Skip to main content Accessibility help
  • Print publication year: 2014
  • Online publication date: April 2014

Chapter 24 - Dysautonomia in movement disorders

from Section V - Systemic complications of movement disorders



The autonomic nervous system (ANS) mediates neuroendocrine, visceral, and behavioral responses to environmental and inner challenges in order to ensure body homeostasis. The insular cortex, together with the medial prefrontal cortex and the extended amygdala, exerts high-order autonomic control on multiple parallel interconnections of the ANS subcortical integrative network constituted from hypothalamus, periaqueductal grey matter, parabrachial pontine complex, and ventro-lateral medullary nuclei (Benarroch 1993). Main output of the central ANS runs through pre-ganglionic sympathetic and parasympathetic cholinergic neurons, the former located in the intermediolateral columns of the thoraco-lumbar spinal cord, the latter in the brainstem and sacral spinal metameria. Parasympathetic cholinergic post-ganglionic fibers arise from ganglia which are generally located close to or within the target organ. Regional activation of parasympathetic fibers induces myosis, promotes salivation, intestinal peristalsis, vesical detrusor contraction, penis (clitoral) engorgement, and decreased heart rate. Noradrenergic sympathetic post-ganglionic neurons originate from the paravertebral ganglia and mediate midriasis, blood vessel constriction, and inotropic and cronotropic cardiac effects, among others. Further, a subgroup of cholinergic sympathetic fibers runs stimulation to cutaneous sweat glands (Goldstein 2006).

Disorders of the ANS are described as primary, if displaying a neurodegenerative origin, or secondary, if developing after brain injury of any cause or metabolic diseases like diabetes. The first report of degenerative dysautonomia dates back to 1925 when Bradbury and Egglestone described a case of orthostatic hypotension (OH) with impotence and anhidrosis of idiopathic origin (Bradbury et al. 1925). In the 1960s Shy and Drager further reported the case of two men who developed multi-domain autonomic failure along with cerebellar, parkinsonian, and pyramidal signs (Shy et al. 1960). Since then, dysautonomia (see Table 24.1) has been recognized as a major non-motor feature of multiple system atrophy (MSA), Parkinson’s disease (PD), as well as other movement disorders with prominent diagnostic, therapeutic, and prognostic implications.

Abrams, P., Cardozo, L., and Wein, A. (2011). “The 2nd International Consultation on Incontinence, Research Society meeting 2010,” Neurourol. Urodyn. 30(5): 683.
Akaogi, Y., Asahina, M., Yamanaka, Y., Koyama, Y., and Hattori, T. (2009). “Sudomotor, skin vasomotor and cardiovascular reflexes in 3 clinical forms of Lewy body disease,” Neurology 73: 59–65.
Allcock, L. M., Kenny, R. A., and Burn, D. J. (2006). “Clinical phenotype of subjects with Parkinson’s disease and orthostatic hypotension: autonomic symptom and demographic comparison,” Mov. Disord. 21: 1851–5.
Andrich, J. J., Schmitz, T., Saft, C., Postert, T., Kraus, P., Epplen, J. T., et al. (2002). “Autonomic nervous system function in Huntington’s disease,” J. Neurol. Neurosurg. Psychiatry 72: 726–31.
Asahina, M., Katogiri, A., Yamanaka, Y., Akaogi, Y., Fukushima, T., Kanai, K., et al. (2010). “Spectral analysis of the heart rate variability in patients with Machado-Joseph disease,” Aut. Neurosci. 154: 99–101.
Aziz, N. A., Angielova, G. V., Marinus, J., Van Dijk, J. G., and Roos, R. A. (2010). “Autonomic symptoms in patients and pre-manifest mutation carriers of Huntington’s disease,” Eur. J. Neurol. 17: 1068–74.
Azuma, T., Uemichi, T., Funauchi, M., Nagai, Y., and Matsubara, T. (2002). “Ambulatory blood pressure monitoring in patients with spinocerebellar degeneration,” Acta Neurol. Scan. 106: 213–17.
Ballard, C., Shaw, F., McKeith, I., and Kenny, R. (1998). “High prevalence of neurovascular instability in neurodegenerative dementias,” Neurology 51: 1760–2.
Barone, P., Antonini, A., Colosimo, C., Marconi, R., Morgante, L., Avarello, T. P., et al. (2009). “The PRIAMO study: a multi center assessment of non motor symptoms and their impact on quality of life in Parkinson’s disease,” Mov. Dis. 24(11): 1641–9.
Batthacharya, K., Velickovic, M., Schilsky, M., and Kaufmann, H. (2002). “Autonomic cardiovascular reflexes in Wilson’s disease,” Clin. Auton. Res. 12: 190–2.
