Autonomic dysfunction in different subtypes of multiple system atrophy

Abstract

Multiple system atrophy (MSA) can clinically be divided into the cerebellar (MSA-C) and the parkinsonian (MSA-P) variant. However, till now, it is unknown whether autonomic dysfunction in these two entities differs regarding severity and profile. We compared the pattern of autonomic dysfunction in 12 patients with MSA-C and 26 with MSA-P in comparison with 27 age- and sex-matched healthy controls using a standard battery of autonomic function tests and a structured anamnesis of the autonomic nervous system. MSA-P patients complained significantly more often about the symptoms of autonomic dysfunctions than MSA-C patients, especially regarding vasomotor, secretomotor, and gastrointestinal subsystems. However, regarding cardiovascular, sudomotor pupil, urogenital, and sleep subsystems, there were no significant quantitative or qualitative differences as analyzed by autonomic anamnesis and testing. Our results suggest that there are only minor differences in the pattern of autonomic dysfunction between the two clinical MSA phenotypes.

The close relationship between life-threatening breathing disorders and urine storage dysfunction in multiple system atrophy

“…Second, almost all patients in this study had MSA-C, which is predominant in Japanese MSA patients [37]. Since the equivalent prevalence of AF and sleep-disordered breathing in MSA-C and MSA-P patients remains controversial [38][39][40], the close relationship between AF and sleep-disordered breathing in this study might seem likely only in MSA-C. Third, this study was a cross-sectional study involving a small number of patients. To clarify whether or not the occurrence of a storage disorder warrants a close examination of sleepdisordered breathing with PSG and laryngoscopy, a longitudinal study from the time of clinical diagnosis should be performed in larger groups of patients with MSA-P as well as MSA-C.…”

Review: Treatment of dysautonomia in extrapyramidal disorders

“…MSA is an important differential diagnosis that must be considered, especially in early dysautonomia. MSA subtypes (MSA-C and MSA-P) only differ little in their autonomic phenotype [Schmidt et al 2008a]. Usually, MSA starts at a younger age than PD, and autonomic dysfunction begins earlier in the course of the illness.…”

Recent developments in multiple system atrophy

“…Autonomic failure is universal in both MSA subtypes [43,202] and the clinical presentation is similar as well [146]. Autonomic failure typically comprises urogenital dysfunction and orthostatic hypotension.…”