Autonomic Dysfunction and Management

Richard B. Dewey, Jr.

Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.

Although Parkinson's disease (PD) is commonly regarded as a disorder of dopamine deficiency, it is actually a multisystem degenerative disorder. As nondopaminergic brain pathways are involved in the genesis of many symptoms, these cannot be successfully treated by merely increasing brain dopaminergic stimulation. The auto-nomic symptoms fall into this category, and thus management is often challenging. The autonomic features of PD affect cardiovascular function, gastrointestinal (GI) motility, urinary bladder function, sexual ability, and thermal regulation. A list of the common symptoms and signs of autonomic dysfunction is shown in Table 1. Although symptoms of autonomic failure typically present later in the course of the disease, rare case reports exist of autonomic abnormalities as the presenting feature (1). This chapter will outline the common autonomic features of PD and discuss treatment approaches for each.

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