Is this MSA

I am 44 year old female dx with POTS, which is a form of dysautonomia, on 2005 due to positive tilt table. In 2008 POTS worsened and I could not work. At that time I began to have tremors, facsiculations,dropping everything,night sweats, tripping, neuropathy in feet, muscle weaknesss, etc. In 2010 I was dx with ataxia, and tested for MS.All test were fine except CSF showed very high in some type of protein and very low glucose., and the neuro exam was terrible. I have babinski and rhombergs signs. I have been told by neurologist and PCP that this is related to POTS- does that mean this is MSA? I am very ill and progressing rapidly. I became so confused recently that I briefly did not recognize my family. I also have emotional lability which has only developed in the last 6 months, and I sleep a lot in the day. Also the muscle spasms in feet have now turned into dystonia!!! I should also mention that I have had recurring Ramsay Hunt ( shingles inside the craniel nerves) since 2006, at least twice each year. I have a positive ANA. My doctor is urging me to go to MAYO, which I would like to avoid. Please advise, Thanks  
Please forgive me if I double post, I tried to post this earlier and I don't think it worked.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history from you and examine you, I can not comment on a formal diagnosis or treatment plan for your symptom. However, I will try to provide you with some information regarding this matter.

POTS does not mean you have MSA. The diagnosis of MSA is clinical and needs to include other autonomic and/or extrapyramidal (i.e., Parkinsonism) features and/or cerebellar features. You mention several features that could be attributed to MSA; however, given your history of rheumatological positive serology and infectious workup, it is a complicated picture. Have you had an MRI of your brain? Did you have a IgG index, oligoclonal bands, and myelin basic protein sent from your CSF? There are other conditions (such as infectious and rheumatological) that can affect the brainstem and cause similar features as what you are describing. Also, genetic conditions should be evaluated.

I agree that you probably should be evaluated by at an academic medical center. Your clinical history, examination, and workup are complicated. Many tests may need to be repeated.  

Thank you for using the forum, I hope you find this information useful, good luck.