Epidemiology, Diagnosis, and Management of Neurogenic Orthostatic Hypotension

Palma, Jose‐Alberto; Kaufmann, Horacio

doi:10.1002/mdc3.12478

Cited by 66 publications

(77 citation statements)

References 84 publications

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“…Supine hypertension appears to be slightly more severe in MSA compared to PD (Pilleri et al, 2014; Schmidt et al, 2009a; Vichayanrat et al, 2017). In addition, AMBP can be useful to detect hypotensive episodes not found during a regular clinic visit, for example after meals (i.e., postprandial hypotension), and to further define treatment of OH and supine hypertension (Fanciulli et al, 2016; Gibbons et al, 2017; Jordan et al, 2002; Norcliffe-Kaufmann et al, 2014; Palma et al, 2017; Pavelic et al, 2017; Umehara et al, 2016). …”

Section: Autonomic Testingmentioning

confidence: 99%

Diagnosis of multiple system atrophy

Palma

Norcliffe‐Kaufmann

Kaufmann

2018

Autonomic Neuroscience

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118

114

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Multiple system atrophy (MSA) may be difficult to distinguish clinically from other disorders, particularly in the early stages of the disease. An autonomic-only presentation can be indistinguishable from pure autonomic failure. Patients presenting with parkinsonism may be misdiagnosed as having Parkinson disease. Patients presenting with the cerebellar phenotype of MSA can mimic other adult-onset ataxias due to alcohol, chemotherapeutic agents, lead, lithium, and toluene, or vitamin E deficiency, as well as paraneoplastic, autoimmune, or genetic ataxias. A careful medical history and meticulous neurological examination remain the cornerstone for the accurate diagnosis of MSA. Ancillary investigations are helpful to support the diagnosis, rule out potential mimics, and define therapeutic strategies. This review summarizes diagnostic investigations useful in the differential diagnosis of patients with suspected MSA. Currently used techniques include structural and functional brain imaging, cardiac sympathetic imaging, cardiovascular autonomic testing, olfactory testing, sleep study, urological evaluation, and dysphagia and cognitive assessments. Despite advances in the diagnostic tools for MSA in recent years and the availability of consensus criteria for clinical diagnosis, the diagnostic accuracy of MSA remains sub-optimal. As other diagnostic tools emerge, including skin biopsy, retinal biomarkers, blood and cerebrospinal fluid biomarkers, and advanced genetic testing, a more accurate and earlier recognition of MSA should be possible, even in the prodromal stages. This has important implications as misdiagnosis can result in inappropriate treatment, patient and family distress, and erroneous eligibility for clinical trials of disease-modifying drugs.

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Section: Autonomic Testingmentioning

confidence: 99%

Diagnosis of multiple system atrophy

Palma

Norcliffe‐Kaufmann

Kaufmann

2018

Autonomic Neuroscience

Self Cite

118

114

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“…As shown in Figure , the underlying factors that may contribute to dyspnea in PD are multifactorial and involve a complex interplay between the effects of the disease on the respiratory system as a whole, sensory and perceptual changes, psychological factors, medication effects and other comorbidities. Another possible contributory factor of particular relevance to orthostatic dyspnea, which has so far received little attention, is ventilation‐perfusion mismatch because of inadequate perfusion of the lung apices, which occurs in patients with orthostatic hypotension …”

Section: Dyspnea In Pd and Underlying Mechanismsmentioning

confidence: 99%

Brainstem Ventilatory Dysfunction: A Plausible Mechanism for Dyspnea in Parkinson's Disease?

et al. 2020

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Dyspnea is an under‐recognized and debilitating symptom that is reported in up to 40% of patients with Parkinson's disease and may have multiple origins. Despite its frequency, it is poorly researched, and there is a general lack of understanding of the pathophysiology of dyspnea and respiratory dysfunction in PD. Consequently, a number of PD patients are labelled as having “unexplained dyspnea.” Studies to date have focused mainly on evaluating ventilatory capacity and lung volumes, and little is known about the effects of the disease on the medullary and pontine ventilatory control centers within the brainstem. This is of particular relevance in view of neuropathological studies demonstrating early involvement of the dorsal medulla and other brainstem structures by the disease process. The possibility that impaired brainstem ventilatory control is a contributory mechanism for dyspnea and could be a premotor manifestation in some PD patients therefore warrants further attention. This review focuses on clinical, pathological, and experimental evidence for the involvement of brainstem respiratory centers in PD. We highlight the need for further research, particularly in PD patients with unexplained dyspnea. © 2020 International Parkinson and Movement Disorder Society

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“…1 OH is a common problem in patients with several medical disorders that reduce cardiac output or impair vasoconstrictor mechanisms. 2 When OH is due to impaired activation of sympathetic vasoconstrictor neurons, the condition is called neurogenic OH and is a hallmark feature of autonomic failure. 3, 4 Diagnosing neurogenic OH is important because it indicates the presence of an underlying pathology affecting autonomic neurons and has a much worse prognosis than non-neurogenic OH.…”

Section: Introductionmentioning

confidence: 99%