Benarroch, E. E. (1993). “The central autonomic network: functional organization, dysfunction and perspective,” Mayo Clin. Proc. 68: 988–1001.
Benarroch, E. E., Schmeichel, A. M., and Parisi, J. E. (2000). “Involvement of the ventrolateral medulla in parkinsonism with autonomic failure,” Neurology 54: 963–8.
Benarroch, E. E. (2003). “Brainstem in multiple system atrophy: clinicopathological correlations,” Cell. Mol. Neurobiol. 23: 519–26.
Benarroch, E. E., Schmeichel, A. M., Low, P. A., Boeve, B. F., Sandroni, P., and Parisi, J. E. (2005). “Involvement of medullary regions controlling sympathetic output in Lewy Body Disease,” Brain 128: 338–44.
Bradbury, S. and Egglestone, C. (1925). “Postural hypotension. A report of three cases,” Am. Heart J. 1: 73–86.
Braune, S. (2001). “The role of cardiac metaiodobenzylguanidine uptake in the differential diagnosis of parkinsonian syndromes,” Clinical Autonomic Research 11: 351–5.
Brockmann, K., Srulijes, K., Hauser, A. K., Schulle, K., Csoti, I., and Gasser, T. (2011). “GBA-associated PD presents with non motor characteristics,” Neurology 77: 276–80.
Brown, R. G., Lacomblez, L., Landwehmeyer, B. G., Bak, T., Uttner, I., Dubois, B., et al. (2010). “Cognitive impairment in patients with multiple system atrophy and progressive supranuclear palsy,” Brain 133(Pt. 8): 2382–93.
Castelli, L., Perozzo, P., Genesia, M. L., Torre, E., Pesore, M., Cinquepalmi, A., et al. (2004). “Sexual well being in parkinsonian patients after deep brain stimulation of the subtalamic nucleus,” J. Neurol. Neurosurg. Psychiatry 75(9): 1260–4.
Claus, D., Druschky, A., and Erbguth, F. (1995). “Botulinum toxin: influence on respiratory heart rate variation,” Mov. Dis. 10(5): 574–9.
Colosimo, C., Morgante, L., Antonini, A., Barone, P., Avarello, T. P., Bottacchi, E., et al. (2010). “Non-motor symptoms in atipica and secondary parkinsonism: the PRIAMO study,” J. Neurol. 257(1): 5–14.
Consensus Committee of the American Autonomic Society and the American Academy of Neurology (1996). “Consensus statement of the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy,” Neurology 46: 1470.
Dalmau, J., Gleichman, A., Hughes, E. G., Rossy, J. E., Peng, X., Lai, M., et al. (2008). “Anti-NMDA receptor encephalitis: case series and analysis of the effects of antibodies,” Lancet Neurol. 7(12): 1091–8.
De Boer, R., Marinus, J., Van Hilten, J., Huygen, F. J., Van Eijs, F., Van Kleef, M., et al. (2011). “Distribution of signs and symptoms of complex regional pain syndrome type I in patients meeting the diagnostic criteria of the International Association for the Study of Pain,” Eur. J. Pain 830: e1–8.
Deguchi, K., Sasaki, I., Tsukaguchi, M., Kamada, M., Touge, T., Takeuchi, H., et al. (2002). “Abnormalities of rate-corrected QT intervals in Parkinson’s disease – a comparison with multiple system atrophy and progressive supranuclear palsy,” J. Neurol. Sci. 199: 31–7.
Del Sorbo, F., Elia, A. E., De Joanna, G., Romito, L. M., Garavaglia, B., and Albanese, A. (2007). “Normal cardiovascular reflex testing in patients with parkin disease,” Mov. Dis. 22(4): 528–32.
Dressler, D. and Benecke, R. (2003). “Autonomic side effects of botulinum toxin type B treatment of cervical dystonia and hyperhidrosis,” Eur. Neurol. 49(1): 34–8.
Espay, A. J. and Chen, R. (2006). “Rigidity and spasms from autoimmune encephalomyelopathies: stiff-person syndrome,” Muscle Nerve 34(6): 677–90.
Fedorowski, A., Engstroem, G., Hedblad, B., and Melander, O. (2010). “Orthostatic hypotension predicts incidence of heart failure: the Malmö preventive project,” Am. J. Hypertension 23(11); 1209–15.
Finazzi-Agrò, E., Peppe, A., Dámico, A., Petta, F., Mazzone, P., Stanzione, P., et al. (2003). “Effects of subthalamic nucleus stimulation on urodynamic findings in patients with Parkinson’s disease,” J. Urol. 169: 1388–91.
Fotiou, D. F., Stergiou, V., Tsiptsios, D., Lithori, C., Nakou, M., and Karlovasitou, A. (2009). “Cholinergic deficiency in Alzheimer’s and Parkinson’s disease: evaluation with pupillometry,” Int. J. Psychophysiol. 73: 143–9.
