Types of Multiple System Atrophy (MSA)
Understanding MSA-P and MSA-C
Multiple System Atrophy (MSA) is a rare, progressive neurological condition that affects movement, coordination and automatic functions of the body.
Although people with MSA can experience many similar symptoms, the condition is commonly described using two main types:
- MSA-P — Multiple System Atrophy, Parkinsonian type.
- MSA-C — Multiple System Atrophy, Cerebellar type.
These classifications describe which movement-related symptoms are most prominent.
They are not separate diseases, and people with either type can experience symptoms associated with the other.
Understanding the differences can help individuals and families have more informed conversations with their healthcare professionals.
What Is MSA-P?
Multiple System Atrophy — Parkinsonian Type
MSA-P is characterised mainly by movement difficulties that resemble some of the symptoms associated with Parkinson’s disease.
These symptoms are known as parkinsonism.
People with MSA-P may experience:
- Slowness of movement: Everyday activities may take longer or become more difficult.
- Muscle stiffness: Muscles may feel rigid, making movement uncomfortable or restricted.
- Walking difficulties: Steps may become smaller, slower or less steady.
- Balance problems: Maintaining posture and avoiding falls may become more difficult.
- Tremor: Some people experience shaking or involuntary movements, although the pattern may differ from typical Parkinson’s disease.
These symptoms can affect activities such as walking, dressing, eating and moving around safely.
Is MSA-P the Same as Parkinson’s Disease?
No. Although MSA-P and Parkinson’s disease share certain movement symptoms, they are different neurological conditions.
People with Parkinson’s disease often experience meaningful improvement from medicines containing levodopa.
In MSA-P, the response to levodopa is frequently more limited or less sustained, although some individuals may benefit.
A person’s response to medication alone cannot confirm or exclude MSA.
Other symptoms, including problems with blood pressure regulation and bladder control, may also help doctors distinguish between the conditions.
Diagnosing MSA-P requires assessment by an appropriately qualified neurologist.
What Is MSA-C?
Multiple System Atrophy — Cerebellar Type
MSA-C is characterised mainly by difficulties with balance, coordination and controlled movement.
These symptoms are associated with dysfunction of the cerebellum and its connections.
The cerebellum is an area of the brain involved in coordinating movement and maintaining balance.
People with MSA-C may experience:
- Unsteady walking: Walking may become wide-based or difficult to control.
- Poor balance: Standing, turning or changing direction may become challenging.
- Loss of coordination: Activities requiring accurate movements, such as using utensils or writing, may become difficult.
- Speech changes: Speech may become slower, less clear or unusually rhythmic.
- Difficulty with precise movements: Reaching for objects or coordinating hand movements may become increasingly challenging.
The medical term ataxia is often used to describe difficulties with coordination and balance.
Is MSA-C the Same as Other Cerebellar Conditions?
No. Several neurological conditions can cause ataxia and coordination difficulties.
MSA-C is distinguished through a combination of clinical features, progression and investigations.
Doctors may consider other causes of cerebellar symptoms before reaching a diagnosis.
A specialist neurological assessment is important because some conditions with similar symptoms have different management approaches.
How Do MSA-P and MSA-C Compare?
| Feature | MSA-P | MSA-C |
|---|---|---|
| Main movement difficulty | Slowness and stiffness | Balance and coordination |
| Common movement pattern | Parkinsonism | Cerebellar ataxia |
| Walking difficulties | Slow or stiff movements | Unsteady or poorly coordinated movements |
| Hand movements | Reduced speed and ease | Reduced accuracy and coordination |
| Speech changes | May occur | May occur |
| Autonomic symptoms | May occur | May occur |
This table describes typical patterns. The symptoms experienced by any individual may overlap or change over time.
Symptoms Shared by Both Types
Although MSA-P and MSA-C are classified according to their predominant movement symptoms, both can affect the autonomic nervous system.
The autonomic nervous system controls functions that normally occur without conscious effort.
People with either type may experience the following.
Blood Pressure Problems
A fall in blood pressure when standing, known as orthostatic hypotension, can cause dizziness, light-headedness or fainting.
Bladder Problems
These may include urinary urgency, incontinence or difficulty emptying the bladder.
Bowel Problems
Constipation and other difficulties with bowel function can occur.
Speech and Swallowing Difficulties
Changes affecting communication and swallowing may develop.
Sleep and Breathing Problems
MSA can affect sleep and breathing, including breathing disturbances during sleep.
