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Treatment of dysautonomia in extrapyramidal disorders

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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.

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References

  1. Albanese A, Brisinda G, Bentivoglio AR, Maria G (2003) Treatment of outlet obstruction constipation in Parkinson’s disease with botulinum neurotoxin A. Am J Gastroenterol 98:1439–1440

    Article  PubMed  CAS  Google Scholar 

  2. Ashraf W, Wszolek ZK, Pfeiffer RF, Normand M, Maurer K, Srb F, Edwards LL, Quigley EM (1995) Anorectal function in fluctuating (on-off) Parkinson’s disease: evaluation by combined anorectal manometry and electromyography. Mov Disord 10:650–657

    Article  PubMed  CAS  Google Scholar 

  3. Baijens LW, Speyer R (2009) Effects of therapy for dysphagia in Parkinson’s disease: systematic review. Dysphagia 24:91–102

    Article  PubMed  Google Scholar 

  4. Barone JA (1999) Domperidone: a peripherally acting dopamine2-receptor antagonist. Ann Pharmacother 33:429–440

    Article  PubMed  CAS  Google Scholar 

  5. Benarroch EE, Schmeichel AM, Sandroni P, Low PA, Parisi JE (2006) Involvement of vagal autonomic nuclei in multiple system atrophy and Lewy body disease. Neurology 66:378–383

    Article  PubMed  CAS  Google Scholar 

  6. Berger Y, Blaivas JG, DeLaRocha ER, Salinas JM (1987) Urodynamic findings in Parkinson’s disease. J Urol 138:836–838

    PubMed  CAS  Google Scholar 

  7. Bleasdale-Barr KM, Mathias CJ (1998) Neck and other muscle pains in autonomic failure: their association with orthostatic hypotension. J R Soc Med 91:355–359

    PubMed  CAS  Google Scholar 

  8. Braak H, Ghebremedhin E, Rub U, Bratzke H, Del Tredici K (2004) Stages in the development of Parkinson’s disease-related pathology. Cell Tissue Res 318:121–134

    Article  PubMed  Google Scholar 

  9. Chandiramani VA, Palace J, Fowler CJ (1997) How to recognize patients with parkinsonism who should not have urological surgery. Br J Urol 80:100–104

    PubMed  CAS  Google Scholar 

  10. Chaudhuri KR, Ellis C, Love-Jones S, Thomaides T, Clift S, Mathias CJ, Parkes JD (1997) Postprandial hypotension and parkinsonian state in Parkinson’s disease. Mov Disord 12:877–884

    Article  PubMed  CAS  Google Scholar 

  11. Djaldetti R, Baron J, Ziv I, Melamed E (1996) Gastric emptying in Parkinson’s disease: patients with and without response fluctuations. Neurology 46:1051–1054

    PubMed  CAS  Google Scholar 

  12. Edwards LL, Pfeiffer RF, Quigley EM, Hofman R, Balluff M (1991) Gastrointestinal symptoms in Parkinson’s disease. Mov Disord 6:151–156

    Article  PubMed  CAS  Google Scholar 

  13. Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P (2002) Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia 17:139–146

    Article  PubMed  Google Scholar 

  14. Freeman R (2008) Clinical practice. Neurogenic orthostatic hypotension. N Engl J Med 358:615–624

    Article  PubMed  CAS  Google Scholar 

  15. Friedenberg FK, Parkman HP (2007) Advances in the management of gastroparesis. Curr Treat Options Gastroenterol 10:283–293

    Article  PubMed  Google Scholar 

  16. Friedenberg FK, Parkman HP (2006) Delayed gastric emptying: whom to test, how to test, and what to do. Curr Treat Options Gastroenterol 9:295–304

    Article  PubMed  Google Scholar 

  17. Friedrich C, Rudiger H, Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Globas C, Schols L, Berg D, Reichmann H, Ziemssen T (2010) Baroreflex sensitivity and power spectral analysis during autonomic testing in different extrapyramidal syndromes. Mov Disord 25:315–324

    PubMed  Google Scholar 

  18. Friedrich C, Rudiger H, Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Globas C, Schols L, Berg D, Reichmann H, Ziemssen T (2008) Baroreflex sensitivity and power spectral analysis in different extrapyramidal syndromes. J Neural Transm 115:1527–1536

    Article  PubMed  CAS  Google Scholar 

  19. Goldstein DS, Holmes CS, Dendi R, Bruce SR, Li ST (2002) Orthostatic hypotension from sympathetic denervation in Parkinson’s disease. Neurology 58:1247–1255

    PubMed  CAS  Google Scholar 

  20. Goldstein DS, Pechnik S, Holmes C, Eldadah B, Sharabi Y (2003) Association between supine hypertension and orthostatic hypotension in autonomic failure. Hypertension 42:136–142

