At the moment there is no cure for MSA. Symptomatic treatment is aimed at reducing the disabling effects of each symptom associated with MSA.
Cerebellar ataxia (incoordination and tremulous goal-directed movements of the limbs, gait unsteadiness, slurred speech) is difficult to control by drugs, however, all patients with parkinsonism should receive dopaminergic replacement therapy including levodopa and dopamine agonists since there is a 30% chance of benefit. A range of pharmacological and physical measures can be tried to alleviate the symptoms of orthostatic hypotension, in most instances a salt-rich diet, head-up tilt at night, elastic stockings, low dose fludrocortisone and midodrine will improve patients. Urogenital symptoms can also often be treated effectively; patients should be referred to expert uroneurologists and incontinence advisors. Sofar, the relentless disease progression cannot be halted or stopped by any medication, however, with increasing understanding of cell death mechanisms in MSA novel strategies will become available. A multicentre trial of riluzole, a glutamate release blocker, has just been launched to address the neuroprotective potential of antiglutamatergic therapy in MSA.