Striatonigral Degeneration Treatment & Management

Updated: Nov 13, 2019
  • Author: Ahmad El Kouzi, MD; Chief Editor: Selim R Benbadis, MD  more...
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Treatment

Approach Considerations

In patients with multiple system atrophy, response to antiparkinsonian medications is suboptimal at best. However, these drugs remain the treatment of choice in the absence of better options. [29] Other medical therapies used in multiple system atrophy target associated symptoms (eg, orthostatic hypotension). [30] Surgical treatment

Currently, no surgical treatment is appropriate for multiple system atrophy. Because it can be difficult to clinically distinguish multiple system atrophy from Parkinson disease, there are cases of multiple system atrophy patients undergoing placement of deep brain stimulators. The outcomes have generally been poor, even in patients who responded well to levodopa therapy. [31, 32]

Inpatient care

Multiple system atrophy with predominantly parkinsonian features (MSA-P) is unlikely to be the primary cause of a patient’s hospitalization. Thus, the focus of care would be treatment of the diagnoses that required admission.

Outpatient care

Outpatient care includes the following:

  • Management of antiparkinsonian drug regimen (if used)

  • Patient education regarding orthostatic hypotension

  • Assessment for history or physical signs of falls at each office visit

  • Assistive devices as needed - Cane, walker, wheelchair, and household implements

  • Patient education regarding self-catheterization if urinary retention develops

  • Referrals as needed

Consultations

Consultations in multiple system atrophy can include professionals in the following specialties:

  • Neurology

  • Sleep medicine

  • Otolaryngology

  • Physical and occupational therapy

  • Speech-language pathology

  • Psychiatry or counseling

Diet

Unless there are contraindications, patients with symptomatic postural hypotension may benefit from increased salt intake.

Activity

Patients with symptomatic postural hypotension should be advised to avoid activities or environments that produce excessive vagal stimulation or vasodilation (eg, extreme heat, overeating, straining at stool) and to rise slowly and carefully from seated or recumbent positions.