    Article  PubMed  CAS  Google Scholar 

  21. Hunter PC, Crameri J, Austin S, Woodward MC, Hughes AJ (1997) Response of parkinsonian swallowing dysfunction to dopaminergic stimulation. J Neurol Neurosurg Psychiatry 63:579–583

    Article  PubMed  CAS  Google Scholar 

  22. Hyson HC, Johnson AM, Jog MS (2002) Sublingual atropine for sialorrhea secondary to parkinsonism: a pilot study. Mov Disord 17:1318–1320

    Article  PubMed  Google Scholar 

  23. Jansen RW, Lipsitz LA (1995) Postprandial hypotension: epidemiology, pathophysiology, and clinical management. Ann Intern Med 122:286–295

    PubMed  CAS  Google Scholar 

  24. Jost WH (2003) Autonomic dysfunctions in idiopathic Parkinson’s disease. J Neurol 250 Suppl 1:I28–I30

    PubMed  Google Scholar 

  25. Jost WH, Schimrigk K (1997) Long-term results with cisapride in Parkinson’s disease. Mov Disord 12:423–425

    Article  PubMed  CAS  Google Scholar 

  26. Kaufmann H (1996) Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy. Clin Auton Res 6:125–126

    Article  PubMed  CAS  Google Scholar 

  27. Kimber J, Mathias CJ, Lees AJ, Bleasdale-Barr K, Chang HS, Churchyard A, Watson L (2000) Physiological, pharmacological and neurohormonal assessment of autonomic function in progressive supranuclear palsy. Brain 123(Pt 7):1422–1430

    Article  PubMed  Google Scholar 

  28. Kirchhof K, Apostolidis AN, Mathias CJ, Fowler CJ (2003) Erectile and urinary dysfunction may be the presenting features in patients with multiple system atrophy: a retrospective study. Int J Impot Res 15:293–298

    Article  PubMed  CAS  Google Scholar 

  29. Lamarre-Cliche M, Souich P, Champlain J, Larochelle P (2008) Pharmacokinetic and pharmacodynamic effects of midodrine on blood pressure, the autonomic nervous system, and plasma natriuretic peptides: a prospective, randomized, single-blind, two-period, crossover, placebo-controlled study. Clin Ther 30:1629–1638

    Article  PubMed  CAS  Google Scholar 

  30. Lemack GE, Dewey RB Jr, Roehrborn CG, O’Suilleabhain PE, Zimmern PE (2000) Questionnaire-based assessment of bladder dysfunction in patients with mild to moderate Parkinson’s disease. Urology 56:250–254

    Article  PubMed  CAS  Google Scholar 

  31. Lertxundi U, Peral J, Mora O, Domingo-Echaburu S, Martinez-Bengoechea MJ, Garcia-Monco JC (2008) Antidopaminergic therapy for managing comorbidities in patients with Parkinson’s disease. Am J Health Syst Pharm 65:414–419

    Article  PubMed  Google Scholar 

  32. Lewy FH (1913) Zur pathologischen Anatomie der Paralysis agitans. Dtsch Z Nervenheilk 50:50–55

    Google Scholar 

  33. Lieberman AN, Horowitz L, Redmond P, Pachter L, Lieberman I, Leibowitz M (1980) Dysphagia in Parkinson’s disease. Am J Gastroenterol 74:157–160

    PubMed  CAS  Google Scholar 

  34. Logemann JA, Gensler G, Robbins J, Lindblad AS, Brandt D, Hind JA, Kosek S, Dikeman K, Kazandjian M, Gramigna GD, Lundy D, McGarvey-Toler S, Miller Gardner PJ (2008) A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson’s disease. J Speech Lang Hear Res 51:173–183

    Article  PubMed  Google Scholar 

  35. Maranki J, Parkman HP (2007) Gastric electric stimulation for the treatment of gastroparesis. Curr Gastroenterol Rep 9:286–294

    Article  PubMed  Google Scholar 

  36. Mathias CJ, Senard JM, Braune S, Watson L, Aragishi A, Keeling JE, Taylor MD (2001) l-threo-dihydroxyphenylserine (l-threo-DOPS; droxidopa) in the management of neurogenic orthostatic hypotension: a multi-national, multi-center, dose-ranging study in multiple system atrophy and pure autonomic failure. Clin Auton Res 11:235–242

    Article  PubMed  CAS  Google Scholar 

  37. Maule S, Papotti G, Naso D, Magnino C, Testa E, Veglio F (2007) Orthostatic hypotension: evaluation and treatment. Cardiovasc Hemato Disord Drug Targets 7:63–70

