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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Neurology

Symptom Management and Treatment Options

At a Glance

While there is no cure for MSA-C, aggressive symptom management can significantly improve your quality of life. Treatment focuses on physical therapy for ataxia, compression and medications for blood pressure drops, and specialized care for bladder and swallowing issues.

While there are currently no treatments that can stop or reverse Multiple System Atrophy, Cerebellar type (MSA-C), aggressive management of your symptoms is the most powerful tool you have to maintain your safety and quality of life [1][2]. Focusing on the symptoms you can control can help you stay active and engaged for as long as possible.

Managing Cerebellar Ataxia

Ataxia—the loss of coordination and balance—is a defining symptom of MSA-C. Since there is no medication to resolve ataxia, management relies on practical and therapeutic interventions:

  • Physical Therapy (PT): A PT specialized in neurodegenerative disorders can design a tailored exercise program focusing on core strength and balance to reduce your fall risk [3].
  • Mobility Aids: Using walking sticks, rollators, or eventually a wheelchair can help preserve your independence while preventing traumatic injuries [4].
  • Home Safety: Work with an Occupational Therapist (OT) to identify fall hazards in your home (like removing throw rugs, installing grab bars, and securing cables) [2].

Managing Urinary Dysfunction

Urinary retention (incomplete bladder emptying) and incontinence are often the first signs of MSA-C and require active management to prevent discomfort and dangerous infections.

  • Medications: Drugs that relax the bladder sphincter can sometimes help ease urinary flow, while others may help calm an overactive bladder [5].
  • Urology Referral: A urologist is vital. They may recommend intermittent self-catheterization—a safe and effective way to ensure the bladder is fully emptied if medications are insufficient [6].

Managing Orthostatic Hypotension (BP Drops)

Orthostatic hypotension (OH)—a sudden drop in blood pressure when you stand up—can lead to severe dizziness or fainting [7]. Managing this requires a “step-up” approach:

1. Physical Methods (Non-Medication)

  • Compression: Use abdominal binders and waist-high compression stockings. These help prevent blood from “pooling” in your legs and belly [2][8].
  • Hydration and Salt: Increase your fluid intake (aiming for 2-3 liters daily) and liberalize your salt intake, as both help “bulk up” your blood volume [2][9].
  • Avoid Triggers: Real-world triggers, such as taking very hot showers, standing motionless for long periods, or eating large carbohydrate-heavy meals, can worsen OH [9].

2. Medications
If physical methods aren’t enough, your doctor may prescribe medications:

  • Midodrine or Droxidopa: These help constrict your blood vessels to keep your pressure up [10][11].
  • Caution: These drugs can cause high blood pressure when you lie down (supine hypertension). Your doctor will likely advise you to sleep with the head of your bed elevated [12][13].

Managing Swallowing and Speech

Managing dysphagia (difficulty swallowing) is critical because it significantly affects survival. When swallowing becomes uncoordinated, food or liquid can enter the lungs, leading to pneumonia [14][15].

  • Early Evaluation: You should work with a Speech-Language Pathologist (SLP) early on. They use specialized tests like FEES (Fiberoptic Endoscopic Evaluation of Swallowing) to see how your throat muscles are performing [16].
  • Speech Support: SLPs also assist with managing speech changes (dysarthria), teaching techniques to project your voice and speak more clearly [2].
  • Advanced Support: In later stages, your team may discuss the placement of a feeding tube (PEG) to ensure you get enough nutrition safely [2].

Common questions in this guide

How can I manage blood pressure drops when standing up?
You can manage sudden blood pressure drops by using abdominal binders or waist-high compression stockings, increasing fluid and salt intake, and avoiding hot showers. If these methods aren't enough, your doctor may prescribe medications like midodrine or droxidopa to help stabilize your blood pressure.
What can be done for MSA-C balance and coordination issues?
Physical therapy is the primary treatment for ataxia in MSA-C. A specialized physical therapist can design exercises to improve core strength and balance, while an occupational therapist can recommend home safety adjustments and mobility aids to help prevent dangerous falls.
Why is a swallowing evaluation important for MSA-C patients?
Swallowing difficulties, known as dysphagia, can cause food or liquids to enter the lungs and lead to serious pneumonia. A Speech-Language Pathologist can evaluate your swallowing and teach you techniques to eat and drink safely, protecting your lungs.
How is urinary retention treated in MSA-C?
Urinary issues are very common and can be managed with medications that relax the bladder or calm overactivity. In many cases, a urologist may also recommend intermittent self-catheterization to ensure your bladder empties completely and safely.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Should I start with an abdominal binder or waist-high compression stockings to manage my blood pressure drops?
  2. 2.Can you refer me to a Speech-Language Pathologist (SLP) for a baseline swallowing evaluation (like a FEES or MBSS)?
  3. 3.What are the risks and benefits of midodrine versus droxidopa for my specific case, especially regarding blood pressure when I'm lying down?
  4. 4.Are there specific physical therapies or balance exercises tailored for my type of ataxia?
  5. 5.Can you refer me to a urologist to help manage my urinary retention symptoms safely?

