Effect of cold oral stimulation on orthostatic hypotension in multiple system atrophy: a case study

[Purpose] The aim of this case study is to reconsider the method for preventing orthostatic hypotension in multiple system atrophy. [Participant and Methods] The case was that of a 70-year-old female with multiple system atrophy who experienced frequent falls and orthostatic hypotension. An orthostatic test was performed, and the effect of cold oral stimulation before standing was compared with no stimulation. Outcome measures were blood pressure, heart rate variability and autonomic variables. [Results] In the control test, blood pressure decreased from 150/72 mmHg in the supine position to 98/58 mmHg in the standing position. Heart rate increased from 71 bpm to 82 bpm, high frequency declined from 16.48 msec² to 14.07 msec², and low/high frequency increased from 2.56 to 5.13. Cold stimulation in the standing position induced changes in blood pressure from 168/82 mmHg to 104/72 mmHg, heart rate from 73 bpm to 83 bpm, high frequency from 61.29 msec² to 24.56 msec², and low/high frequency from 1.45 to 6.33 msec². [Conclusion] Standing after cold stimulation affected autonomic variables, but did not affect the heart rate or blood pressure, possibly because of damaged peripheral blood vessels. Further research is required to demonstrate the effect of cold stimulation on orthostatic hypotension.