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Review

State-of-the-art pharmacotherapy for autonomic dysfunction in Parkinson’s disease

, , &
Pages 445-457 | Received 26 Sep 2019, Accepted 06 Jan 2020, Published online: 20 Jan 2020

References

  • McDonald C, Gordon G, Hand A, et al. 200 Years of Parkinson’s disease: what have we learnt from James Parkinson? Age Ageing. 2018;47:209–214.
  • Li K, Reichmann H, Ziemssen T. Recognition and treatment of autonomic disturbances in Parkinson’s disease. Expert Rev Neurother. 2015;15:1189–1203.
  • Seppi K, Ray Chaudhuri K, Coelho M, et al. Update on treatments for nonmotor symptoms of Parkinson’s disease-an evidence-based medicine review. Mov Disord. 2019;34:180–198.
  • Chaudhuri KR, Schapira AH. Non-motor symptoms of Parkinson’s disease: dopaminergic pathophysiology and treatment. Lancet Neurol. 2009;8:464–474.
  • De Pablo-Fernandez E, Tur C, Revesz T, et al. Association of autonomic dysfunction with disease progression and survival in Parkinson Disease. JAMA Neurol. 2017;74:970–976.
  • Merola A, Romagnolo A, Rosso M, et al. Autonomic dysfunction in Parkinson’s disease: A prospective cohort study. Mov Disord. 2018;33:391–397.
  • Ziemssen T, Reichmann H. Cardiovascular autonomic dysfunction in Parkinson’s disease. J Neurol Sci. 2010;289:74–80.
  • Palma JA, Kaufmann H. Treatment of autonomic dysfunction in Parkinson disease and other synucleinopathies. Mov Disord. 2018;33:372–390.
  • Goldstein DS. Orthostatic hypotension as an early finding in Parkinson’s disease. Clin Auton Res. 2006;16:46–54.
  • Pfeiffer RF. Gastrointestinal, urological, and sexual dysfunction in Parkinson’s disease. Mov Disord. 2010;25(Suppl 1):S94–7.
  • Hinnell C, Hurt CS, Landau S, et al. Nonmotor versus motor symptoms: how much do they matter to health status in Parkinson’s disease? Mov Disord. 2012;27:236–241.
  • Santos-Garcia D, de la Fuente-fernandez R. Impact of non-motor symptoms on health-related and perceived quality of life in Parkinson’s disease. J Neurol Sci. 2013;332:136–140.
  • Fedorowski A, Stavenow L, Hedblad B, et al. Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project). Eur Heart J. 2010;31:85–91.
  • Centi J, Freeman R, Gibbons CH, et al. Effects of orthostatic hypotension on cognition in Parkinson disease. Neurology. 2017;88:17–24.
  • Merola A, Romagnolo A, Rosso M, et al. Orthostatic hypotension in Parkinson’s disease: does it matter if asymptomatic? Parkinsonism Relat Disord. 2016;33:65–71.
  • Hiorth YH, Pedersen KF, Dalen I, et al. Orthostatic hypotension in Parkinson disease: A 7-year prospective population-based study. Neurology. 2019;93:e1526–e34.
  • Quarracino CO-LM, Capani F, Pérez-Lloret S. Prevalence and factors related to orthostatic syndromes in recently diagnosed, drug-naïve Parkinson’s disease patients. Clin Auton Res. 2019 Dec 17. doi: 10.1007/s10286-019-00652-6. [Epub ahead of print]
  • Merello M. Sialorrhoea and drooling in patients with Parkinson’s disease: epidemiology and management. Drugs Aging. 2008;25:1007–1019.
  • Srivanitchapoom P, Pandey S, Hallett M. Drooling in Parkinson’s disease: a review. Parkinsonism Relat Disord. 2014;20:1109–1118.
  • Bernard BA, Metman LV, Levine L, et al. Sildenafil in the treatment of erectile dysfunction in Parkinson’s disease. Mov Disord Clin Pract. 2017;4:412–415.
  • Bronner G. Practical strategies for the management of sexual problems in Parkinson’s disease. Parkinsonism Relat Disord. 2009;15(Suppl 3):S96–100.
  • Bronner G. Sexual problems in Parkinson’s disease: the multidimensional nature of the problem and of the intervention. J Neurol Sci. 2011;310:139–143.
  • Herschorn S, Pommerville P, Stothers L, et al. Tolerability of solifenacin and oxybutynin immediate release in older (> 65 years) and younger (</= 65 years) patients with overactive bladder: sub-analysis from a Canadian, randomized, double-blind study. Curr Med Res Opin. 2011;27:375–382.
  • Perez-Lloret S, Rey MV, Pavy-Le Traon A, et al. Emerging drugs for autonomic dysfunction in Parkinson’s disease. Expert Opin Emerg Drugs. 2013;18:39–53.
  • Yoo ES, Kim BS, Kim DY, et al. The impact of overactive bladder on health-related quality of life, sexual life and psychological health in Korea. Int Neurourol J. 2011;15:143–151.
