Autonomic dysfunction in multiple system atrophy

Abstract

Autonomic dysfunction in multiple system atrophy (MSA) is mainly caused by the accumulation of α-synuclein, mainly in the central nervous system, and partly in post-sympathetic ganglion fibers. Typical autonomic dysfunctions are urinary dysfunction, impaired orthostatic blood pressure regulation, and sleep-related breathing disorders, which also affect life prognosis. Urinary incontinence and orthostatic decrease of blood pressure are included in the diagnostic criteria for probable MSA, but assessment of residual urine volume and active standing and/or prolonged standing time might improve the sensitivity and specificity of the diagnosis. Since it is difficult to predict sudden death in MSA during sleep, periodical evaluation of respiratory function during natural and drug-induced sleep is warranted.