Objective: To clarify the responsible lesion of orthostatic hypotension (OH) in Parkinson’s disease (PD) by measuring the catecholamine level and using a cardiac MIBG scintigraphy.

Background: OH is one of the non-motor manifestations of PD. OH causes transient cerebral hypoperfusion. The presence of OH markedly impairs the quality of life of patients with PD. To date, the responsible lesion of OH in PD is still unclear.

Methods: Fourteen patients with PD from January 2014 to June 2016 were retrospectively included. All patients underwent head up tilt test (HUTT, 10min at 60 degree) and cardiac 123I-meta-iodobenzylguanidine (MIBG) scintigraphy and were measured plasma noradrenaline (NA) and vasopressin (AVP) level.  OH was defined according to a reduction of systolic blood pressure of equal to or more than 20 mmHg or diastolic BP of equal to or more than 10 mmHg within 3 minutes of HUTT.  We measured NA and AVP value three times (at the time of HUTT starting, 5 minutes later, and 10 minutes later).

Results: Six of the 14 PD patients performing HUTT showed OH.  The median heart mediastinum ratio of MIBG scintigraphy (early 1.68 vs 2.08; delay 1.3 vs 1.74) was the low tendency by PD patients with OH more than a group without OH, but there were no significant differences.  Basal plasma NA levels were normal or increased in 14 patients.  During HUTT, plasma NA levels rose in six of the 8 patients without OH in whom it was measured (75%). There was no rising in patients with OH. During HUTT, plasma AVP levels showed no reaction or low in 12 PD patients (85.7%).

Conclusions: PD causes pre and post-synaptic alterations. In this study, the main lesions that cause OH in PD might be related to central and pre-synaptic sympathetic fiber.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/where-are-the-main-lesions-that-cause-orthostatic-hypotension-in-parkinsons-disease/