This medical journal article provides a good overview of autonomic dysfunction in Parkinson’s Disease, MSA, and DLB.
The non-motor symptoms addressed include:
* orthostatic hypotension: If you are dealing with OH, I especially recommend you review Box 1, “Nonpharmacological and pharmacological treatment of orthostatic hypotension.” I’ve copied the box below as best I can.
* supine hypertension: This is probably the best overview I’ve seen.
* cardiovascular effects of antiparkinsonian drugs
* dysphagia (swallowing problems)
* gastric motor dysfunction (delayed gastric emptying). Note that the medication “Domperidone speeds up the emptying of the stomach…” This medication is not available in the US.
* constipation
* bowel dysfunction
* urinary dysfunction. I had never seen this data before: “More than 50% of MSA patients suffer from recurrent infections and a significant number (approximately 25%) die of subsequent complications.”
And this is a useful point as well: “Missclassification of urogenital autonomic dysfunction as benign prostatic hyperplasia has been reported which may increase the risk of unnecessary urological surgery.”
* sexual dysfunction
* sweating abnormalities
I suggest reading only about the symptoms or disorder of interest to you.
Wonderfully, the full article is available online at no charge via the PubMed system:
www.ncbi.nlm.nih.gov/pmc/articles/PMC3002611/
Therapeutic Advances in Neurological Disorders. 2010 Jan;3(1):53-67.
Treatment of dysautonomia in extrapyramidal disorders.
Ziemssen T, Reichmann H.
ANF Laboratory, Department of Neurology, University Clinic Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.
Again, Box 1 about orthostatic hypotension is copied below.
Robin
www.ncbi.nlm.nih.gov/pmc/articles/PMC3002611/table/table2-1756285609348902/
Box 1. Nonpharmacological and pharmacological treatment of orthostatic hypotension.
Nonpharmacological procedures
* Avoid sudden posture changes, particularly after long periods in supine position or during venodilating conditions (i.e. hot baths).
* Increase of daily salt (3-6 g NaCl) and water (2-3 l) intake.
* Diet low in carbohydrates; increase of meal frequency while meal size should be decreased.
* Isotonic exercise such as swimming, aerobic training, bicycling or walking at moderate level.
* Application of counter manoeuvres such as squatting or ‘derby chair’.
* Wearing of elastic stockings or an elastic suit.
* Raised upper body position during sleeping (15-30 cm).
Pharmacological procedures – Increase of blood volume
* Fludrocortisone initial dose of 0.1-0.2mg/d; up to a max of 1mg/d. Caution: cardiac insufficiency, hypocalcaemia, oedema.
* Erythropoietin 4000 IE s.c. twice a week. Caution: iron substitution; increase in haematocrit; hypertension.
* Desmopressin nasal application via pump spray, particularly indicated in nycturia. Caution: hyponatraemia, hypertension.
Pharmacological procedures – Increase of peripheral vasoconstriction
* Midodrine three times 2.5-10mg/d, up to a max 40mg/d; administration not later than 5 pm. Caution: supine hypertension, pruritus.
* Ephedrine three times 12.5-25mg/d. Caution: tachycardia, tremor, supine hypertension.
* Yohimbine two to three times 8mg/d p.o. Caution: diarrhoea, nervousness, panic attacks.
* Caffeine 250mg (=2 cups of coffee) in the morning. Caution: tachyphylaxia.