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PubMed This is a summary of 15 peer-reviewed journal articles Updated
Neurology

Building Your Multidisciplinary Care Team

At a Glance

Managing Multiple System Atrophy, cerebellar type (MSA-C) requires a multidisciplinary care team led by a movement disorder neurologist. Essential specialists include urologists, therapists, and early palliative care to manage complex symptoms, maintain quality of life, and plan for the future.

Because Multiple System Atrophy, Cerebellar type (MSA-C) affects many different systems in the body, no single doctor can manage it alone. Building a multidisciplinary care team—a group of specialists working together—is the gold standard for managing symptoms and maintaining your quality of life [1][2].

Your Core Care Team

A well-rounded team ensures that each of your symptoms is addressed by the most qualified expert.

  • Movement Disorder Neurologist: This is your “quarterback.” They are neurologists with extra training in conditions like MSA-C. They oversee your diagnosis, manage your medications, and coordinate the rest of your team [3].
  • Urologist: Since MSA-C often involves significant bladder issues (like not being able to empty the bladder fully), a urologist is essential for preventing infections and maintaining comfort [4][5].
  • Speech-Language Pathologist (SLP): They are critical for monitoring your swallowing safety and helping you with speech or communication changes [1].
  • Physical (PT) and Occupational (OT) Therapists: PT focuses on balance and preventing falls, while OT helps you adapt your home and daily routines to stay independent [1].
  • Autonomic Specialist: If available, these experts specialize in managing blood pressure drops and other “autopilot” system failures [6].

The Role of Early Palliative Care

It is a common misconception that palliative care is only for the very end of life. In MSA-C, the best practice is to involve a palliative care team early in the process [7].

  • Symptom Relief: They specialize in managing complex symptoms like pain, sleep issues, and anxiety that other specialists might overlook [7][8].
  • Future Planning: They help you and your family have honest conversations about your goals for the future, helping you complete “advance care planning” while you are still able to express your wishes clearly [9][10].

Preparing for Your First Appointment

Movement disorder specialists are often in high demand. To make the most of your first visit, you should arrive with the following “artifacts”:

  1. MRI Disks: Bring the actual CD/disk of your brain scans, not just the printed report. The specialist will want to look at the images personally for subtle signs like the ‘hot cross bun’ sign [11][12].
  2. Blood Pressure Log: Keep a 3-to-5-day diary of your blood pressure. Take readings while you are lying down and again after you have been standing for 3 minutes [13].
  3. Bladder Diary: Record how much you drink and how often you go (or try to go) over a 48-hour period [2].
  4. Prior Test Results: Bring copies of any previous genetic testing (for SCAs) or “post-void residual” (PVR) scans you have already had [13][14].

Choosing the Right Specialist

Not all neurologists have extensive experience with MSA-C. When vetting a potential doctor, don’t be afraid to ask about their specific experience. A doctor who is well-versed in the 2022 MDS diagnostic criteria and the use of the UMSARS rating scale will be best equipped to track your progress and adjust your care plan as needed [13][15].

Common questions in this guide

What doctors should be on my MSA-C care team?
Your core team should be led by a movement disorder neurologist. Essential team members also include a urologist, speech-language pathologist, physical and occupational therapists, and an autonomic specialist if available.
When should I involve palliative care for MSA-C?
It is best to involve a palliative care team early after your diagnosis. They specialize in managing complex symptoms like pain and sleep issues, and help you and your family plan for future care needs.
What should I bring to my first appointment with a movement disorder specialist?
You should bring the actual MRI disks of your brain scans, a 3-to-5-day log of your blood pressure lying down and standing, a 48-hour bladder diary, and any prior genetic testing or scan results.
How do I choose the right neurologist for MSA-C?
Look for a movement disorder neurologist who has extensive experience specifically managing MSA-C. They should be well-versed in the 2022 MDS diagnostic criteria and use the UMSARS rating scale to appropriately track your disease progression.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.How many patients with Multiple System Atrophy (MSA) do you currently manage, and how many have the cerebellar (MSA-C) type?
  2. 2.Do you use the 2022 MDS (Movement Disorder Society) criteria to distinguish MSA-C from look-alike conditions like Spinocerebellar Ataxia (SCA)?
  3. 3.Can you recommend a physical therapist and a speech-language pathologist who have specific experience with atypical parkinsonism or ataxia?
  4. 4.How often should we be doing a 'post-void residual' (PVR) scan to check my bladder function?
  5. 5.Will you be coordinating my care with other specialists, such as a urologist or an autonomic specialist?
  6. 6.What are the current clinical trials for MSA-C, and do you believe I might qualify for any?

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References

References (15)
  1. 1

    Therapeutic Management of the Overlapping Syndromes of Atypical Parkinsonism.

