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Venn diagram showing similarities and differences between Multiple System Atrophy and Parkinson

Multiple System Atrophy (MSA) vs. Parkinson’s: What’s the Difference?

Both multiple system atrophy (MSA) and Parkinson’s disease are degenerative diseases of the nervous system that affect movement and worsen over time.1 Their early signs and symptoms are generally quite similar, so it can be difficult to tell them apart, especially in their early days.2

In general, both diseases show up and progress differently in different people. Some people get worse faster than others, and patients come to the doctor for the first time with differing symptoms. People tend to develop MSA in their 50s to 60s, and the disease often progresses faster than it does with Parkinson’s.3 Parkinson often emerges after age 60.

What are common symptoms of these diseases?

  • Disturbances in movement
  • Clumsy walk
  • Awkward balance
  • Impaired speech
  • Lightheadedness
  • Trouble sleeping
  • Difficulty with urination2,4

What are different symptoms of these diseases?

Parkinson’s symptoms

  • Tremors, like the distinctive touching of the thumb and index finger known as the “pill roll,” are common in Parkinson’s but not MSA
  • A stiff, masked look in the face is more characteristic of Parkinson’s
  • Loss of smell
  • Confusion or dementia3

MSA symptoms

  • Balance problems happen earlier and get worse faster with MSA patients
  • Sexual problems and inability to have an erection
  • Sweating abnormalities
  • Major problems with posture, including stooping, and a bent neck
  • Emotional outbursts2

What causes MSA and Parkinson’s?

Neither disease has a clearly understood cause, but Parkinson’s seems to have more of a genetic component than MSA, meaning it runs in families. MSA almost always occurs “sporadically,” meaning randomly, without any recognizable pattern. Both diseases seem to have some connection with environmental contaminants.3

One key difference is that the nerve destruction in Parkinson’s tends to occur in the areas of the brain that control movement, whereas MSA affects what’s called the autonomic nervous system. This is the system that controls the automatic functions of the body, like blood pressure, breathing, bladder function, and muscle control.5

How common are MSA and Parkinson’s?

Parkinson’s is much more common than MSA, with 60,000 Americans diagnosed every year. Approximately 15% of people who get Parkinson’s have a family history of the disease.6 MSA is a very rare condition. Researchers believe that it affects 15,000 – 50,000 Americans.4

How do you diagnose these diseases?

Both diseases can be difficult to diagnose, and they require a neurology workup and medical history. You might have some brain imaging or blood tests to rule out other causes for your symptoms.

For MSA, doctors will test your autonomic functions, like how well you produce sweat and how well your body maintains a stable blood pressure when you stand up after sitting or lying down.5 Parkinson’s doesn’t have a specific test for diagnosis. Sometimes doctors will prescribe anti-Parkinson’s medication and diagnose Parkinson’s if it helps improve your symptoms.1

A new blood test that might help with diagnosis

Researchers recently discovered a blood test that can detect a specific protein found in the blood of Parkinson’s patients but not MSA patients. The protein, known as alpha-synuclein, is produced in nerve cells in the brain and can be detected in the blood. It is one of the proteins that accumulate and damages the brains of people with both MSA and Parkinson’s. However, the protein collects in different cells in the brain, depending on which disease it is.7

  1. Parkinson’s Disease. The Mayo Clinic. Updated June 30, 2018. Available at Accessed March 14, 2019.
  2. Multiple System Atrophy: Differential Diagnosis. MSA Coalition. Available at Accessed March 14, 2019.
  3. Multiple System Atrophy Fact Sheet. National Institute of Neurological Disorders and Stroke. National Institutes of Health, Bethesda, MD. Updated July 24, 2018. Available at Accessed March 14, 2019.
  4. 10 Early Signs of Parkinson’s Disease. The Parkinson’s Foundation. Available at Accessed March 14, 2019.
  5. Muscular system atrophy (MSA). The Mayo Clinic. Updated June 17, 2017. Available at Accessed March 14, 2019.
  6. Parkinson Disease. Genetics Home Reference. National Library of Medicine. March 12, 2019. Available at Accessed March 14, 2019.
  7. Nancy A. Melville. Biomarker May Distinguish Parkinson's From MSA. MedScape, October 22, 2018. Available at Accessed March 14, 2019.


  • TerryB
    3 weeks ago

    I now take the Carbidopa/Levodopa 25/250 mg tab every 4 hours every day, and have been on this same dose for 12 months now. It helps but they wear off by 3.5 hours, I’m going to ask the doctor if there’s some other medication I could take that wouldn’t wear off as quickly. I have the alarm on my phone set for every 4 hours.

  • Jessica.Hall moderator
    3 weeks ago

    Hi @TerryB, what a great use of technology! Others in the community have mentioned utilizing their phones in the same manner. Hoping you and your doctor can find a plan that is helpful for you. We appreciate you being here with us and checking back in. Kindly, Jessica- Team Member

  • mbachura
    6 months ago

    Good morning all. I have been experiencing a lot of freezing gait this week. Can anyone help me understand why?
    Thank you , mary

  • Chris H. moderator
    6 months ago

    Hi, @mbachura – That sounds tough! We have some information on gait issues here and here. Hope this helps! – Chris, Team

  • mbachura
    6 months ago

    Thank you Chris. I have been taking carbidopa / levadopa 25-100 , 3 times a day. I have tried to increase it but it really upsets my stomach. The doctor has recommended 1pill 4. times a day . I m going to try that. I do find that my symptoms are worst when my legs are very tired. I also had a kidney transplant 4+ years ago and take several pills for that. However , I m still hanging in there. Thank you again, mary

  • binky571
    8 months ago

    Is the New blood test available yet?

  • Chris H. moderator
    8 months ago

    Hi, @binky571 – Thanks for your question! I’d recommend that you reach out to your doctor/neurologist to see if this blood test is available. Let us know what you find out! – Chris, Team

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