MSA Pathway

Multiple System Atrophy (MSA) health care pathway

First neurological symptom suggestive of MSA

GP

• Assessment

• Referral to most appropriate local service

Co-morbidities, general well-being, symptom management, deterioration or symptom change

– Primary care

Progression of disability symptom management

The MSA Trust recommends that all people with MSA should be reviewed at least 6 monthly by their specialist or local centre and that many people with MSA may require a more frequent review

Palliative care

End of life care

• Treatment of infections Person with movement

• Awareness of red flags for MSA (low blood pressure, bladder dysfunction, erectile failure)

• Timely referral to neurology

• Identify care coordinator

• Access to counselling/psychological support

DIAGNOSIS

• Awareness of red flags suggestive of MSA diagnosis

• MRI brain where atypical parkinsonism suspected

• Signpost to MSA Trust

INITIATION OF TREATMENT

• Consider levodopa treatment in MSA-P presentation with escalation up to 800-1000 mg levodopa/day

• Refer for baseline PT/OT/SLT input

• Continence team input

• Bone protection

• Ongoing regular clinical review

• Liaison with MSA Trust Nurse and Health Care Specialists

• Referral to specialist palliative care and for Bowel and Bladder, Fatigue, Carer support where appropriate

SPECIALIST INTERVENTIONS

• Consider referral to local urology, gastroenterology, ENT specialists, Falls Clinic where appropriate

• Information on benefits and CHC (can be facilitated by MSA Trust)

SYMPTOM

MANAGEMENT AND DIAGNOSTIC REVIEW

• Bladder and bowel management

• BP treatments

• Sleep

• Pain

• Ongoing liaison with AHPs to cope with progression of disability

DIAGNOSIS

• Further specialist opinion where needed

• Specialist investigation (FDG PET, MIBG SPECT)

• Autonomic investigations

INITIATION OF TREATMENT

• Early discussion of palliative care and advance care planning

• Ongoing regular clinical review

• Liaison with MSA Trust Nurse and Health Care Specialists

SPECIALIST INTERVENTIONS

• Investigation and intervention for sleep disordered breathing (sleep studies, CPAP, tracheostomy, cough assist)

• Gastrostomy

• BoNT for salivation/dystonia

• Access to research trials

• Specialist neuropsychology input

• Information about support available eg. Voice Banking Service