Sympathetic Neurocirculatory Failure in Parkinson Disease: Evidence for an Etiologic Role of α-Synuclein

Letters4 December 2001Sympathetic Neurocirculatory Failure in Parkinson Disease: Evidence for an Etiologic Role of α-SynucleinDavid S. Goldstein, MD, PhD, Sheng-Ting Li, MD, and Irwin J. Kopin, MDDavid S. Goldstein, MD, PhDNational Institute of Neurological Disorders and Stroke; Bethesda, MD 20892-1620, Sheng-Ting Li, MDNational Institute of Neurological Disorders and Stroke; Bethesda, MD 20892-1620, and Irwin J. Kopin, MDNational Institute of Neurological Disorders and Stroke; Bethesda, MD 20892-1620Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-11-200112040-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In Parkinson disease, orthostatic hypotension reflects sympathetic neurocirculatory failure, characterized by cardiac sympathetic denervation (1). An Italian-American family has been shown to carry a mutation of the α-synuclein gene, with autosomal dominant transmission of Parkinson disease (2). We report neurogenic orthostatic hypotension and cardiac sympathetic denervation in an affected family member. Physical examination showed pill-roll tremor, bradykinesia, and cogwheel rigidity that improved with L-dopa–carbidopa. The patient had reproducible orthostatic hypotension without tachycardia. Speech and gait were approximately normal. Beat-to-beat blood pressure responses to the Valsalva maneuver indicated sympathetic neurocirculatory failure (3). The concentration of norepinephrine in antecubital ...References1. Goldstein D, Holmes C, Li S, Bruce S, Metman L, Cannon R. Cardiac sympathetic denervation in Parkinson disease. Ann Intern Med. 2000;133:338-47. [PMID: 10979878] LinkGoogle Scholar2. Polymeropoulos M, Lavedan C, Leroy E, Ide S, Dehejia A, Dutra A, et al . Mutation in the α-synuclein gene identified in families with Parkinson's disease. Science. 1997;276:2045-7. [PMID: 9197268] CrossrefMedlineGoogle Scholar3. Goldstein DS, Tack C. Noninvasive detection of sympathetic neurocirculatory failure. Clin Auton Res. 2000;10:285-91. [PMID: 11198484] CrossrefMedlineGoogle Scholar4. Ziegler M, Lake C, Kopin I. The sympathetic-nervous-system defect in primary orthostatic hypotension. N Engl J Med. 1977;296:293-7. [PMID: 831126] CrossrefMedlineGoogle Scholar5. Iwanaga K, Wakabayashi K, Yoshimoto M, Tomita I, Satoh H, Takashima H, et al . Lewy body-type degeneration in cardiac plexus in Parkinson's and incidental Lewy body diseases. Neurology. 1999;52:1269-71. [PMID: 10214756] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: David S. Goldstein, MD, PhD; Sheng-Ting Li, MD; Irwin J. Kopin, MDAffiliations: National Institute of Neurological Disorders and Stroke; Bethesda, MD 20892-1620 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPathophysiological significance of increased α-synuclein deposition in sympathetic nerves in Parkinson's disease: a post-mortem observational studyThe Impact of SNCA Variations and Its Product Alpha-Synuclein on Non-Motor Features of Parkinson's DiseaseAlpha-Synuclein Deposition Within Sympathetic Noradrenergic Neurons Is Associated With Myocardial Noradrenergic Deficiency in Neurogenic Orthostatic HypotensionThe heart of PD: Lewy body diseases as neurocardiologic disordersSpectrum of abnormalities of sympathetic tyrosine hydroxylase and alpha-synuclein in chronic autonomic failureAutonomic dysfunction in genetic forms of synucleinopathiesLinking Stress, Catecholamine Autotoxicity, and Allostatic Load with Neurodegenerative Diseases: A Focused Review in Memory of Richard KvetnanskyEffects of Progressive Resistance Training on Cardiovascular Autonomic Regulation in Patients With Parkinson Disease: A Randomized Controlled TrialThe autonomic medical historyDysautonomia in Parkinson DiseaseSympathetic neuroimagingStress, Allostatic Load, Catecholamines, and Other Neurotransmitters in Neurodegenerative DiseasesOrthostatic Hypotension in Parkinson's DiseaseEvaluation of gastric emptying in familial and sporadic Parkinson diseaseDetection of Lewy body disease in patients with late-onset depression, anxiety and psychotic disorder with myocardial meta-iodobenzylguanidine scintigraphyPeripheral Oedema Related to Quetiapine TherapyCatecholamine Metabolism: A Contemporary View with Implications for Physiology and MedicineAssociation between cardiac denervation and parkinsonism caused by α‐synuclein gene triplicationDysautonomia in Parkinson's disease: neurocardiological abnormalities 4 December 2001Volume 135, Issue 11Page: 1010-1011KeywordsDenervationHeart diseasesHeart failureHypotensionNervesNorepinephrineParkinson diseasePathogensPatient advocacyTachycardia ePublished: 4 December 2001 Issue Published: 4 December 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...