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The nature of the autonomic dysfunction in multiple system atrophy
Samir M Parikh1, André Diedrich, Italo Biaggioni
1Autonomic Dysfunction Center, Department of Medicine, Vanderbilt University, AA 3228 MCN, Nashville, TN 37232-2195, USA.
Journal of the Neurological Sciences
|July 20, 2002
Summary
Multiple system atrophy (MSA) is not solely autonomic failure; functioning nerves persist even in advanced stages. This understanding requires revising MSA diagnosis and treatment, potentially using bionic baroreflexes for blood pressure control.
Area of Science:
- Neuroscience
- Autonomic Neurology
Background:
- Multiple system atrophy (MSA), also known as Shy-Drager syndrome, has long been considered a disorder of the autonomic nervous system.
- Recent consensus highlights the autonomic component's centrality in MSA diagnosis, despite increased focus on its movement disorder aspects.
Purpose of the Study:
- To reexamine the autonomic pathophysiology in MSA.
- To challenge the traditional view of MSA as pure autonomic failure.
- To explore the implications of persistent autonomic tone for diagnosis and therapy.
Main Methods:
- Review of recent evidence on autonomic tone in MSA.
- Analysis of sympathetic and parasympathetic nerve function in advanced disease stages.
Main Results:
- Contrary to "autonomic failure" concept, evidence shows persistent functioning sympathetic and parasympathetic nerves in advanced MSA.
- This persistence helps explain previously poorly understood clinical features of MSA.
Conclusions:
- MSA involves persistent, constitutive autonomic tone, necessitating a revision of diagnostic and therapeutic strategies.
- Therapeutic implications include the potential development of a bionic baroreflex for improved blood pressure regulation.