These symptoms require appropriate medical assessment.
Not every person experiences all these difficulties, and symptoms can vary considerably.
Can Someone Have Symptoms of Both MSA-P and MSA-C?
Yes.
The two classifications describe the predominant movement symptoms rather than mutually exclusive groups.
For example, someone whose main symptoms initially involve stiffness and slow movement may later develop more noticeable coordination difficulties.
Similarly, someone with predominantly cerebellar symptoms may develop features of parkinsonism.
This overlap is recognised in the clinical understanding of MSA.
The type of MSA does not, by itself, determine exactly which symptoms someone will develop or how quickly their condition will progress.
Can the Type of MSA Change?
As MSA progresses, the combination and prominence of symptoms may change.
A person’s clinical presentation can become more mixed, and the description used by their neurologist may be reviewed as new symptoms develop.
This does not mean that one disease has turned into another.
It reflects changes in how the underlying condition affects the nervous system.
How Is the Type of MSA Diagnosed?
A neurologist may use a combination of information to assess MSA and determine which movement pattern is predominant.
This may include:
- Reviewing symptoms and medical history.
- Performing a neurological examination.
- Assessing walking, balance and coordination.
- Evaluating movement speed and muscle stiffness.
- Measuring blood pressure while lying down and standing.
- Investigating bladder and other autonomic symptoms.
- Considering brain MRI findings and other relevant tests.
- Reviewing symptoms and clinical changes over time.
No single routine test can reliably diagnose every case of MSA.
The Movement Disorder Society’s diagnostic criteria also distinguish between levels of diagnostic certainty, such as clinically established and clinically probable MSA. These are different from the MSA-P and MSA-C classifications.
An experienced neurologist, particularly one specialising in movement disorders, can explain the diagnosis and its implications.
Does Treatment Differ Between MSA-P and MSA-C?
Care and treatment depend on the symptoms and needs of the individual.
There is currently no cure for MSA and no established treatment proven to stop its progression.
However, healthcare professionals can recommend approaches to help manage particular symptoms.
For someone with predominantly MSA-P symptoms, management may focus on movement difficulties, stiffness, walking and mobility.
For someone with predominantly MSA-C symptoms, management may place greater emphasis on balance, coordination and safe movement.
People with either type may also require assistance with blood pressure regulation, bladder function, speech, swallowing or other symptoms.
Support may involve neurologists, physiotherapists, occupational therapists, speech pathologists and other healthcare professionals.
Care should be tailored to the individual rather than determined by the MSA classification alone.
Living With MSA-P or MSA-C
A diagnosis of MSA can bring uncertainty for individuals and families.
Understanding the terminology used by medical professionals may make it easier to ask questions and participate in care planning.
People living with either type may benefit from discussing changing symptoms, practical support needs and future care preferences with their healthcare team.
Family members and carers may also find it helpful to access reliable information and appropriate support services.
National MSA Research provides educational resources and information about organisations that may assist people affected by MSA.
Explore Patient & Family Support
Why Research Into Both Types Matters
Researchers continue to investigate the biological processes associated with MSA and the reasons different movement symptoms develop.
Understanding these differences may help improve diagnosis, identify useful biomarkers and support the development of future treatments.
Research also seeks to understand the symptoms and mechanisms shared across MSA-P and MSA-C.
National MSA Research supports greater awareness of these scientific challenges and encourages research and collaboration aimed at improving outcomes for people affected by the condition.
Learn More About MSA Research
Understanding MSA Together
Whether a person is diagnosed with MSA-P, MSA-C or has overlapping symptoms, the challenges associated with Multiple System Atrophy deserve greater understanding and attention.
At National MSA Research, our mission is to increase awareness, support access to appropriate information and encourage progress towards more effective treatments and ultimately a cure.
Combatting MSA Together — Through Awareness, Alleviation and Advancement.
Further Information
For more information, explore our pages covering:
- Understanding Multiple System Atrophy.
- Diagnosis of MSA.
- Treatment and Management.
- Patient & Family Support.
- Research and Clinical Trials.
For general enquiries:
National MSA Research
Rare Neurological Disease Research Ltd
ABN: 55 681 229 032
Email: info@nationalmsaresearch.org.au
Website: www.nationalmsaresearch.org.au
Medical disclaimer: The information on this page is provided for general educational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. If you have questions about symptoms, diagnosis or treatment, consult an appropriately qualified healthcare professional.