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Autonomic nervous system testing may not distinguish multiple system atrophy from Parkinson’s disease

Department of Neurology, University Hospitals of Cleveland and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA

Correspondence to:
Correspondence to:
Dr David Riley, Department of Neurology, University Hospitals of Cleveland, 11100 Euclid Ave, Cleveland, Ohio 44106, USA;
david.riley{at}uhhs.com

Objective: To characterise the profiles of autonomic disturbances in patients in whom the diagnosis of Parkinson’s disease or MSA used criteria other than autonomic dysfunction.

Methods: 47 patients with parkinsonism and autonomic symptoms who had undergone autonomic laboratory testing were identified and their case records reviewed for non-autonomic features. They were classified clinically into three diagnostic groups: Parkinson’s disease (19), MSA (14), and uncertain (14). The performance of the patients with Parkinson’s disease was compared with that of the MSA patients on five autonomic tests: RR variation on deep breathing, heart rate changes with the Valsalva manoeuvre, tilt table testing, the sudomotor axon reflex test, and thermoregulatory sweat testing.

Results: None of the tests distinguished one group from the other with any statistical significance, alone or in combination. Parkinson’s disease and MSA patients showed similar patterns of autonomic dysfunction on formal testing of cardiac sympathetic and parasympathetic, vasomotor, and central and peripheral sudomotor functions.

Conclusions: This study supports the clinical observation that Parkinson’s disease is often indistinguishable from MSA when it involves the autonomic nervous system. The clinical combination of parkinsonism and dysautonomia is as likely to be caused by Parkinson’s disease as by MSA. Current clinical criteria for Parkinson’s disease and MSA that direct patients with dysautonomia into the MSA group may be inappropriate.

Keywords: Parkinson's disease; multiple system atrophy; autonomic nervous system

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