  • Okereke CS. Role of integrative pharmacokinetic and pharmacodynamic optimization strategy in the management of Parkinson”s disease patients experiencing motor fluctuations with levodopa. J Pharm Pharm Sci. 2002;5:146–161.
  • Kaye J, Gage H, Kimber A, et al. Excess burden of constipation in Parkinson’s disease: a pilot study. Mov Disord. 2006;21:1270–1273.
  • Swinn L, Schrag A, Viswanathan R, et al. Sweating dysfunction in Parkinson’s disease. Mov Disord. 2003;18:1459–1463.
  • Merola A, Sawyer RP, Artusi CA, et al. Orthostatic hypotension in Parkinson disease: impact on health care utilization. Parkinsonism Relat Disord. 2018;47:45–49.
  • Shibao C, Raj SR, Gamboa A, et al. Norepinephrine transporter blockade with atomoxetine induces hypertension in patients with impaired autonomic function. Hypertension. 2007;50:47–53.
  • Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol. 2017;264:1567–1582.
  • Poon IO, Braun U. High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans. J Clin Pharm Ther. 2005;30:173–178.
  • Perez-Lloret S, Rey MV, Fabre N, et al. Factors related to orthostatic hypotension in Parkinson’s disease. Parkinsonism Relat Disord. 2012;18:501–505.
  • Logan IC, Witham MD. Efficacy of treatments for orthostatic hypotension: a systematic review. Age Ageing. 2012;41:587–594.
  • Naschitz JE, Slobodin G, Elias N, et al. The patient with supine hypertension and orthostatic hypotension: a clinical dilemma. Postgrad Med J. 2006;82:246–253.
  • Fanciulli A, Jordan J, Biaggioni I, et al. Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society (AAS) and the European Federation Of Autonomic Societies (EFAS): endorsed by the European Academy Of Neurology (EAN) and the European Society Of Hypertension (ESH). Clin Auton Res. 2018;28:355–362.
  • Perez-Lloret S, Quarracino C, Otero-Losada M, et al. Droxidopa for the treatment of neurogenic orthostatic hypotension in neurodegenerative diseases. Expert Opin Pharmacother. 2019;20:635–645.
  • Biaggioni I, Freeman R, Mathias CJ, et al. Randomized withdrawal study of patients with symptomatic neurogenic orthostatic hypotension responsive to droxidopa. Hypertension. 2015;65:101–107.
  • Hauser RA, Isaacson S, Lisk JP, et al. Droxidopa for the short-term treatment of symptomatic neurogenic orthostatic hypotension in Parkinson’s disease (nOH306B). Mov Disord. 2015;30:646–654.
  • Kaufmann H, Freeman R, Biaggioni I, et al. Droxidopa for neurogenic orthostatic hypotension: a randomized, placebo-controlled, phase 3 trial. Neurology. 2014;83:328–335.
  • Hauser RA, Hewitt LA, Isaacson S. Droxidopa in patients with neurogenic orthostatic hypotension associated with Parkinson’s disease (NOH306A). J Parkinsons Dis. 2014;4:57–65.
  • Arnold AC, Raj SR. Orthostatic hypotension: A practical approach to investigation and management. Can J Cardiol. 2017;33:1725–1728.
  • Joseph A, Wanono R, Flamant M, et al. Orthostatic hypotension: A review. Nephrol Ther. 2017;13(Suppl 1):S55–S67.
  • Schoffer KL, Henderson RD, O’Maley K, et al. Nonpharmacological treatment, fludrocortisone, and domperidone for orthostatic hypotension in Parkinson’s disease. Mov Disord. 2007;22:1543–1549.
  • Perez-Lloret S. Investigational drugs for autonomic dysfunction in Parkinson’s disease. Expert Opin Investig Drugs. 2016;25:259–262.
  • Pfeiffer RF. Management of autonomic dysfunction in Parkinson’s disease. Semin Neurol. 2017;37:176–185.
  • Bacchi S, Chim I, Kramer P, et al. Domperidone for hypotension in Parkinson’s disease: a systematic review. J Parkinsons Dis. 2017;7:603–617.
  • Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, et al. Salivary secretory disorders, inducing drugs, and clinical management. Int J Med Sci. 2015;12:811–824.
  • Seppi K, Weintraub D, Coelho M, et al. The movement disorder society evidence-based medicine review update: treatments for the non-motor symptoms of Parkinson’s disease. Mov Disord. 2011;26(Suppl 3):S42–80.
  • Chinnapongse R, Gullo K, Nemeth P, et al. Safety and efficacy of botulinum toxin type B for treatment of sialorrhea in Parkinson’s disease: a prospective double-blind trial. Mov Disord. 2012;27:219–226.
  • Lagalla G, Millevolte M, Capecci M, et al. Botulinum toxin type A for drooling in Parkinson’s disease: a double-blind, randomized, placebo-controlled study. Mov Disord. 2006;21:704–707.
  • Lagalla G, Millevolte M, Capecci M, et al. Long-lasting benefits of botulinum toxin type B in Parkinson’s disease-related drooling. J Neurol. 2009;256:563–567.
