Multiple system atrophy (MSA) is an atypical form of parkinsonism that can initially look very similar to Parkinson's Disease (PD). MSA generally progresses more rapidly that PD and most commonly affects persons in their 50s and 60s. It is estimated that 80% of persons with MSA have symptoms similar to PD such as slowness, stiffness, balance problems and tremor, which can be more "jerky" than that seen in PD. In addition, they have early autonomic symptoms, which include orthostatic hypotension (dizziness when changing positions such as sitting to standing), urinary incontinence and erectile dysfunction. Treatment options for MSA are limited. Levodopa may provide some benefit early in the disease, but this is generally minimal and does not last long-term. Speech, physical and occupational therapy can be very helpful in addition to specific treatment of autonomic symptoms.