Franca, M. C., D’Abreu, A., Nucci, A., and Lopes-Cerdes, I. (2010). “Clinical correlates of autonomic dysfunction in patients with Machado-Joseph disease,” Acta Neurol. Scand. 121: 422–5.
Freeman, R., Wieling, W., Axelrod, F. B., Benditt, D. G., Benarroch, E. E., Biaggioni, I., et al. (2011). “Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome,” Clin. Auton. Res. 21(2): 69–72.
Fuchs, J., Nilsson, C., Kachergus, J., Munz, M., Larsson, E. M., Schuele, B., et al. (2007). “Phenotypic variation in a large Swedish pedigree due to SNCA duplication and triplication,” Neurology 68: 916–22.
Ghika, J. and Bogousslavsky, J. (1997). “Presymptomatic hypertension is a major feature in the diagnosis of progressive supranuclear palsy,” Arch. Neurol. 54(9): 1104–9.
Giannantoni, A., Rossi, A., Mearini, E., Del Zingaro, M., Porena, M., Berardelli, A., et al. (2009). “Botulinum toxin A for overactive bladder and detrusor muscle overactivity in patients with Parkinson´s disease and multiple system atrophy,” J. Urol. 182(4): 1453–7.
Gierga, K., Buerk, K., Bauer, M., Orozco Diaz, G., Auburger, G., Schultz, C., et al. (2005). “Involvement of the cranial nerves and their nuclei in spinocerebellar ataxia type 2 (SCA2),” Acta Neuropathol. 109: 617–31.
Gilman, S., Wenning, G. K., Low, P. A., Brooks, D. J., Mathias, C. J., Trojanowski, J. Q., et al. (2008). “Second consensus statement on the diagnosis of multiple system atrophy,” Neurology 71: 670–6.
Goetz, C. G. and Klawans, H. L. (1983). “On the mechanism of sudden death in Moersch-Wolfman syndrome,” Neurology 33: 930–2.
Goldstein, D. S. (2006). Adrenaline and the Inner World. An Introduction to Scientific Integrative Medicine (Baltimore, MD: John Hopkins University Press).
Goldstein, D. S., Holmes, C., Sewell, L., Pechnik, S., and Kopin, I. J. (2011). “Effects of carbidopa and entacapone on the metabolic fate of the norepinephrine prodrug L-DOPS,” J. Clin. Pharm. 51(1): 66–74.
Gu, W., Ma, H., Wang, K., Miao, J., Yongxing, Z., Xingzhou, L., et al. (2004). “The shortest expanded allele of the MJD1 gene in a Chinese MJD kindred with autonomic dysfunction,” Eur. Neurol. 52: 107–11.
Ha, A. D., Brown, C. H., York, M. K., and Jankovic, J. (2011). “The prevalence of symptomatic orthostatic hypotension in patients with Parkinson’s disease and atypical parkinsonism,” Park. Rel. Dis. 17(8): 625–8.
Haensch, C. A., Lerch, H., Jörg, J., and Isenmann, S. (2009). “Cardiac denervation occurs independent of orthostatic hypotension and impaired heart rate variability in Parkinson’s disease,” Park. Rel. Dis. 15: 134–7.
Halim, A., Baumgartner, L., and Binder, D. K. (2011). “Effect of deep brain stimulation on autonomic dysfunction in patients with Parkinson’s disease,” J. Clin. Neurosci. 18: 804–6.
Harrington, C. R., Perry, H. R., Perry, E. K., Hurt, J., Mc Keith, I. G., Roth, M., et al. (1994). “Senile dementia of Lewy body type and Alzheimer type are biochemically distinct in terms of paired helical filaments and hyperphosphorylated tau protein,” Dementia 5: 215–28.
Herzog, J., Weiss, P. H., Assmus, A., Wefer, B., Seif, C., Braun, P. M., et al. (2008). “Improved sensory gaiting of urinary bladder afferents in Parkinson’s disease following subthalamic stimulation,” Brain 131: 132–45.
Hirayama, M., Hakusui, S., Koike, Y., Ito, K., Kato, T., Ikeda, M., et al. (1995). “A scintigraphical qualitative analysis of peripheral vascular sympathetic function with meta-[123I]iodobenzylguanidine in neurological patients with autonomic failure,” J. Auton. Nerv. Syst. 53: 230–4.
Hori, N., Takamori, M., Hirayama, M., Watanabe, H., Nakamura, T., and Yamashita, F. (2008). “Pupillary supersensitivity and visual disturbance in Parkinson’s disease,” Clin. Auton. Res. 18: 20–7.
