Autonomic dysfunction in de novo patients with idiopathic Parkinson’s disease and multiple system atrophy

J Korean Neurol Assoc > Volume 16(6); 1998 > Article

Journal of the Korean Neurological Association 1998;16(6): 851-858.

치료 받은 적이 없는 특발성 파킨슨 씨 병 (idiopathic Parkinson’s disease)과 다계통 위축증 (multiple system atrophy) 환자에서의 자율 신경 기능 부전

김원찬, 이현정, 양진우, 이명식*

영동 세브란스 병원 신경과, 연세 대학교 의과 대학

Autonomic dysfunction in de novo patients with idiopathic Parkinson’s disease and multiple system atrophy

Won Chan Kim, M.D., Hyun Jeong Lee, M.D., Jin Woo Yang, M.D., Myung Sik Lee, M.D.

Department of Neurology, Youngdong Severance Hospital, Yonsei University College of Medicine.

Abstract

Background : In the previous literature, about 70-80% of patients with parkinsonism or Parkinson’s disease have autonomic dysfunction. However, most of such studies did not differentiate patients with multiple system atrophy (MSA) from those with idiopathic Parkinson’s disease (IPD). Moreover, many of the patients included in the previous studies had already been on antiparkinsonian medication when they were examined. Therefore, we analyzed cardiovascular autonomic function in de novo patients with IPD and MSA to define the value of autonomic function tests for the differential diagnosis between IPD and MSA. Methods : To exam the sympathetic cardiovascular function, we measured the blood pressure changes after standing-up and isometric exercise. We also examined the parasymathetic control of the cardiovascular function by mesuring the heart rate changes after standing-up; heart rate changes during deep breathing and during Valsalva maneuver in 37 untreated patients with parkinsonian syndrome (26 with IPD and 11 with MSA). Results : Mean of the age, disease duration, age of onset, and UPDRS score were not significantly different between patients with IPD and MSA. Twenty four of the 26 with IPD and all 11 with MSA showed abnormalities in more than one of the 5 autonomic function tests. A significant difference between patients with IPD and MSA was found only in heart rate variability during deep breathing. Conclusions : Among the 5 cardiovascular autonomic function tests, only measurements of heart rate variability during deep breathing had some values for the differential diagnosis between IPD and MSA. Key Words : Idiopathic Parkinson’s disease, Multiple system atrophy, Autonomic failure, Cardiovascular autonomic function tests