Objective: Multiple system atrophy (MSA) is a rapidly progressive neurodegenerative disease clinically characterized by various combinations of Parkinsonism with resistance to levodopa, cerebellar, autonomic, and motor disorders. Early diagnosis of this disease is difficult, postmortem studies show that the accuracy of diagnosis is only 62-79% [1].

Background: The disease has no pathogenetic treatment [10]. In about 30% of cases, it is possible to obtain a weak and rapid response to levodopa drugs. However, the dopaminergic drugs can exacerbate the manifestations of orthostatic hypotension in this category of patients, as well as enhance dystonic manifestations.

Method: Patient M. 1981. Complaints at the time of examination of stiffness in the limbs, weakness in the limbs, slowness of movement, slight trembling in the right hand, general weakness, sweating, and sleep disturbance. The diagnosis was made: Parkinsonism, and Nakom (Levodopum + Carbidopum) 250mg/25mg was prescribed 1/2 tab 3 times per day. Neurological status: the patient is conscious. The face is symmetrical, with amymia, and tongue along the middle line. Muscle strength in the extremities is 5.0 points. Bradykinesia. Minor tremor when moving the right hand. Muscle tone is increased according to the plastic type (a pronounced symptom of a “gear wheel”). Pathological stop signs: Babinsky’s symptom (+) on both sides. Coordination tests: the finger-nose test is performed with dysmetry, and the heel-knee test is performed with dysmetry.

Results: Based on the diagnostic criteria for the MSA from 2022, we made the diagnosis: Clinically probable multiple system atrophy. Considering the presence of two of the key symptoms (Parkinsonism with a low response to levodopa, and ataxia in coordinate tests (dynamic cerebellar ataxia)), and characteristic atrophic changes in the brain (although it was not required for this category).

Conclusion: Despite the successes achieved in recent years in understanding the etiology and pathogenesis of MSA, no treatment tactics and names of drugs have been proposed that could significantly slow down the rate of disease progression and show high effectiveness. It is recommended to diagnose all adult patients with the following symptoms of MSA: Parkinsonism or ataxia; autonomic dysfunction.

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