RT Journal Article SR Electronic T1 Central and peripheral effects of arecoline in patients with autonomic failure. JF Journal of Neurology, Neurosurgery & Psychiatry JO J Neurol Neurosurg Psychiatry FD BMJ Publishing Group Ltd SP 807 OP 812 DO 10.1136/jnnp.54.9.807 VO 54 IS 9 A1 R J Polinsky A1 R T Brown A1 M T Curras A1 S M Baser A1 C E Baucom A1 D R Hooper A1 A M Marini YR 1991 UL http://jnnp.bmj.com/content/54/9/807.abstract AB Increased plasma adrenalin (A) levels following arecoline in normal subjects and patients with multiple system atrophy (MSA) may result from nicotinic adrenal stimulation. Lack of this response in patients with pure autonomic failure (PAF) is consistent with peripheral sympathetic dysfunction. The mechanisms underlying diminished plasma corticotropin (ACTH) responses to arecoline may differ in patients with autonomic failure. Hypothalamic, cholinergic degeneration could prevent the response in MSA whereas patients with PAF do not manifest the normal increase in A which may be required to elicit an ACTH response. The appearance and exacerbation of tremor, vertigo, and pathological affect in the MSA group suggest that some central cholinergic receptors remain functional.