    CAS  Google Scholar 

  38. McKee RF, McEnroe L, Anderson JH, Finlay IG (1999) Identification of patients likely to benefit from biofeedback for outlet obstruction constipation. Br J Surg 86:355–359

    Article  PubMed  CAS  Google Scholar 

  39. Micieli G, Tosi P, Marcheselli S, Cavallini A (2003) Autonomic dysfunction in Parkinson’s disease. Neurol Sci 24 Suppl 1:S32–S34

    Article  PubMed  CAS  Google Scholar 

  40. Naumann M, Jost W (2004) Botulinum toxin treatment of secretory disorders. Mov Disord 19 Suppl 8:S137–S141

    Article  PubMed  Google Scholar 

  41. Pal PK, Calne DB, Calne S, Tsui JK (2000) Botulinum toxin A as treatment for drooling saliva in PD. Neurology 54:244–247

    PubMed  CAS  Google Scholar 

  42. Papatsoris AG, Papapetropoulos S, Singer C, Deliveliotis C (2007) Urinary and erectile dysfunction in multiple system atrophy (MSA). Neurourol Urodyn

  43. Parkinson J (1817) An essay on shaking palsy. Sherwood, Neely and Jones, London

    Google Scholar 

  44. Peralta C, Stampfer-Kountchev M, Karner E, Kollensperger M, Geser F, Wolf E, Seppi K, Benke T, Poewe W, Wenning GK (2007) Orthostatic hypotension and attention in Parkinson’s disease with and without dementia. J Neural Transm 114:585–588

    Article  PubMed  CAS  Google Scholar 

  45. Pfeiffer RF (2003) Gastrointestinal dysfunction in Parkinson’s disease. Lancet Neurol 2:107–116

    Article  PubMed  Google Scholar 

  46. Pursiainen V, Haapaniemi TH, Korpelainen JT, Sotaniemi KA, Myllyla VV (2007) Sweating in Parkinsonian patients with wearing-off. Mov Disord 22:828–832

    Article  PubMed  Google Scholar 

  47. Rabine JC, Barnett JL (2001) Management of the patient with gastroparesis. J Clin Gastroenterol 32:11–18

    Article  PubMed  CAS  Google Scholar 

  48. Reichmann H, Ziemssen T (2009) Treatment strategies for nonmotor manifestations of Parkinson’s disease. Expert Opin Pharmacother 10:773–784

    Article  PubMed  CAS  Google Scholar 

  49. Reimann M, Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Globas C, Schoels L, Reichmann H, Berg D, Ziemssen T (2010) Comprehensive autonomic assessment does not differentiate between Parkinson’s disease, multiple system atrophy and progressive supranuclear palsy. J Neural Transm 117:69–76

    Article  PubMed  Google Scholar 

  50. Robertson D (2008) The pathophysiology and diagnosis of orthostatic hypotension. Clin Auton Res 18 Suppl 1:2–7

    Article  PubMed  Google Scholar 

  51. Robertson DR, Renwick AG, Macklin B, Jones S, Waller DG, George CF, Fleming JS (1992) The influence of levodopa on gastric emptying in healthy elderly volunteers. Eur J Clin Pharmacol 42:409–412

    PubMed  CAS  Google Scholar 

  52. Sage JI, Mark MH (1994) Basic mechanisms of motor fluctuations. Neurology 44:S10–S14

    PubMed  CAS  Google Scholar 

  53. Sakakibara R, Uchiyama T, Yamanishi T, Shirai K, Hattori T (2008) Bladder and bowel dysfunction in Parkinson’s disease. J Neural Transm 115:443–460

    Article  PubMed  CAS  Google Scholar 

  54. Schestatsky P, Valls-Sole J, Ehlers JA, Rieder CR, Gomes I (2006) Hyperhidrosis in Parkinson’s disease. Mov Disord 21:1744–1748

    Article  PubMed  Google Scholar 

  55. Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Globas C, Schols L, Antoni S, Ferger D, Reichmann H, Wilhelm H, Berg D, Ziemssen T (2007) Pupil diameter in darkness differentiates progressive supranuclear palsy (PSP) from other extrapyramidal syndromes. Mov Disord 22:2123–2126

    Article  PubMed  Google Scholar 

  56. Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Globas C, Schöls L, Reichmann H, Berg D, Ziemssen T (2008) Autonomic dysfunction in different subtypes of multiple system atrophy. Mov Disord 23:1766–1772

    Article  PubMed  Google Scholar 

  57. Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Globas C, Schöls L, Reichmann H, Berg D, Ziemssen T (2009) Loss of nocturnal blood pressure fall in various extrapyramidal syndromes. Mov Disord 24:2136–2142