Horimoto, Y., Matsumato, M., Akatsu, H., Ikari, H., Kojima, K., and Yamamoto, T. (2003). “Autonomic dysfunctions in dementia with Lewy bodies,” J. Neurol. 250: 530–3.
Hussain, I. F., Brady, C. M., Swinn, M. S., Mathias, C. J., and Fowler, C. J. (2001). “Treatment of erectile dysfunction with sildenafil citrate (Viagra) in Parkinsonism due to Parkinson’s disease or multiple system atrophy with observations on orthostatic hypotension,” J. Neurol. Neurosurg. Psychiatry 71(3): 371–4.
Idiaquez, J. and Roman, G. C. (2011). “Autonomic dysfunction in neurodegenerative dementias,” J. Neurol. Sci. 305: 22–7.
James, T. N., Cobbs, B. W., Coghlan, H. C., McCoy, W. C., and Fisch, C. (1987). “Coronary disease, cardioneuropathy and conduction system abnormalities in the cardiomyopathy of Friedreich’s ataxia,” Br. Heart J. 57: 446–57.
Jankovic, J., Gilden, J. L., Hiner, B. C., Kaufmann, H., Brown, D. L., Coghlan, C. H., et al. (1993). “Neurogenic orthostatic hypotension: a double-blind, placebo-controlled study with Midodrine,” Am. J. Med. 95(1): 38–48.
Jansen, R. W., Connelly, C. M., Kelley-Gagnon, M. M., Parker, J. A., and Lipsitz, L. A. (1995). “Post-prandial hypotension in elderly patients with unexplained syncope,” Arch. Intern. Med. 155(9): 945–52.
Jecmenica-Lukic, M., Poewe, W., Tolosa, E., and Wenning, G. K. (2012). “Premotor signs and symptoms of multiple system atrophy,” Lancet Neurol. 11(4): 361–8.
Jost, W. H., Mueller-Lobeck, H., and Merkle, W. (1998). “Involuntary contractions of the striated anal sphincters as a cause of constipation: report of a case,” Dis. Colon Rectum 41(2): 258–60.
Kaufmann, H., Nahm, K., Purohit, D., and Wolfe, D. (2004). “Autonomic failure as the initial presentation of Parkinson disease and dementia with Lewy bodies,” Neurology 63: 1093–5.
Kaufmann, H. and Goldstein, D. S. (2010). “Pure autonomic failure: a restricted Lewy body synucleinopathy or early Parkinson disease?Neurology 74: 536–7.
Kay, G. G. and Ebinger, L. (2008). “Preserving cognitive function for patients with overactive bladder: evidence for differential effect with darifenacin,” Int. J. Clin. Pract. 62(11): 1792–800.
Kazuta, T., Hayashi, M., Shimizu, T., Iwasaki, A., Nakamura, S., and Hirai, S. (2000). “Autonomic dysfunction in Machado-Joseph disease assessed by iodine 123-labeled MIBG myocardial scintigraphy,” Clin. Aut. Res. 10(3): 111–15.
Kenny, R. A., Shaw, F. E., O’Brien, J. T., Scheltens, P. H., Kalaria, R., and Ballard, C. (2004). “Carotid sinus syndrome is common in dementia with Lewy bodies and correlates with deep white matter lesions,” J. Neurol. Neurosurg. Psychiatry 75: 966–71.
Kikkawa, Y., Asahina, M., Suzuki, A., and Hattori, T. (2003). “Cutaneous sympathetic function and cardiovascular function in patients with progressive supranuclear palsy and Parkinson’s disease,” Park. Rel. Dis. 10: 101–6.
Kimber, J., Mathias, C. J., Lees, A. J., Bleasdale-Barr, K., Chang, H. S., Churchyard, A., et al. (2000). “Physiological, pharmacological and neurohormonal assessment of autonomic function in progressive supranuclear palsy,” Brain 123(7): 1422–30.
Kobal, J., Meglic, B., Mesec, A., and Peterlin, B. (2004). “Early sympathetic hyperactivity in Huntington’s disease,” Eur. J. Neurol. 11: 842–8.
Köllensperger, M., Stampfer-Kountchev, M., Seppi, K., Geser, F., Frick, C., Del Sorbo, F., et al. (2007). “Progression of dysautonomia in multiple system atrophy: a prospective study of self-perceived impairment,” Eur. L. Neurol. 14(1): 66–72.
Köllensperger, M., Krismer, F., Pallua, A., Stefanova, N., Poewe, W., and Wenning, G. K. (2011). “Erythropoietin is neuroprotective in a transgenic mouse model of multiple system atrophy,” Mov. Dis. 26(3): 507–15.
Kurata, T., Kametaka, S., Ohta, Y., Morimoto, M., Deguchi, K., Ikeda, Y., et al. (2011). “PSP as distinguished from CBD, MSA-P and PD by clinical and imaging differences at an early stage,” Intern. Med. 50(22): 2775–81.
