Is There a Difference in Autonomic Dysfunction Between Multiple System Atrophy Subtypes?

Abstract

Background Autonomic dysfunction forms the diagnostic cornerstone in MSA. Data are limited on autonomic dysfunction differences between the two subtypes, MSA‐C and MSA‐P. Objectives To assess autonomic dysfunction in MSA subtypes and Parkinson's disease (PD) and compare it to healthy controls. Methods We conducted a cross‐sectional study. A validated questionnaire (Scales for Outcomes in Parkinson's Disease–Autonomic Dysfunction; SCOPA‐AUT) was used for symptom screening. Cardiovascular autonomic testing included deep breathing (change in heart rate, E: I ratio), Valsalva ratio, diastolic blood pressure (BP) rise (hand grip, cold pressor), and postural (tilt, 30:15 ratio) tests. Disease severity was assessed by the Unified MSA Rating Scale (UMSARS), H & Y stage, and International Parkinson and Movement Disorder Society Unified Parkinson's Disease Rating scale part III. Results MSA‐P (48 subjects; age, 63.6 ± 9.7 years; UMSARS, 45.0 ± 16.5), MSA‐C (52 subjects; age, 58.0 ± 8.1 years; UMSARS, 44.0 ± 12.8), PD (50 subjects; age, 57.6 ± 6.7 years), and healthy controls (50 subjects; age, 58.0 ± 8.0 years) were enrolled. MSA patients had higher SCOPA‐AUT scores in gastrointestinal, urinary, cardiovascular, and sexual domains than controls and in gastrointestinal, urinary, and cardiovascular domains compared to PD. The two MSA subtypes did not differ in autonomic dysfunction. Heart‐rate change on tilt and deep breathing, and diastolic BP rise on cold pressor test, differed significantly between MSA and PD patients. Conclusions Autonomic dysfunction symptomatology and cardiovascular autonomic tests were similar between MSA‐P and MSA‐C patients. Autonomic symptoms were more prominent in MSA than PD. Emphasis on these domains may improve likelihood of accurate clinical diagnosis of MSA at earlier stages.

Non-motor symptoms in multiple system atrophy: A comparative study with Parkinson's disease and progressive supranuclear palsy

“…Endoscopic evaluation of swallowing in patients with MSA and PD by Vogel et al ( 64 ) found that patients with MSA exhibited more symptoms suggestive of oral-phase disturbances (premature spillage, swallowing debris) than patients with PD, which could be the main phenotype of dysphagia in MSA. We found that the incidence of sexual dysfunction was higher in MSA than in PD, which was partially in agreement with Garg et al ( 65 ), who used SCOPA-AUT to assess autonomic dysfunction in MSA and PD and found the incidence of sexual dysfunction in MSA was higher than in PD in males, although this difference did not reach statistical significance. Patients with MSA were more likely to suffer from a lack of motivation, while patients with PSP were more likely to suffer from forgetting things or events.…”

Salivation in Parkinson's disease: A scoping review

“…The frequency of drooling ranged from 5% to 80% (Figure 4). In 18 articles, a control group was included, although three of these did not investigate whether there was a difference between the groups 40‐42 . However, 15 articles did analyse the difference between the control and patient groups, and 14 of these showed a significant difference 1,35,36,43‐53 .…”

“…In 18 articles, a control group was included, although three of these did not investigate whether there was a difference between the groups. [40][41][42] However, 15 articles did analyse the difference between the control and patient groups, and 14 of these showed a significant difference. 1,35,36,[43][44][45][46][47][48][49][50][51][52][53] The presence of drooling in the control group ranged from 0% to 17%.…”

The characteristics and alteration of peripheral immune function in patients with multiple system atrophy

“…In addition, the count of lymphocytes reflected the nutritional status predicting the prognosis of many diseases ( 24 , 25 ), while the nutritional indicators did not have a significant difference between the two groups. Moreover, the autonomic nervous system was reported to influence the distribution of lymphocytes previously, while most patients with MSA exhibited autonomic dysfunction ( 26 ). The alterations in neuroregulatory factors in MSA patients probably affect the distribution of immune cells ( 27 , 28 ).…”