Michael Grozli

We all know Mike has been ill for a while now , in 2016 he left work and hasent been back since.  We had been to doctors after doctors and finally in November we got the formal diagnosis of Multi System Atrophy  (MSA) . When we think back on the sign and symptoms we can go back probably 10 yrs when we actually saw some symptoms but never really thought about it as anything major. 

Well now we have a diagnosis for him it was not what we could have ever imagined for our future.  This disease is incurable and yet to  be figured out why it happens. Below explains what this is all about:

 Multiple system Atrophy, abbreviated MSA defines a specific syndrome within the larger less well defined category of multiple system degenerations. The features of the MSA include: parkinsonism, cerebellar or corticospinal signs, orthostatic hypotension, impotence, and urinary incontinence or retention, usually preceding or within two years after the onset of the motor symptoms. The previous division into Shy Drager Syndrome (SDS), Striato Nigral Degeneration (SND), and Olivopontocerebellar Atrophy (OPCA) has been dropped. Immunohistochemistry demonstrates that these three disorders share a common pathology. The latest diagnostic criteria are shown in the table below.

Wenning et. al. determined that the combination of autonomic insufficiency, speech or bulbar dysfunction, absence of dementia, postural instability with falls, poor response to levodopa, and absence of levodopa-induced confusion gave a diagnostic sensitivity and specificity greater than 90%.

Median age of onset of MSA is about age 55 years (range of 33 to 76). It affects men slightly more than women. Nearly half of patients are disabled or wheelchair bound within 5 years of the onset of motor symptoms. Mean survival is 6 to 7 years. 80% of MSA patients develop predominant parkinsonism (MSA-P) and 20% develop predominant cerebellar signs (MSA-C). The latter statistics are likely skewed by referral patterns to movement disorder centers. There is considerable overlap. Cerebellar features are present in over 40% of patients with SND type, and parkinsonism is detectable in 50% of OPCA type patients. 

30% and 65% of MSA patients had a good levodopa response at some stage. Between 13% and 30% maintained some response through the course of the illness. 25% to 50% of those treated with levodopa had dyskinesias (particularly orofacial) and dystonia, even if they did not experience improvement in motor state.

Autonomic symptoms were the initial feature in 41% of patients, but ultimately 97% of patients developed some degree of autonomic dysfunction. The most frequent autonomic symptom in men was impotence and in women urinary incontinence. Orthostatic hypotension occurred in 68%.

A mild restriction of downgaze may develop in about 10% of MSA cases.. Anterior horn cell loss may occur but is uncommon. Anal sphincter EMG (90% have an abnormality) is a sensitive and specific diagnostic test for MSA. Even less frequently seen is a mild sensory neuropathy. Classic rest tremor is uncommon (29%). Cerebellar signs occurred in 54% of patients and upper motor neuron signs in 49% of the cases. MSA-P type generally demonstrates more tremor, pyramidal signs, and myoclonus than MSA-C type. Severe dementia is uncommon

Respiratory stridor (which ultimately occurs in 1/3 of cases) in combination with parkinsonism is highly suggests MSA until proven otherwise; although stridor can also occur in PD, it is exceptionally rare.

The symptoms Mike is presenting now is tremors both internally and externally, severe pain, weakness especially in the legs, very vivid dreams, falling, low blood pressure, high heart rates at standing and internal overheating.

Since he has been diagnosed he has gone to a walker for assistance and limited trips out of the house a couple of hrs at most and visits here consist of bedroom visits as sitting is to much for him, I try to keep the dirty undies,in the closet before you come over...lol.  He has been on many different mess and we just started him on baclofan which is a Parkinson's med that help with the tremors as well as fentanyl patches, diloted, sleeping pills and OxyContin and has many sleepless nights.

When we got back together just over 2 yrs ago we were not expecting this especially when realized we were meant to be then to know that what we have left is going to be so prescious.

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