Treatment of dysautonomia in extrapyramidal disorders

Abstract

Although extrapyramidal diseases are commonly thought to solely affect the (extrapyramidal) motor system, non-motor symptoms such as behavioural abnormalities, dysautonomia, sleep disturbances and sensory dysfunctions are also frequently observed. Autonomic dysfunction is an important clinical component of extrapyramidal disease, but it is often not formally assessed, and thus frequently misdiagnosed. Symptoms of autonomic dysfunction can impact more on quality of life than motor symptoms. Appropriate symptom-oriented diagnosis and symptomatic treatment as part of an interdisciplinary approach can greatly benefit the patient. This review elaborates a limited overview on the treatment of cardiovascular, gastrointestinal, urogenital and sudomotor autonomic dysfunction in various extrapyramidal syndromes.

The effects of neuropeptide urocortin 2 on the spontaneous discharge and glutamatergic neurotransmission of striatum neurons

“…It was also suggested that UCN served to maintain sufficient functions of nigra-striatum neurons by influencing CRF receptors (Bale and Vale, 2004;Colosimo et al, 2010). These findings were of great potential significance in the treatment of PD induced by the degeneration of nigra-striatum neurons (Ziemssen et al, 2011). Our experiments suggested that in the pathological condition of PD or epilepsy, UCN2 might inhibit high frequency discharge of STR neurons and suppress GLU neuronal toxicity, thereby constraining the occurrence and development of the disease.…”

Cardiovascular autonomic testing in extrapyramidal disorders

“…This screening should include a standardized autonomic questionnaire [33], an active standing test and 24 h ABPM [26]. In the case of pathological findings, detailed autonomic testing should follow including spectral and baroflex analysis as well as passive orthostasis for the quantification of orthostatic hypotension and of supine hypertension [34]. In addition, pupillography demonstrating miosis is most useful for the diagnosis of PSP [9].…”

Nonmotor Disorders and Their Correlation With Dopamine

“…Prevalence of dysautonomia in PD patients is quite variable depending on the study population and methodology, ranging from 14% to 80%. 13 In a casecontrol study on 141 patients with PD and 50 age-matched controls, it was observed that the incidence of orthostatism (48% vs. 22%), bladder dysfunction (45% vs. 24%), erectile dysfunction (64% vs. 20%), and hyperhidrosis (46% vs. 22%) was significantly higher in the former, and in at least 50% these symptoms greatly altered the quality of life. 14…”