Kwon, O. Y., Kim, S. H., Kim, J. H., Kim, M. O., and Ko, M. K. (1994). “Schirmer test in Parkinson’s disease,” J. Kor. Med. Sci. 9(3): 239–42.
Lim, T. S., Lee, P. H., Kim, H. S., and Yong, S. W. (2009). “White matter hyperintensities in patients with multiple system atrophy,” J. Neurol. 256: 1663–70.
Lin, I., Wu, R. M., Lee-Chen, G. J., Shon, D. E., and Gwinn-Hardy, K. (2007). “The SCA17 phenotype can include features of MSA-C, PSP and cognitive impairment,” Park. Rel. Dis. 13: 246–9.
Linder, J., Libelius, R., Nordh, E., Holmberg, B., Stenlurd, H., and Forsgren, L. (2012). “Anal sphincter electromyography in patients with newly diagnosed idiopathic parkinsonism,” Acta Neurol. Scand. [E-pub ahead of print].
Lipp, A., Sandroni, P., Ahlskog, J., Fealey, R. D., Kimpinski, K., Iodice, V., et al. (2009). “Prospective differentiation of multiple system atrophy from Parkinson’s disease, with and without autonomic failure,” Arch. Neurol. 66(6): 742–50.
Marion, M. H., Klap, P., Perrin, A., and Cohen, M. (1992). “Stridor and focal laryngeal dystonia,” Lancet Neurol. 339: 457–9.
Mathias, C. J. (2008). “L-dihydroxyphenylserine (Droxidopa) in the treatment of orthostatic hypotension: the European experience,” Clin. Auton. Res. 18(Suppl. 1): 25–9.
McKeith, I. G., Dickson, D. W., Lowe, J., Emre, M., O’Brien, J. T., Feldman, H., et al. (2005). “Diagnosis and management of dementia with Lewy bodies. Third report of DLB consortium,” Neurology 65: 1863–72.
Meenakshi-Sundaram, S., Taly, A. B., Kamath, V., Arunodaya, G. R., Rao, S., and Swamy, H. S. (2002). “Autonomic dysfunction in Wilson’s disease – a clinical and electrophysiological study,” Clin. Auton. Res. 12: 185–9.
Montes-Brown, J., Sanchez-Cruz, J., Garcia, A. M., Boez, M. M. E., and Velazquez-Perez, L. (2010). “Heart rate variability in type 2 spinocerebellar ataxia,” Acta Neurol. Scand. 122: 329–35.
Montes-Brown, J., Machado, A., Estevez, M., Corricarte, C., and Velazquez-Perez, L. (2012). “Autonomic dysfunction in presymptomatic spinocerebellar ataxia type-2,” Acta Neurol. Scand. 125: 24–9.
Mostile, G. and Jankovic, J. (2009). “Treatment of dysautonomia associated with Parkinson’s disease,” Park. Rel. Disord. 15(Suppl. 3): S224–32.
Nardulli, R., Monirillo, V., Losquio, E., Fiore, P., Nicolardi, G., and Megna, G. (1992). “Urodynamic evaluation of 12 ataxic subjects: neurophysiopathologic consideration,” Funct. Neurol. 7: 223–5.
Nazif, T. M., Vazquez, J., Hong, L. S., and Dizon, J. M. (2012). “Anti-N-methyl-D-aspartate receptor encephalitis: an emerging cause of centrally mediated sinus node dysfunction,” Europace [E-pub. ahead of print].
Nebe, A., Schelosky, L., Wissel, J., Ebersbach, G., Scholz, U., and Poewe, W. (1996). “No effects on heart-rate variability and cardiovascular reflex tests after botulinum toxin treatment of cervical dystonia,” Mov. Dis. 11(3): 337–9.
Netravathi, M., Sathyaprabha, T. N., Jayalaxmi, K., Datta, P., Nirmala, M., and Pal, P. K. (2009). “A comparative study of cardiac dysautonomia in autosomal dominant spinocerebellar ataxias and idiopathic sporadic ataxias,” Acta Neurol. Scand. 120: 204–9.
Nolano, M., Provitera, V., Crisci, C., Saltalamacchia, A. M., Wendelschafer-Crabb, G., Kennedy, W. R., et al. (2001). “Small fibers involvement in Friedreich’s ataxia,” Ann. Neurol. 50: 17–25.
Oertel, W. H., Waechter, T., Quinn, N., Ulm, G., and Brandstaedter, D. (2003). “Reduced genital sensitivity in female patients with multiple system atrophy of parkinsonian type,” Mov. Dis. 18(4): 430–2.
