and elastic support stockings or tights could be used. Other agents that help postural hypotension include ephedrine fludrocortisone and octreotide. Urinary bladder dysfunction can be helped with oxybutynin, as well as intermittent catheterization. Some patients have respiratory failure such as respiratory stridor, which may require tracheostomy (a tube inserted in the wind-pipe to help a person breath) if indicated. Some patients have dysphagia, which may require gastrostomy (a tube inserted in the stomach through which nutrition is given). In general, the medical treatment of multiple system atrophy is disappointing. Physical therapy, occupational therapy, speech therapy, and other measures for safety are of paramount importance.

SULTAN DARVESH

See also BRAIN; DEMENTIA; DEMETIA WITH LEWY BODIES; FAINTING; PARKINSONISM.

BIBLIOGRAPHY

ADAMS, R. D., VAN BOGAERT, L.; and VANDER EECKEN, H. "Striato-nigral Degeneration." Journal of Neuropathology and Experimental Neurology 23 (1964): 584–608.

DÉJÉINE, J., and THOMAS, A. A. "L'atrophie olivo-ponto-cérébelleuse." Nouveau Inconog. Salpetriere 13 (1900): 330–370.

GRAHAM, J. G., and OPPENHEIMER, D. R. "Orthostatic Hypotension and Nicotine Sensitivity in a Case of Multiple System Atrophy." Journal of Neurology, Neurosurgery and Psychiatry 32 (1969): 28–34.

NAKAZATO, Y.; YAMAZAKI, H.; HIRATO, J.; ISHIDA, Y.; and YAMAGUCHI, H. "Oligodendroglial Microtubular Tangles in Olivopontocerebellar Atrophy." Journal of Neuropathology and Experimental Neurology 49 (1990): 521–530.

QUINN, N. P., and WENNING, G. K. "Multiple System Atrophy." Advances in Neurology 69 (1996): 413–419.

SHY, G. M., and DRAGER, G. A. "A Neurologic Syndrome Associated with Orthostatic Hypotension." Archives of Neurology 2 (1960): 511–527.

WENNING, G. K.; BEN SHIOMO, Y.; MAGALHAES, M.; DANIEL, S. E.; and QUINN, N. P. "Clinical Features and Natural History of Multiple System Atrophy: An Analysis of 100 Cases." Brain 117 (1994): 835–845.

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