The nature of the autonomic dysfunction in multiple system atrophy

Samir M. Parikh, André Diedrich, Italo Biaggioni, David Robertson

Research output: Contribution to journalReview articlepeer-review

40 Scopus citations

Abstract

The concept that multiple system atrophy (MSA, Shy-Drager syndrome) is a disorder of the autonomic nervous system is several decades old. While there has been renewed interest in the movement disorder associated with MSA, two recent consensus statements confirm the centrality of the autonomic disorder to the diagnosis. Here, we reexamine the autonomic pathophysiology in MSA. Whereas MSA is often thought of as 'autonomic failure', new evidence indicates substantial persistence of functioning sympathetic and parasympathetic nerves even in clinically advanced disease. These findings help explain some of the previously poorly understood features of MSA. Recognition that MSA entails persistent, constitutive autonomic tone requires a significant revision of our concepts of its diagnosis and therapy. We will review recent evidence bearing on autonomic tone in MSA and discuss their therapeutic implications, particularly in terms of the possible development of a bionic baroreflex for better control of blood pressure.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalJournal of the Neurological Sciences
Volume200
Issue number1-2
DOIs
StatePublished - Aug 15 2002
Externally publishedYes

Keywords

  • Autonomic
  • Multiple system atrophy
  • Norepinephrine
  • Orthostatic hypotensive
  • Parasympathetic
  • Sympathetic

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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