Orimo, S., Kanazawa, T., Nakamura, A., Uchihara, T., Mori, F., Kakita, A., et al. (2007). “Degeneration of cardiac sympathetic nerve can occur in multiple system atrophy,” Acta Neuropathol. 113: 81–6.
Orimo, S., Uchihara, T., Nakamura, A., Mori, F., Kakita, A., Wakabayashi, K., et al. (2008). “Axonal α-synuclein aggregates herald centripetal degeneration of cardiac sympathetic nerve in Parkinson’s disease,” Brain 131: 642–50.
Orimo, S., Uchihara, T., Nakamura, A., Mori, F., Ikeuchi, T., Onodera, O., et al. (2008). “Cardiac sympathetic denervation in Parkinson’s disease linked to SNCA duplication,” Acta Neuropathol. 116: 575–7.
O’Sullivan, S. S., Massey, L. A., Williams, D. R., Silveira-Moriyama, L., Kempster, P. A., and Holton, J. L. (2008). “Clinical outcomes of progressive supranuclear palsy and multiple system atrophy,” Brain 131: 1362–72.
Papatsoris, A. G., Papapetropoulos, S., Singer, C., and Delivetiolis, C. (2008). “Urinary and erectile dysfunction in multiple system atrophy,” Neurourol. Urodyn. 27: 22–7.
Papp, M. I. and Lantos, P. L. (1994). “The distribution of oligodendroglial inclusions in multiple system atrophy and its relevance to clinical symptomatology,” Brain 117: 235–43.
Peralta, C., Stampfer-Kountchev, M., Karner, E., Köllensperger, M., Geser, F., and Wolf, E. (2007). “Orthostatic hypotension and attention in Parkinson’s disease with and without dementia,” J. Neural. Transm. 114: 585–8.
Plaschke, M., Trenkwalder, P., Dahlheim, H., Lechner, C., and Trenkwalder, C. (1998). “Twenty-four-hour blood pressure profile and blood pressure responses to head-up tilt tests in Parkinson’s disease and multiple system atrophy,” J. Hypertension 16: 1433–41.
Poewe, W. (2007). “Dysautonomia and cognitive dysfunction in Parkinson’s disease,” Mov. Disord. 22(Suppl. 17): S374–81.
Pousset, F., Kalotka, H., Durr, A., Isnard, R., Lechat, P., Le-Heuzey, J. Y., et al. (1996). “Parasympathetic activity in Friedreich’s ataxia,” Am. J. Card. 78: 847–50.
Pradhan, C., Yashavantha, B. S., Pal, P. K., and Sathyaprabha, T. N. (2008). “Spinocerebellar ataxia type 1, 2, 3: a study of heart rate variability,” Acta Neurol. Scand. 117: 337–42.
Raffel, D. M., Koeppe, R. A., Little, R., Wang, C. N., Liu, S., Junck, L., et al. (2006). “PET measurement of cardiac and nigrostriatal denervation in parkinsonian syndromes,” J. Nucl. Med. 47(11): 1769–77.
Rascol, O. and Schelosky, L. (2009). “123I-metaiodobenzylguanidine scintigraphy in Parkinson’s disease and related disorders,” Mov. Dis. 24(Suppl. 2): 5732–41.
Robottom, B. J., Weiner, W. J., and Factor, S. A. (2011). “Movement disorders emergencies Part 1. Hypokinetic disorders,” Arch. Neurol. 68(5): 567–72.
Rüb, U., Del Tredici, K., Schiltz, C., De Vos, R. A. I., Jansen Steuer, E., Arai, K., et al. (2002). “Progressive supranuclear palsy: neuronal and glial cytoskeletal pathology in the higher order processing autonomic nuclei of the lower brainstem,” Neuropath. App. Neurobiol. 28: 12–22.
Ruiz-Martinez, J., Gorostidi, A., Goyenechea, E., Alzualde, A., Poza, J. J., Rodriguez, F., et al. (2011). “Olfactory deficits and cardiac 123I-MIBG in Parkinson’s disease related to LRRK R1441G and G20195 mutations,” Mov. Dis. 26(11): 2026–31.
Sakakibara, R., Hattori, T., Tojo, M., Yamanishi, T., Yasuda, K., and Hirayama, K. (1993). “Micturitional disturbancies in progressive supranuclear palsy,” J. Auton. Nerv. Syst. 45: 101–6.
Sakakibara, R., Hattori, T., Uchiyama, T., Kita, K., Asahina, M., Suzuki, A., et al. (2000). “Urinary dysfunction and orthostatic hypotension in multiple system atrophy: which is the more common and earlier manifestation?J. Neurol. Neurosurg. Psychiatry 68: 65–9.
Sakakibara, R., Uchiyama, T., Yamanishi, T., and Hattori, T. (2004). “Urinary function in patients with corticobasal degeneration; comparison with normal subjects,” Neurourol. Urodyn. 23: 154–8.
