The role of autonomic testing in the differentiation of Parkinson's disease from multiple system atrophy

Kurt Kimpinski, Valeria Iodice, Duane D. Burton, Michael Camilleri, Brian P. Mullan, Axel Lipp, Paola Sandroni, Tonette L. Gehrking, David M. Sletten, J. E. Ahlskog, Robert D. Fealey, Wolfgang Singer, Phillip A. Low

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Differentiation of idiopathic Parkinson's disease (PD) from multiple system atrophy (MSA) can be difficult. Methods devised to help distinguish the two disorders include standardized autonomic testing and cardiac imaging with iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. MSA patients had more severe adrenergic and overall autonomic dysfunction when compared to control and PD patients. Area of anhidrosis on thermoregulatory sweat test was greater in MSA (67.4 ± 12.42, p < 0.001) versus PD patients (area of anhidrosis, 1.7 ± 2.96). Postganglionic cardiac sympathetic innervation (iodine-123 meta-iodobenzylguanidine) expressed as heart to mediastinal ratio was significantly lower in Parkinson's disease patients (1.4 ± 0.40, p = 0.025) compared to controls (2.0 ± 0.29), but not in multiple system atrophy (2.0 ± 0.76). These findings indicate that autonomic dysfunction is generalized and predominantly preganglionic in multiple system atrophy, and postganglionic in Parkinson's disease. In our hands the thermoregulatory sweat test provides the best distinction between MSA and PD. However further confirmatory studies using larger patient numbers are required. Currently a combination of clinical judgment and autonomic testing is recommended to help differentiate MSA and PD.

Original languageEnglish (US)
Pages (from-to)92-96
Number of pages5
JournalJournal of the neurological sciences
Issue number1-2
StatePublished - Jun 15 2012


  • Autonomic reflex screen
  • I MIBG myocardial scintigraphy
  • Multiple system atrophy
  • Parkinson's disease

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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