ABSTRACT
A large number of patients with Parkinson's disease were reported to have abnormal visual-evoked potentials (VEPs) and spatiotemporal contrast sensitivity (STCS) suggesting dopaminergic deficiency in the visual pathway, probably the retina. Until now, VEPs and STCS have not been studied in multiple system atrophy (MSA). We investigated 12 patients with idiopathic Parkinson's disease (IPD) and 12 patients with MSA. The age medians were 64.5 years for IPD and 63.5 years for MSA. None of the patients showed any ocular disease that could interfere with the results. Checkboard VEPs and STCS measurements to horizontal sinusoidal gratings were evaluated. Statistical analysis was performed, including Student's t test and two- or three-way analysis of variance. A significant interocular difference in spatial contrast sensitivity was observed in IPD, which was not present in MSA. VEPs were not delayed in MSA, whereas latency of the major component and the second negative deflection were increased in IPD. VEPs and STCS measurements might provide useful help for distinguishing IPD from MSA.
Subject(s)
Contrast Sensitivity/physiology , Evoked Potentials, Visual/physiology , Multiple System Atrophy/diagnosis , Orientation/physiology , Space Perception/physiology , Aged , Dopamine/physiology , Female , Humans , Male , Middle Aged , Multiple System Atrophy/physiopathology , Pattern Recognition, Visual/physiology , Photic Stimulation , Reaction Time/physiology , Retina/physiopathology , Visual Pathways/physiopathologyABSTRACT
We compared autonomic function in patients with multiple system atrophy (MSA) or with idiopathic Parkinson's disease (IPD) by measuring sympathetic skin response (SSR) and R-R interval variability (RRIV). SSR was investigated in 26 patients (13 with MSA and 13 patients with IPD). RRIV during deep breathing, Valsalva maneuver, and on standing was investigated in 20 patients (nine with MSA and 11 with IPD). MSA and IPD patients had similar age, illness duration, and therapy. Abnormal SSR was more frequent in MSA (69%) than in IPD (7.7%; x2, 10.4; p < 0.002). RRIV during deep breathing and the Valsalva maneuver was lower in MSA than in IPD (p = 0.02). RRIV during standing up was not significantly different in IPD and MSA. These differences between MSA and IPD may be due to more severe and widespread autonomic disturbance in MSA, related to more severe neuropathologic involvement of the autonomic nervous system. SSR and RRIV may aid in the differential diagnosis of parkinsonism and help to exclude from clinical trials MSA patients clinically misdiagnosed as having IPD.
Subject(s)
Arousal/physiology , Autonomic Nervous System Diseases/diagnosis , Electrocardiography , Galvanic Skin Response/physiology , Heart Rate/physiology , Olivopontocerebellar Atrophies/diagnosis , Parkinson Disease/diagnosis , Sympathetic Nervous System/physiopathology , Aged , Aged, 80 and over , Autonomic Nervous System Diseases/physiopathology , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Neurologic Examination , Olivopontocerebellar Atrophies/physiopathology , Parkinson Disease/physiopathologySubject(s)
Contrast Sensitivity/physiology , Evoked Potentials, Visual/physiology , Nervous System Diseases/physiopathology , Parkinson Disease/physiopathology , Aged , Antiparkinson Agents/therapeutic use , Atrophy/pathology , Female , Humans , Levodopa/therapeutic use , Male , Middle Aged , Motion Perception , Movement/physiology , Nervous System Diseases/pathology , Nervous System Diseases/psychology , Parkinson Disease/drug therapy , Parkinson Disease/psychology , Space Perception/physiology , Time Perception/physiology , Vision, Monocular/physiologyABSTRACT
In nine patients with orthostatic hypotension due to multiple system atrophy, the effects of octreotide (100 micrograms s.c.), a somatostatin analogue, on blood pressure (BP), heart rate (HR), and norepinephrine (NE) plasma levels after 60 degrees head up tilt test were evaluated by a randomly controlled study. Octreotide increased supine BP, tilt-test duration (+28%), and delay to obtain minimal BP during the 60 degrees head up tilt (+50%). Octreotide changed neither HR nor NE plasma levels.
Subject(s)
Hypotension, Orthostatic/drug therapy , Octreotide/therapeutic use , Aged , Blood Pressure/drug effects , Female , Heart Rate/drug effects , Humans , Hypotension, Orthostatic/physiopathology , Male , Middle AgedABSTRACT
The aim of the study was to determine the potential effect of octreotide chronic administration on the functional prognosis of patients suffering from multiple system atrophy (MSA) with orthostatic hypotension (OH). Five patients received octreotide (100 micrograms s.c. injections t.i.d.) during 6 months in an open trial. Patients experienced functional improvement after 6 months of treatment. All of them continued to receive octreotide after the 6-month evaluation period (mean duration: 12 months).