Sakakibara, R., Uchiyama, T., Yamanishi, T., and Kishis, M. (2009). “Sphincter EMG as a diagnostic tool in autonomic disorders,” Clin. Aut. Res. 19: 20–31.
Sakakibara, R., Kishi, M., Ogawa, E., Tateno, F., Uchiyama, T., Yamamoto, T., et al. (2011). “Bladder, bowel and sexual dysfunction in Parkinson’s disease,” Parkinson’s Disease [E-pub ahead of print], article ID: 924605.
Sassone, J., Calciago, C., Cislaghii, G., Silani, V., and Ciammola, A. (2009). “Huntington’s disease: the current state of research with peripheral tissues,” Exp. Neurol. 219: 385–97.
Schmidt, C., Herting, B., Prieur, S., Junghanns, S., Schweitzer, K., Reichmann, H., et al. (2008). “Autonomic dysfunction in patients with progressive supranuclear palsy,” Mov. Dis. 23(14): 2083–9.
Schmidt, C., Berg, D., Herting, M. D., Prieur, S., Junghanns, S., Schweitzer, K., et al. (2009). “Loss of nocturnal blood pressure fall in various extrapyramidal syndromes,” Mov. Dis. 24: 2136–42.
Senard, J. M., Chamontin, B., Rascol, A., and Montastruc, J. L. (1992). “Ambulatory blood pressure in patients with Parkinson’s disease without and with orthostatic hypotension,” Clin. Aut. Res. 2: 99–104.
Seppi, K., Weintraub, D., Coelho, M., Perez Lloret, S., Fox, S. H., Katzenschlager, R., et al. (2011). “The Movement Disorder Society Evidence-Based Medicine Review Update: treatments for the non-motor symptoms of Parkinson’s disease,” Mov. Dis. 26:(Suppl. 3): S42–80.
Shibao, C., Gamboa, A., Abrahm, R., Raj, S. R., Diedrich, A.Black, B., et al. (2006). “Clonidine for the treatment of supine hypertension and pressure natriuresis in autonomic failure,” Hypertension 47(3): 522–6.
Shibata, M., Morita, Y., Shimizu, T., Takahashi, K., and Suzuki, N. (2009). “Cardiac parasympathetic dysfunction concurrent with cardiac sympathetic denervation in Parkinson’s disease,” J. Neurol. Sci. 276: 79–83.
Shy, G. M. and Drager, G. A. (1960). “A neurological syndrome associated with orthostatic hypotension. A clinical-pathological study,” Arch. Neurol. 2: 511–27.
Singer, W., Opfer-Gehrking, T. L., McPhee, B. R., Hilz, M. J., Bharucha, A. E., and Low, P. A. (2003). “Acetylcholinesterase inhibition: a novel approach in the treatment of neurogenic orthostatic hypotension,” J. Neurol. Neurosurg. Psychiatry 74: 1294–8.
Soni, D., Shukla, G., Singh, S., Goyal, V., and Behari, M. (2009). “Cardiovascular and sudomotor autonomic dysfunction in Wilson’s disease – limited correlation with clinical severity,” Auton. Neurosci. 151: 154–8.
Stemper, B., Berich, A., Welsch, G., Haendl, T., Sterio, D., and Hilz, M. J. (2006). “Deep brain stimulation improves orthostatic regulation of patients with Parkinson’s disease,” Neurology 67: 1781–5.
Staessen, J. A., Asmar, R., De Buyzere, M., Imay, I., Parati, G., Shimada, K., et al. (2001). “Task force II: blood pressure measurement and cardiovascular outcome,” Blood Press. Monit. 6(6): 355–70.
Swinn, L., Schrag, A., Viswanathan, R., Bloem, B. R., Lees, A., and Quinn, N. (2003). “Sweating dysfunction in Parkinson’s disease,” Mov. Dis. 18(12): 1459–63.
Tada, M., Onodera, O., Tada, M., Ozawa, T., Piao, Y. S., and Kakita, A. (2007). “Early development of autonomic dysfunction may predict poor prognosis in patients with multiple system atrophy,” Arch. Neurol. 64: 256–60.
Thaisetthawatkul, P., Boeve, B. F., Benarroch, E. E., Sandroni, P., Fernan, T. J., Petersen, R., et al. (2004). “Autonomic dysfunction in dementia with Lewy bodies,” Neurology 62: 1804–9.
Tijero, B., Gomez-Esteban, J. C., Llorens, V., Lezcaro, F., Gonzalez-Fernandez, M. C., Martinez de Pancabo, M., et al. (2010). “Cardiac sympathetic denervation precedes nigrostriatal loss in the E46K mutation of the α-synuclein gene (SNCA),” Clin. Aut. Res. 20: 267–9.
