Brain Matters

The autonomic system regulates:

• * blood pressure
• * body temperature
• * heart rate
• * sweating
• * eye blinking
• * swallowing
• * urinary system
• * bowel system
• * erectile system (in men)

In atypical parkinsonism disorders, any of these things can become dysfunctional.  Autonomic dysfunction is most severe in MSA.

Blood pressure

Orthostatic hypotension means lightheadedness upon standing from a seated or prone (lying down) position.

Most (but not all) those with MSA experience OH.  One diagnostic criterion for MSA is:

orthostatic decrease of blood pressure within 3 minutes of standing by at least 30 mm Hg systolic or 15 mm Hg diastolic

Studies show that about 40% of those with LBD experience orthostatic hypotension.

Orthostatic hypotension is also common (30-45%) in Parkinson's Disease.  Generally speaking, the OH seen in PD is not as severe as the OH seen in MSA.  The standard definition of orthostatic hypotension is:

orthostatic decrease of blood pressure within 3 minutes of standing by at least 20 mm Hg systolic or 10 mm Hg diastolic

Read more about orthostatic hypotension

Body temperature

This is a common issue in MSA.  Often those with MSA have a normal body temperature of 96 degrees.  It's important to know what your normal body temperature is so that it's easier to determine if you have a fever.

Sweating

Issues with sweating can occur in all of the atypical parkinsonism disorders.  There can be several kinds of issues.

Hyperhidrosis is when there's excessive sweating.  This is also called diaphoresis.

Anhidrosis is when there is a lack of sweating.  This can be a dangerous situation if someone goes outside on a hot day and, because the body doesn't sweat, the person can become over-heated.  If the person can't avoid the heat, this problem can be addressed with ice packs or by wearing a special vest that has pockets for ice packs.

Anhidrosis is evaluated through a thermoregulatory sweat test (TST).

In MSA, anhidrosis can occur over the entire body while in Parkinson's Disease it might occur in the limbs.

Swallowing

We swallow saliva and secretions automatically throughout the day.  In atypical parkinsonism disorders, this automatic ability can be compromised, resulting in drooling (sialorrhea).  Studies in those with Parkinson's Disease demonstrate that drooling is due to a decreased frequency of swallowing rather than the over-production of saliva.

Read more about drooling

Difficulty swallowing is called dysphagia.  Dysphagia can occur in all of the atypical parkinsonism disorders.  Compared to Parkinson's Disease, dysphagia occurs earlier in the atypical parkinsonism disorders.

Read more about dysphagia

Urinary system

Bladder dysfunction can include both urinary frequency and urgency.  Frequency usually means the need to urinate every two hours.  Incontinence is involuntary bladder emptying -- either partial or total emptying.

These are common problems in all of the atypical parkinsonism disorders.  Most with MSA experience dysfunctional bladder control.

Read more about urinary incontinence

Bowel system

Bowel dysfunction can include constipation and reduced motility.

Read more about constipation

Erectile system

Most (but not all) men with MSA experience erectile dysfunction.  This is often a first symptom of MSA in men.