Objective: This study describes the results of a complete autonomic evaluation in patients with Atypical Parkinsonism without a final diagnosis conclusion, performed in a Mexican population sample.

Background: Atypical Parkinsonism (AP) are neurodegenerative disease spectrum that includes LBD, MSA, PSP and CBD that presents autonomic dysfunction (AD) (1); requesting information about AD features in the interview and an autonomic clinical examination (ACE) is essential for diagnosis. We described the autonomic approach to unspecified Parkinsonism in Mexican patients.

Method: Possible AP cases were sent to dysautonomia and small fiber Unit in 12 months. ACE, autonomic interrogatory (AI) and autonomic laboratory tools (ALT) were performed on 15 patients. All the patients were screened with an orthostatic blood pressure challenge (OBPC) (blood pressure measures seated and standing at the first, third, and fifth minutes; extension time was performed until fifteen minutes).

Results: The average age was 69 (range 55-94). AD were founded in all patients. The OBPC was positive (n=5). The later OH was found in n=12 after 10 minutes. AI findings were OH (n=8) and post-prandial hypotension (n=6) that was registered in 24-hours ABMP, bladder dysfunction (n=11), erectile dysfunction (n=7), nausea (n=5), post-prandial fullness (n=6) and constipation (n=6). In the 15 cases, n=9 presented parasympathetic failure, n=14) with severe sympathetic adrenergic failure and n=1 with parasympathetic cholinergic failure in the Sudoscan test. Otherwise, in the tilt test, (n=8) presented early neurogenic OH, and (n=4) later supine hypertension after 15 minutes of measure.

Conclusion: AI, ACE and OBPC are easily performed as screening in patients with AP features. All the patients enrolled have AD regardless of the diagnosis. ALT is the complementary approach suggested when patients have a positive screening in the clinical interview. It is reasonable to perform the protocol if the suspicion is high in individual cases because many patients have a significant offset and later develop clinical symptoms. OBPC would sometimes be unremarkable in the first 10 minutes of measure. AD considerably cause morbidity and mortality in these patients (2). Early diagnosis avoids therapeutic mistakes, changes the prognosis, and modifies the QoL in the long-term following.

References: 1. Bae HJ, Cheon SM, Kim JW. Autonomic dysfunctions in parkinsonian disorders. J Mov Disord. 2009 Oct;2(2):72-7. doi: 10.14802/jmd.09019
2. Bäckström D, Granåsen G, Domellöf ME, Linder J, Jakobson Mo S, Riklund K, Zetterberg H, Blennow K, Forsgren L. Early predictors of mortality in parkinsonism and Parkinson disease: A population-based study. Neurology. 2018 Nov 27;91(22):e2045-e2056.

« Back to 2023 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/autonomic-dysfunction-in-the-early-stages-of-atypical-parkinsonism-would-have-the-first-approach-in-the-diagnosis-a-report-of-fifteen-cases-in-the-mexican-population/