This Second Consensus Statement defines two categories of MSA, based on the predominant symptoms of the disease at the time of evaluation. These are:

MSA with predominant parkinsonism (MSA-P) - defined as MSA where extrapyramidal features predominate. It is sometimes termed striatonigral degeneration, a parkinsonian variant. MSA with cerebellar features (MSA-C) -  defined as MSA in which cerebellar ataxia predominates. It is sometimes termed sporadic olivopontocerebellar atrophy. Management
Supervision
Ongoing care from a neurologist specializing in movement disorders is recommended, because the complex symptoms of MSA are often not familiar to less-specialized neurologists. Hospice/homecare services can be very useful as disability progresses. Drug therapy
Levodopa (L-Dopa), a drug used in the treatment of Parkinsons disease, improves parkinsonian symptoms in a small percentage of MSA patients. A recent trial reported that only 1.5% of MSA patients experienced any improvement at all when taking levodopa, their improvement was less than 50%, and even that improvement was a transient effect lasting less than one year. Poor response to L-Dopa has been suggested as a possible element in the differential diagnosis of MSA from Parkinsons disease.The drug riluzole is ineffective in treating MSA or PSP. Rehabilitation
Management by rehabilitation professionals including physiatrists, physiotherapists, occupational therapists, speech therapists, and others for difficulties with walking/movement, daily tasks, and speech problems is essential.Physiotherapists can help to maintain the patients mobility and will help to prevent contractures. Instructing patients in gait training will help to improve their mobility and decrease their risk of falls.
In nephrology, vascular access steal syndrome is a syndrome caused by ischemia (not enough blood flow) resulting from a vascular access device (such as an arteriovenous fistula or synthetic vascular graft–AV fistula) that was installed to provide access for the inflow and outflow of blood during hemodialysis. Signs
Pallor
Diminished pulses (distal to the fistula)
Necrosis
Decreased wrist-brachial index (ratio of blood pressure measured in the wrist and the blood pressure measured in the upper arm), especially if below 0.6

Symptoms
Pain distal to the fistula.Symptoms are graded by their severity:
Grade 0: No symptoms of steal
Grade 1: Mild - cool extremity, improvement in hand pulse with access occlusion
Grade 2: Moderate - Ischemic symptoms during dialysis
Grade 3: Severe - Ischemic hand pain outside of dialysis; Ulcers or gangrene of the fingers

Diagnosis
History and physical exam - relief of symptoms with compression of the fistula on exam is highly suggestive of steal
Arteriography
Duplex ultrasound

Treatment
The fistula flow can be restricted through banding, or modulated through surgical revision. Revascularization techniques
Distal Revascularization and Interval Ligation (DRIL) procedure
PAI (Proximalization of the Arterial Inflow)
RUDI (Revision Using Distal Inflow)

Banding techniques
Narrowing suture
Plication
Minimally invasive MILLER banding
Tapering
Surgical bandingIf the above methods fail, the fistula is ligated, and a new fistula is created in a more proximal location in the same limb, or in the contralateral limb. Incidence
DASS occurs in about 1% of AV fistulas and 2.7-8% of PTFE grafts.