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.
Signs and symptoms
MSA is characterized by the following, which can be present in any combination:
autonomic dysfunction
parkinsonism (muscle rigidity +/ tremor and slow movement)
cerebellar ataxia (Poor coordination/unsteady walking, double vision)A variant with combined features of MSA and dementia with Lewy bodies may also exist. There have also been occasional instances of frontotemporal lobar degeneration associated with MSA. Initial presentation
The most common first sign of MSA is the appearance of an "akinetic-rigid syndrome" (i.e. slowness of initiation of movement resembling Parkinsons disease) found in 62% at first presentation. Other common signs at onset include problems with balance (cerebellar ataxia) found in 22% at first presentation, followed by genito-urinary symptoms (9%): both men and women often experience urgency, frequency, incomplete bladder emptying, or an inability to pass urine (retention). About 1 in 5 MSA patients experience a fall in their first year of disease.For men, the first sign can be erectile dysfunction. Women have also reported reduced genital sensitivity. Progression
As the disease progresses one of three groups of symptoms predominates.