Emma Rushton

May 25, 2023 | pn.bmj.com | Emma Saunders |Samantha Pavey |Emma Rushton |Niall Quinn

ExaminationAs in all of neurology, the examination of an MSA patient begins from the waiting room. Patients may have a wide-based or shuffling gait, often with a stooped posture. Retrocollis or a rigid extended posture might suggest progressive supranuclear palsy. Abnormal postures such as Pisa syndrome (laterocollis of the trunk), disproportionate antecollis or contractures of the hands and feet may indicate MSA. Asymmetrical limb dystonia (or an alien limb) could relate to corticobasal syndrome.

Mar 16, 2023 | pn.bmj.com | Emma Saunders |Samantha Pavey |Emma Rushton |Niall Quinn

Motor symptomsTables 6–10 summarise our general approach to managing symptoms in MSA. Although the 2022 MSA diagnostic criteria suggest a chronic levodopa trial (starting 62.5 mg three times a day, increasing by 62.5–125 mg every 2 weeks, until reaching 250 mg four times a day) for 1 month, in practice, we often give it for 3–6 months before reviewing for benefit. Crucially, patients should be informed as to which symptoms the medication is aiming to treat, to best review its effects.