Multiple System Atrophy (MSA) is a degenerative disease that worsens in intensity over time. MSA affects the body’s autonomic functions, movement, and balance. Patients go on suffering mounting disability as the disease advances, eventually reaching its terminal stage, which is marked by severe complications and a substantial reduction in the quality of life.

Symptoms in the Final Stage of Multiple System Atrophy

Throughout its terminal stage, MSA signs and symptoms worsen significantly. Some of these may be:

• Severe Mobility Complications: The patient may end up being completely bedridden due to extreme rigidity of muscles and loss of coordination.
• Difficulty Swallowing (Dysphagia): Dysphagia makes it more risky for a patient to aspirate pneumonia, which can be fatal.
• Dysarthria, a Speech Impairment: The communication is nearly unattainable since speech is made weak or unintelligible.
• Bladder and Bowel Dysfunction:  Complete loss of bowel and bladder control may lead to catheterization and other medical interventions.
• Severe Breathing Complications: Difficulty in respiration may ensue due to muscular weakening, which may call for greater ventilatory support.

Cognitive and Emotional Challenges

MSA is different from such diseases, which in most cases lead to severe cognitive impairment. Some of its patients, however, can have:

• Emotional Distress: Anxiety and depression caused by loss of autonomy.
• Sleep Disorders: Disorders such as REM sleep behavior disorder worsen.
• Memory and Attention Difficulties: Mild cognitive impairment may occur in a few.

End-of-Life Complications

The last phase of MSA is usually followed by severe medical complications such as:

• Aspiration Pneumonia: The leading cause of death in MSA patients due to swallowing difficulties.
• Fluctuations in Blood Pressure: A sudden drop in blood pressure (orthostatic hypotension) is a risk for fainting and falls.
• Respiratory Failure: Patients can become dependent on oxygen supplementation or mechanical ventilation as muscles of respiration weaken.

Palliative Support and Care

Because there is not yet a cure for MSA, end-stage care is aimed at maintaining comfort and controlling symptoms. This entails:

• Aches Relief and Muscle Relaxation.
• Nutritional Support Through Tube Feedings.
• Physical therapy to prevent bedsores.
• Both caregivers and patients must be given support.

MSA end stage is challenging, which calls for full-time care and medical care so that the patient can be as comfortable as possible.

Dr. Navin Tiwari
Consulting Neurologist