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Shy-Drager Syndrome/Multiple System Atrophy

Submitted by rchunco on Mon, 03/28/2011 - 17:33
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Why you might want to know this: 
  • MTs should be aware of the slight differences between Shy-Drager syndrome and Parkinson's disease, since Shy-Drager syndrome sufferers can have a dramatic blood pressure drop from orthostatic hypotension.  Sufferers of this disease may have dizziness or light-headedness. Information gathering on the levels of orthostatic hypertension and other symptoms should be gathered, and adjustments made to planned massages accordingly.
  • MTs should be aware that the disease usually results in death 7-9 years after symptoms begin.(1)
Introduction: 

Shy-Drager syndrome is a rare, progressive disorder that is thought to be a form of multiple systems atrophy (MSA), which are:

"a group of overlapping disorders that cause many symptoms and simultaneously affect several body systems" (2)

 

MSAs are of unknown cause and the current treatment is symptomatic.  Although there is a good chance that many therapists may never meet someone with this condition since it is so rare, knowledge of how it is slightly different from Parkinsons' and the effect that it can have on family members and loved ones of the sufferer may be of use if we are working on a relative of someone who has the disease:

"Shy-Drager Syndrome is so rare that few patients, prior to diagnosis and few physicians have any knowledge of the disease. Because of the rarity and severity of the disorder, patients, their caregivers and family members feel isolated and confused about how to deal with the condition. Likewise, the medical profession, has difficulty in dealing with the diagnosis and treatment of this rare syndrome. People affected by Shy-Drager need a support system to help them deal with the many issues sorrounding the illness."(3) From the SDS support group website

Most MTs are familiar with Parkinson's Disease, and SDS is very similar, but with some slight differences that we should be aware of.

Take home points: 
  • It is a progressive disorder.
  • A result of the degeneration of the parts of the brain involved in the autonomic nervous system - including the basal ganglia, spinal cord and the motor nerves of the cerebellum.
  • Similar to Parkinson's disease in that it can cause tremor, muscle rigidity, and problems with coordination and movements, but it also causes a malfunction of the autonomic nervous system, and so can affect heart rate, hormone secretion, body temperature, bladder and bowel functioning, bodily temperature, and focussing of the eyes.  All of these should be taken into consideration in massage sessions.
  • Family members and loved ones of sufferers of SDS will undoubtedly be under considerable stress.

 

Main Body: 

Shy-Drager syndrome is so named because of the two doctors that discovered it in 1960. It affects approximately 4.6 people per 100,000.(4)

The condition has a number of symptoms including: poor coordination (ataxia), fatigue, changes in facial expression, frequent falls, constipation, tremor, rigidity, muscle wasting, orthostatic hypotension and lightheadedness, urinary incontinence, sleep apnea, and loss of language skills. (5)

Sufferers may also have bouts of crying or laughing brought on by minor stimuli. (6)

The term "Multiple System Atrophy" is the current redefinition of SDS since it is the term that now applies to what was previously referred to as three different disorders : SDS, striatonigral degeneration and olivopontocerebellar atrophy (7).  It may also be referred to as "multiple system atrophy with autonomic phenomena"

Implications for massage:

Care should be taken when working on a sufferer of this disease and although massage may help with stiffness, consideration should be given to the degree of the symptoms. For example, the sufferer may want to have assistance getting on and off the table, they may have urinary incontinence, and loss of language skills may require the help of a family member. 

References: 

1. Multiple system atrophy Shy-Drager syndrome; Neurologic orthostatic hypotension; Shy-McGee-Drager syndrome; Parkinson's plus syndrome; MSA-P; MSA-C

2. The Merck Manual of Medical Information Second Merck Research Laboratories Home Edition 2003

3. Shy-Drager Support Group Website http://www.shy-drager.org/

4. MSA 

5. NIH National Institute of Neurological disorders and Stroke

6. Vanderbilt Autonomic Dysfunction Center

7. Werner R, Disease Handbook for Massage Therapists LWW In Touch Series 2010 p.163 2010

 

MeSH Terms: 

Shy-Drager Syndrome

 

Physiopedia Refs: 

n/a

Wikipedia Refs: 

5. MSA 

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