Tintner, R., Gross, R., Winzer, U. F., Smalky, K. A., and Jankovic, J. (2005). “Autonomic function after botulinum toxin type A or B: a double-blind, randomized trial,” Neurology 65: 765–7.
Tiple, D., Strano, S., Colosimo, C., Fabbrini, G., Calcagnini, G., Prencipe, M., et al. (2008). “Autonomic cardiovascular function and baroreflex sensitivity in patients with cervical dystonia receiving treatment with boulinum toxin type A,” J. Neurol. 255: 843–7.
Tison, F., Arne, P., Sourgen, C., Chrysostome, V., and Yeklef, F. (2000). “The value of external and sphincter electromyography for the diagnosis of multiple system atrophy,” Mov. Dis. 15(6): 1148–57.
Todorova, A., Vonderheid-Guth, B., and Dimpfel, W. (2001). “Effects of tolterodine, trospium chloride and oxybutinin on the central nervous system,” J. Clin. Pharm. 41(6): 636–44.
Tubani, L., Donato, G., Perciaccante, A., Baratta, L., Fiorentini, A., and Fiorilli, M. (2006). “Autonomic dysfunction in patients with ataxia-telangiectasia,” Clin. Neurophysiol. 117: 1630–5.
Umoto, M., Miwa, H., Ando, R., Kajimoto, Y., and Kondo, T. (2012). “White matter hyperintensities in patients with multiple system atrophy,” Park. Rel. Dis. 18(1): 17–20.
Van Dijk, J. G., Haan, J., Koenderink, M., and Roos, R. A. (1991). “Autonomic nervous function in progressive supranuclear palsy,” Arch. Neurol. 48(10): 1083–4.
van Rooijen, D. E., Geraedts, E. J., Marinus, J., Jankovic, J., and van Hilten, J. J. (2011). “Peripheral trauma and movement disorders: a systematic review of reported cases,” J. Neurol. Neurosurg. Psychiatry 82: 892–8.
Velseboer, D. C., De Hann, R. J., Wieling, W., Goldstein, D. S., and De Bie, R. M. (2011). “Prevalence of orthostatic hypotension in Parkinson’s disease: a systematic review and meta-analysis,” Parkinsonism Relat. Disord. 17: 724–9.
Vezina, J. G., Bouchard, J. P., and Bouchard, R. (1982). “Urodynamic evaluation of patients with hereditary ataxias,” Can. J. Neurol. Sci. 9(2): 127–9.
Vodusek, D. B. (2005). “How to diagnose MSA early: the role of sphincter EMG,” J. Neural. Transm. 112: 1657–68.
Wenning, G. K., Ben-Shlomo, Y., Magalhaes, M., Daniel, S. F., and Quinn, N. P. (1994). “Clinical features and natural history of multiple system atrophy. An analysis of 100 cases,” Brain 117(4): 835–45.
Wenning, G. K., Tison, F., Ben-Schlomo, Y., Daniel, S. E., and Quinn, N. P. (1997). “Multiple system atrophy: a review of 203 pathologically proven cases,” Mov. Disord. 12: 133–47.
Wenning, G. K., Scherfler, C., Granata, R., Boesch, S., Verny, M., Chaudhuri, K. R., et al. (1999). “Time course of symptomatic orthostatic hypotension and urinary incontinence in patients with post-mortem confirmed parkinsonian syndromes: a clinicopathological study,” J. Neurol. Neurosurg. Psychiatry 67: 620–3.
Wenning, G. K., Geser, F., and Poewe, W. (2005). “Therapeutic strategies in multiple system atrophy,” Mov. Disord. 20(Suppl. 12): 567–76.
Wenning, G. K., Granata, R., Krismer, F., Duerr, S., Seppi, K., Poewe, W., et al. (2012). “Orthostatic hypotension is differentially associated with the cerebellar versus the parkinsonian variant of multiple system atrophy: a comparative study,” Cerebellum 11(1): 223–6.
Witjas, T., Kaphan, E., Regis, J., Jouve, E., Ali-Cherif, A., Peragut, J. C., et al. (2007). “Effects of chronic subthalamic stimulation on non-motor fluctuation in Parkinson’s disease,” Mov. Dis. 22(12): 1729–34.
Yamanaka, Y., Asahina, M., Hiraga, A., and Sakakibara, R. (2007). “Over 10 years of isolated autonomic failure preceeding dementia and parkinsonism in 2 patients with Lewy body disease,” Mov. Dis. 22(4): 595–6.
Young, T. M. and Mathias, C. J. (2004). “The effects of water ingestion on orthostatic hypotension in two groups of chronic autonomic failure: multiple system atrophy and pure autonomic failure,” J. Neurol. Neurosurg. Psychiatry 75: 1737–41.