Treatment of autonomic dysfunction in Parkinson disease and other synucleinopathies

ABSTRACT Dysfunction of the autonomic nervous system afflicts most patients with Parkinson disease and other synucleinopathies such as dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure, reducing quality of life and increasing mortality. For example, gastrointestinal dysf...

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Bibliographic Details
Published in:Movement disorders 2018-03, Vol.33 (3), p.372-390
Main Authors: Palma, Jose‐Alberto, Kaufmann, Horacio
Format: Article
Language:English
Subjects:
Atrophy
autonomic failure
Autonomic nervous system
Autonomic Nervous System Diseases - etiology
Autonomic Nervous System Diseases - therapy
Blood pressure
Clinical trials
Constipation
Dementia disorders
Drug therapy
Dysautonomia
Dysphagia
Fractures
Gastrointestinal diseases
Humans
Hypotension
Lewy bodies
Movement disorders
multiple system atrophy
Neurodegenerative diseases
nonmotor symptoms
Parkinson Disease - complications
Parkinson's disease
Pathophysiology
Pharmacodynamics
Quality of life
Saliva
Syncope
Synucleins - metabolism
treatment
Urinary bladder
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Summary:ABSTRACT Dysfunction of the autonomic nervous system afflicts most patients with Parkinson disease and other synucleinopathies such as dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure, reducing quality of life and increasing mortality. For example, gastrointestinal dysfunction can lead to impaired drug pharmacodynamics causing a worsening in motor symptoms, and neurogenic orthostatic hypotension can cause syncope, falls, and fractures. When recognized, autonomic problems can be treated, sometimes successfully. Discontinuation of potentially causative/aggravating drugs, patient education, and nonpharmacological approaches are useful and should be tried first. Pathophysiology‐based pharmacological treatments that have shown efficacy in controlled trials of patients with synucleinopathies have been approved in many countries and are key to an effective management. Here, we review the treatment of autonomic dysfunction in patients with Parkinson disease and other synucleinopathies, summarize the nonpharmacological and current pharmacological therapeutic strategies including recently approved drugs, and provide practical advice and management algorithms for clinicians, with focus on neurogenic orthostatic hypotension, supine hypertension, dysphagia, sialorrhea, gastroparesis, constipation, neurogenic overactive bladder, underactive bladder, and sexual dysfunction. © 2018 International Parkinson and Movement Disorder Society
ISSN:0885-3185
1531-8257
DOI:10.1002/mds.27344