Multiple System Atrophy

Autonomic dysfunction occurs in a significant number of patients with multiple system atrophy and is more prominent in patients with Shy-Drager Syndrome. Clinical manifestations of autonomic dysfunction include orthostatic hypotension, gastrointestinal disturbance (i.e., constipation or fecal incontinence), urinary disturbance including urinary retention, urinary incontinence, and impotence. In addition to this, there is impairment in sweating. Postural hypotension in which there is a drop in the systolic blood pressure of 20 mm or more upon standing can cause significant disability in these patients. Some of the symptoms include lightheadedness, although loss of consciousness can also occur leading to morbidity in these patients. In terms of gastrointestinal symptoms, constipation is more common, however, dysphagia (inability to swallow) may become prominent as the disease progresses. While urinary incontinence and retention may occur, impotence is another significant autonomic dysfunction, particularly in men, which occurs in approximately 95 percent of patients at some point of the disease process.

Other general neurological findings in these patients may include upper motor neuron findings, including brisk deep tendon reflexes (such as knee jerk reflex) and extensor plantar responses (that is, up-going toe on stroking the sole of the foot. Normal response is for the toe to go down or remain in neutral position). These findings may occur in up to two-thirds of patients with multiple system atrophy, but are not a common feature of idiopathic Parkinson's disease.