    Giagkou N, Stamelou M

    CNS drugs 2018; (32(9)):827-837 doi:10.1007/s40263-018-0551-3.

    PMID: 30051337
  2. 2

    A strategic approach of the management of sleep-disordered breathing in multiple system atrophy.

    Laga A, Bauters F, Hertegonne K, et al.

    Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 2025; (21(4)):703-711 doi:10.5664/jcsm.11472.

    PMID: 39539061
  3. 3

    A historical review of multiple system atrophy with a critical appraisal of cellular and animal models.

    Marmion DJ, Peelaerts W, Kordower JH

    Journal of neural transmission (Vienna, Austria : 1996) 2021; (128(10)):1507-1527 doi:10.1007/s00702-021-02419-8.

    PMID: 34613484
  4. 4

    Multiple system atrophy related neurogenic bladder: mechanism and treatment.

    Ren G, Wang Y, Tian H, et al.

    Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 2025; (46(5)):1965-1976 doi:10.1007/s10072-025-08002-3.

    PMID: 39875674
  5. 5

    Vasomotor regulation in patients with multiple system atrophy.

    Shindo K, Tsuchiya M, Ichinose Y, et al.

    Journal of neural transmission (Vienna, Austria : 1996) 2017; (124(4)):477-481 doi:10.1007/s00702-016-1644-0.

    PMID: 27826809
  6. 6

    Symptomatic therapy of multiple system atrophy.

    Rohrer G, Höglinger GU, Levin J

    Autonomic neuroscience : basic & clinical 2018; (211()):26-30 doi:10.1016/j.autneu.2017.10.006.

    PMID: 29104019
  7. 7

    Palliative Care Need and Quality of Life Mediated by Psychological Distress in Neurologic Diseases.

    Chan LML, Choi EPH, Lam WWT, et al.

    Journal of pain and symptom management 2025; (69(6)):641-653.e3 doi:10.1016/j.jpainsymman.2025.03.004.

    PMID: 40081623
  8. 8

    Feasibility and effectiveness of a two-tiered intervention involving training and a new consultation model for patients with palliative care needs in primary care: A before-after study.

    Seiça Cardoso C, Prazeres F, Oliveiros B, et al.

    Palliative medicine 2024; (38(8)):842-852 doi:10.1177/02692163231219682.

    PMID: 38226491
  9. 9

    Effect of Short-term Integrated Palliative Care on Patient-Reported Outcomes Among Patients Severely Affected With Long-term Neurological Conditions: A Randomized Clinical Trial.

    Gao W, Wilson R, Hepgul N, et al.

    JAMA network open 2020; (3(8)):e2015061 doi:10.1001/jamanetworkopen.2020.15061.

    PMID: 32857151
  10. 10

    Effect and Efficiency of an Embedded Palliative Care Nurse Practitioner in an Oncology Clinic.

    Walling AM, D'Ambruoso SF, Malin JL, et al.

    Journal of oncology practice 2017; (13(9)):e792-e799 doi:10.1200/JOP.2017.020990.

    PMID: 28813191
  11. 11

    An update on advances in magnetic resonance imaging of multiple system atrophy.

    Chelban V, Bocchetta M, Hassanein S, et al.

    Journal of neurology 2019; (266(4)):1036-1045 doi:10.1007/s00415-018-9121-3.

    PMID: 30460448
  12. 12

    Anesthetic considerations in a patient with multiple system atrophy-cerebellar for lower limb surgery.

    Agarwal S, Aggarwal R

    Saudi journal of anaesthesia 2017; (11(3)):365-366 doi:10.4103/sja.SJA_57_17.

    PMID: 28757850
  13. 13

    The Movement Disorder Society Criteria for the Diagnosis of Multiple System Atrophy.

    Wenning GK, Stankovic I, Vignatelli L, et al.

    Movement disorders : official journal of the Movement Disorder Society 2022; (37(6)):1131-1148 doi:10.1002/mds.29005.

    PMID: 35445419
  14. 14

    Differential value of external anal- and urethral-sphincter electromyography in multiple system atrophy cerebellar type and spinocerebellar ataxias.

    Miao Y, Wang K, Han J, et al.

    Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 2020; (80()):16-22 doi:10.1016/j.jocn.2020.07.067.

    PMID: 33099340
  15. 15

    Sensitivity to Change and Patient-Centricity of the Unified Multiple System Atrophy Rating Scale Items: A Data-Driven Analysis.

    Krismer F, Seppi K, Jönsson L, et al.

    Movement disorders : official journal of the Movement Disorder Society 2022; (37(7)):1425-1431 doi:10.1002/mds.28993.

    PMID: 35332582

This page provides educational information on building an MSA-C care team. It does not replace professional medical advice. Always consult your neurologist or primary care provider for personalized medical recommendations.

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