    Article  PubMed  Google Scholar 

  58. Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Globas C, Schöls L, Reichmann H, Berg D, Ziemssen T (2009) Valsalva manoeuvre in patients with extrapyramidal disease. J Neural Transm 116:875–880

    Article  PubMed  CAS  Google Scholar 

  59. Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Reichmann H, Berg D, Ziemssen T (2008) Autonomic dysfunction in patients with progressive supranuclear palsy. Mov Disord 23:2083–2089

    Article  PubMed  Google Scholar 

  60. Shibao C, Gamboa A, Diedrich A, Biaggioni I (2006) Management of hypertension in the setting of autonomic dysfunction. Curr Treat Options Cardiovasc Med 8:105–109

    Article  PubMed  Google Scholar 

  61. Stocchi F, Badiali D, Vacca L, D’Alba L, Bracci F, Ruggieri S, Torti M, Berardelli A, Corazziari E (2000) Anorectal function in multiple system atrophy and Parkinson’s disease. Mov Disord 15:71–76

    Article  PubMed  CAS  Google Scholar 

  62. Swinn L, Schrag A, Viswanathan R, Bloem BR, Lees A, Quinn N (2003) Sweating dysfunction in Parkinson’s disease. Mov Disord 18:1459–1463

    Article  PubMed  Google Scholar 

  63. Visser M, Marinus J, Stiggelbout AM, Van Hilten JJ (2004) Assessment of autonomic dysfunction in Parkinson’s disease: the SCOPA-AUT. Mov Disord 19:1306–1312

    Article  PubMed  Google Scholar 

  64. Wakabayashi K, Takahashi H (2006) Cellular pathology in multiple system atrophy. Neuropathology 26:338–345

    Article  PubMed  Google Scholar 

  65. Wakabayashi K, Takahashi H, Ohama E, Takeda S, Ikuta F (1993) Lewy bodies in the visceral autonomic nervous system in Parkinson’s disease. Adv Neurol 60:609–612

    PubMed  CAS  Google Scholar 

  66. Yoshioka M, Oka H, Morita M, Inoue K (2003) [Sudomotor dysfunction in Parkinson’s disease]. Rinsho shinkeigaku = Clinical neurology 43:379-384

    Google Scholar 

  67. Zangaglia R, Martignoni E, Glorioso M, Ossola M, Riboldazzi G, Calandrella D, Brunetti G, Pacchetti C (2007) Macrogol for the treatment of constipation in Parkinson’s disease. A randomized placebo-controlled study. Mov Disord 22:1239–1244

    Article  PubMed  Google Scholar 

  68. Ziemssen T, Reichmann H (2010) Cardiovascular autonomic dysfunction in Parkinson’s disease. J Neurol Sci 289:74–80

    Article  PubMed  CAS  Google Scholar 

  69. Ziemssen T, Reichmann H (2007) Non-motor dysfunction in Parkinson’s disease. Parkinsonism Relat Disord 13:323–332

    Article  PubMed  Google Scholar 

  70. Ziemssen T, Reichmann H (2010) Treatment of dysautonomia in extrapyramidal disorders. Ther Adv Neurol Disord 3:53–67

    Article  PubMed  Google Scholar 

  71. Ziemssen T, Schmidt C, Herting B, Reichmann H (2006) Autonomic dysfunction in Parkinson’s disease and Multiple System Atrophy. Akt Neurol 33:385–393

    Article  Google Scholar 

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Authors and Affiliations

  1. Autonomic and neuroendocrinological laboratory, Department of Neurology, University Clinic Carl Gustav Carus, Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany

    Tjalf Ziemssen

  2. Parkinson Clinic, Wolfach, Germany

    Gerd Fuchs

  3. Neurological clinic, HELIOS clinic Hagen-Ambrock, University Witten/Herdecke, Hagen, Germany

    Wolfgang Greulich

  4. Movement Disorders Research Group, Department of Neurology, University Clinic Carl Gustav Carus, Dresden University of Technology, Dresden, Germany

    Heinz Reichmann & Birgit Herting

  5. Neurological Clinic, Dortmund, Germany

    Michael Schwarz

  6. Neurological clinic, Diakonie hospital, Schwaebisch Hall, Germany

    Birgit Herting

Authors
  1. Tjalf Ziemssen
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  2. Gerd Fuchs
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  3. Wolfgang Greulich
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  4. Heinz Reichmann
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  5. Michael Schwarz
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  6. Birgit Herting
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Correspondence to Tjalf Ziemssen.

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This article is part of a supplement sponsored by GlaxoSmithKline.

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Ziemssen, T., Fuchs, G., Greulich, W. et al. Treatment of dysautonomia in extrapyramidal disorders. J Neurol 258 (Suppl 2), 339–345 (2011). https://doi.org/10.1007/s00415-011-5946-8

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