Questions For You

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References

References (16)
  1. 1

    Fluoxetine for the Symptomatic Treatment of Multiple System Atrophy: The MSA-FLUO Trial.

    Rascol O, Cochen de Cock V, Pavy-Le Traon A, et al.

    Movement disorders : official journal of the Movement Disorder Society 2021; (36(7)):1704-1711 doi:10.1002/mds.28569.

    PMID: 33792958
  2. 2

    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
  3. 3

    Amelioration of motor and nonmotor symptoms in cortical cerebellar atrophy and multiple system atrophy-cerebellar type by inpatient rehabilitation: a retrospective study.

    Sonoda Y, Yamanaka Y, Sawano S, et al.

    International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation 2021; (44(2)):104-109 doi:10.1097/MRR.0000000000000455.

    PMID: 33481455
  4. 4

    Screening for RFC-1 pathological expansion in late-onset ataxias: a contribution to the differential diagnosis.

    Barghigiani M, De Michele G, Tessa A, et al.

    Journal of neurology 2022; (269(10)):5431-5435 doi:10.1007/s00415-022-11192-x.

    PMID: 35633373
  5. 5

    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
  6. 6

    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
  7. 7

    Differential Diagnosis Of Multiple-System Atrophy With Parkinson's Disease By External Anal- And Urethral-Sphincter Electromyography.

    Qiu F, Wang K, Li T, et al.

    Neuropsychiatric disease and treatment 2019; (15()):3061-3067 doi:10.2147/NDT.S218073.

    PMID: 31806975
  8. 8

    Efficacy of Servo-Controlled Splanchnic Venous Compression in the Treatment of Orthostatic Hypotension: A Randomized Comparison With Midodrine.

    Okamoto LE, Diedrich A, Baudenbacher FJ, et al.

    Hypertension (Dallas, Tex. : 1979) 2016; (68(2)):418-26 doi:10.1161/HYPERTENSIONAHA.116.07199.

    PMID: 27271310
  9. 9

    Adding droxidopa to fludrocortisone or midodrine in a patient with neurogenic orthostatic hypotension and Parkinson disease.

    Kremens D, Lew M, Claassen D, Goodman BP

    Clinical autonomic research : official journal of the Clinical Autonomic Research Society 2017; (27(Suppl 1)):29-31 doi:10.1007/s10286-017-0434-6.

    PMID: 28674867
  10. 10

    Standing and Supine Blood Pressure Outcomes Associated With Droxidopa and Midodrine in Patients With Neurogenic Orthostatic Hypotension: A Bayesian Meta-analysis and Mixed Treatment Comparison of Randomized Trials.

    Chen JJ, Han Y, Tang J, et al.

    The Annals of pharmacotherapy 2018; (52(12)):1182-1194 doi:10.1177/1060028018786954.

    PMID: 29972032
  11. 11

    Cardiovascular Safety Considerations in the Treatment of Neurogenic Orthostatic Hypotension.

    Olshansky B, Muldowney J

    The American journal of cardiology 2020; (125(10)):1582-1593 doi:10.1016/j.amjcard.2020.01.037.

    PMID: 32204870
  12. 12

    Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension.

    Isaacson SH, Dashtipour K, Mehdirad AA, Peltier AC

    Current neurology and neuroscience reports 2021; (21(4)):18 doi:10.1007/s11910-021-01104-3.

    PMID: 33687577
  13. 13

    Management of coexistent neurogenic orthostatic hypotension and supine hypertension.

    Cannom DS

    Journal of clinical hypertension (Greenwich, Conn.) 2019; (21(11)):1732-1734 doi:10.1111/jch.13699.

    PMID: 31599484
  14. 14

    Endoscopic Characteristics of Dysphagia in Multiple System Atrophy Compared to Parkinson's Disease.

    Vogel A, Claus I, Ahring S, et al.

    Movement disorders : official journal of the Movement Disorder Society 2022; (37(3)):535-544 doi:10.1002/mds.28854.

    PMID: 34773420
  15. 15

    Early-onset dysphagia predicts short survival in multiple system atrophy.

    Wada T, Shimizu T, Asano Y, et al.

    Journal of neurology 2024; (271(10)):6715-6723 doi:10.1007/s00415-024-12623-7.

    PMID: 39158732
  16. 16

    Swallowing Characteristics in Patients with Multiple System Atrophy Analyzed Using FEES Examination.

    Mozzanica F, Pizzorni N, Eplite A, et al.

    Dysphagia 2024; (39(3)):387-397 doi:10.1007/s00455-023-10619-5.

    PMID: 37733099

This page provides informational content on symptom management for Multiple System Atrophy, Cerebellar type (MSA-C). Always consult your neurologist or care team before making changes to your medications, diet, or physical routines.

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