Treating blood pressure, bladder, constipation, etc. – article by Dr. Golbe

Dr. Lawrence Golbe is a movement disorder specialist at Robert Wood Johnson Medical School in NJ.  He is an expert on progressive supranuclear palsy (PSP), and is the head of the CurePSP Science Advisory Board.  In the latest CurePSP ( newsletter, there’s a short article he authored on palliative measures in multiple system atrophy (MSA).  He defines “palliative measures” as those that will “lessen the severity of…symptoms and…improve both the quality and quantity of life.”

Dr. Golbe addresses these symptoms or treatments:
* anti-parkinson treatment
* low blood pressure
* bladder problems
* constipation
* swallowing problems

As many of these symptoms are found in all the disorders within our group (MSA, LBD, PSP, and CBD) – not just MSA – the article may be of interest to everyone.

The full article is copied below.


———————————————————— –> article on page 3

MSA: Palliative Measures
Lawrence I. Golbe, MD, UMDNJ-Robert Wood Johnson Medical School
CurePSP Newsletter
March/April 2012

There is still no cure for MSA nor any way known to slow its progression, but there are many ways to lessen the severity of the symptoms and to improve both the quality and quantity of life. These are called “palliative” measures.

Antiparkinson treatment: Many people with MSA who have stiffness of limbs and slowness of movement find that carbidopa/levodopa, the main drug used for Parkinson’s disease, can help those symptoms. The duration and intensity of the drug’s effect is usually less than in Parkinson’s.

Low blood pressure: There are many ways to treat low blood pressure. If one is taking drugs or limiting salt intake to treat what once was high blood pressure, these measures could be reduced, but only under the supervision of a physician. Drugs that can increase the blood pressure include fludrocortisone (Florinef), midodrine (Pro-Amatine) and pyridostigmine (Mestinon). There are a handful of other drugs that are often worth a try. Non-drug measures include increasing the salt and fluid intake (if there are no heart or kidney problems that would make that risky), elevating the head of the bed by putting six-inch blocks under the legs at that end and using pressure stockings.

Bladder problems: The need to urinate frequently can be reduced by drugs that inhibit the muscle that empties the bladder. These are called “peripherally acting anticholinergics” and are widely advertised in the popular media.

Constipation: This symptom in MSA is treated as in any other setting. It is best to start with a stool softener (docusate; Colace) or a bulk-forming agent (Metamucil).

Swallowing problems: This is best treated by changing one’s habits regarding choice of foods and food textures, chewing technique and swallowing technique. This is best assessed by a trained speech/swallowing pathologist and often guided by an x-ray video of the person swallowing various food textures, called a “modified barium swallow.”

For severe swallowing difficulties that present a high risk of “aspiration” (food going down the wrong pipe into the lungs), a soft rubber tube can be placed through the skin of the abdomen directly into the stomach (“percutaneous endoscopic gastrostomy” or “PEG”). But this step should not be undertaken lightly. If such a technique becomes necessary to prevent aspiration, a careful decision should be reached by the patient, family, physician and other available advisors. They may decide that while the PEG may prolong life, the quality of life at that point in the disease becomes too low.