Multiple system atrophy

Multiple system atrophy (MSA) is a degenerative central nervous system dise ase of unclear origin. Patients affected typically show symptoms attributab le to the combined involvement of the extrapyramidal, pyramidal, cerebellar and autonomic nervous systems. At onset patients mostly see a doctor becau se of extrapyramidal or - more rarely - cerebellar symptoms. Evidence of au tonomic nervous system involvement is often not apparent, at least to the n eurologist, before the history is taken. In later stages, by contrast, invo lvement of all of the above systems is clinically detectable.