Related degenerative nervous system diseases called MSA
DEAR DR. ROACH: I hope you can answer some questions about a disease called multiple system atrophy. What does it do to your body? Is the cause known? Is there a cure? -- D.B.
ANSWER: Multiple system atrophy is a group of related degenerative diseases of the nervous system. All of them can cause any of three symptoms: ataxia (a specific type of loss of muscular coordination); Parkinsonism (the specific abnormal muscle control and rigidity that usually is seen in Parkinson’s disease); and problems with the autonomic nervous system (the part that regulates blood pressure on standing and bladder control, among many other functions).
MSA with predominant ataxia is also called “olivopontocerebellar atrophy”; MSA with predominant Parkinson’s features is also called “striatonigral degeneration”; and MSA with predominantly autonomic symptoms is also called “ShyDrager syndrome.”
The cause is unknown, though there is promising research being done. Unfortunately, no medication treatment effectively slows or stops the progression of MSA. Treatment is used to help manage symptoms, and it may include physical therapy as well as medications.
MSA is a rare condition, and few doctors are expert in it. I strongly recommend you contact The MSACoalition, an organization devoted to education, support and advocacy for MSA, at www.multiplesystematrophy.org.
DEAR DR. ROACH: About your recent column on melatonin: At 70 years old, I was taking melatonin three to four nights a week for several months. Sometimes it helped; other times not. While purchasing a new bottle, I noticed fine print that read: “Consult a physician if using for more than four weeks.” I asked the pharmacist why, and she said, “If you are having trouble sleeping, talk to your doctor.” I thought melatonin was not addictive or harmful. Why the warning? -- K.W.
ANSWER: Low-dose melatonin is relatively safe, and it almost certainly is substantially safer than most overthe-counter and prescription sleeping medications. Melatonin is proven to be beneficial in people adjusting to new time zones and in people with low melatonin levels. Despite absence of proven benefit in all people, many physicians recommend it for long-term use. I do agree with both your low dose and that you are not taking it every night. I think these will minimize the already small risks.
Why consult a physician? Several potentially serious medical conditions can have insomnia as a symptom, so it is wise to discuss your problem with your doctor. This is not so much because melatonin is dangerous as it is to make sure there’s not some other cause (such as high thyroid level) for your insomnia.
DR. ROACH WRITES: A column on high potassium levels has generated some recent letters and some confusion about the cause of laboratory errors.
Most errors attributed to the lab are due to problems obtaining or storing the sample prior to it getting to the laboratory. In the case of high potassium levels, blood can sit in the lab where it was drawn for hours, causing blood cells to burst and release potassium. A person who is nervous about blood being drawn can breathe rapidly, causing a temporary rise in blood pH, resulting in high potassium. If the samples shake during transportation, it can cause mechanical damage to cells.
An error in a laboratory value doesn’t necessarily mean that an error was made by the laboratory.
READERS: The booklet on vertigo explains this disruptive condition in detail and outlines its treatment. Readers can order a copy by writing:
Dr. Roach, Book No. 80, 628 Virginia Dr., Orlando, FL 32803 Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.