  • Ondo WG, Hunter C, Moore W. A double-blind placebo-controlled trial of botulinum toxin B for sialorrhea in Parkinson’s disease. Neurology. 2004;62:37–40.
  • Arbouw ME, Movig KL, Koopmann M, et al. Glycopyrrolate for sialorrhea in Parkinson disease: a randomized, double-blind, crossover trial. Neurology. 2010;74:1203–1207.
  • Palmer JB, Drennan JC, Baba M. Evaluation and treatment of swallowing impairments. Am Fam Physician. 2000;61:2453–2462.
  • Yeom J, Song YS, Lee WK, et al. Diagnosis and clinical course of unexplained dysphagia. Ann Rehabil Med. 2016;40:95–101.
  • Lertxundi U, Isla A, Solinis MA, et al. Anticholinergic burden in Parkinson’s disease inpatients. Eur J Clin Pharmacol. 2015;71:1271–1277.
  • Zesiewicz TA, Evatt M, Vaughan CP, et al. Randomized, controlled pilot trial of solifenacin succinate for overactive bladder in Parkinson’s disease. Parkinsonism Relat Disord. 2015;21:514–520.
  • Schuster BG, Kosar L, Kamrul R. Constipation in older adults: stepwise approach to keep things moving. Can Fam Physician. 2015;61:152–158.
  • Zangaglia R, Martignoni E, Glorioso M, et al. Macrogol for the treatment of constipation in Parkinson’s disease. A randomized placebo-controlled study. Mov Disord. 2007;22:1239–1244.
  • Ondo WG, Kenney C, Sullivan K, et al. Placebo-controlled trial of lubiprostone for constipation associated with Parkinson disease. Neurology. 2012;78:1650–1654.
  • Zhang Y, Li L, Guo C, et al. Effects of probiotic type, dose and treatment duration on irritable bowel syndrome diagnosed by Rome III criteria: a meta-analysis. BMC Gastroenterol. 2016;16:62.
  • Slavin J. Fiber and prebiotics: mechanisms and health benefits. Nutrients. 2013;5:1417–1435.
  • Barichella M, Pacchetti C, Bolliri C, et al. Probiotics and prebiotic fiber for constipation associated with Parkinson disease: an RCT. Neurology. 2016;87:1274–1280.
  • Collaborators GBDPsD. Global, regional, and national burden of Parkinson’s disease, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17:939–953.
  • Rocca WA. The burden of Parkinson’s disease: a worldwide perspective. Lancet Neurol. 2018;17:928–929.
  • Sharabi Y, Imrich R, Holmes C, et al. Generalized and neurotransmitter-selective noradrenergic denervation in Parkinson’s disease with orthostatic hypotension. Mov Disord. 2008;23:1725–1732.
  • Krapalis AF, Reiter J, Machleidt F, et al. Ghrelin modulates baroreflex-regulation of sympathetic vasomotor tone in healthy humans. Am J Physiol Regul Integr Comp Physiol. 2012;302:R1305–12.
  • Pilotto A, Romagnolo A, Tuazon JA, et al. Orthostatic hypotension and REM sleep behaviour disorder: impact on clinical outcomes in alpha-synucleinopathies. J Neurol Neurosurg Psychiatry. 2019;90:1257–1263.
  • Perez-Lloret S, Barrantes FJ. Deficits in cholinergic neurotransmission and their clinical correlates in Parkinson’s disease. NPJ Parkinsons Dis. 2016;2:16001.
  • Wang CM, Shieh WY, Ho CS, et al. Home-based orolingual exercise improves the coordination of swallowing and respiration in early Parkinson Disease: a quasi-experimental before-and-after exercise program study. Front Neurol. 2018;9:624.
  • El Sharkawi A, Ramig L, Logemann JA, et al. Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT): a pilot study. J Neurol Neurosurg Psychiatry. 2002;72:31–36.
  • Sakakibara R, Uchiyama T, Yamanishi T, et al. Bladder and bowel dysfunction in Parkinson’s disease. J Neural Transm (Vienna). 2008;115:443–460.
  • Palma JA, Kaufmann H. Autonomic disorders predicting Parkinson’s disease. Parkinsonism Relat Disord. 2014;20(Suppl 1):S94–8.
  • Metzger JM, Emborg ME. Autonomic dysfunction in Parkinson disease and animal models. Clin Auton Res. 2019 Aug;29(4):397-414.
  • Coon EA, Low PA. Thermoregulation in Parkinson disease. Handb Clin Neurol. 2018;157:715–725.
  • Johnston TH, Fox SH, Piggott MJ, et al. The alpha(2) adrenergic antagonist fipamezole improves quality of levodopa action in Parkinsonian primates. Mov Disord. 2010;25:2084–2093.
  • Lewitt PA, Hauser RA, Lu M, et al. Randomized clinical trial of fipamezole for dyskinesia in Parkinson disease (FJORD study). Neurology. 2012;79:163–169.
  • Lyytinen J, Sovijarvi A, Kaakkola S, et al. The effect of catechol-O-methyltransferase inhibition with entacapone on cardiovascular autonomic responses in L-Dopa-treated patients with Parkinson’s disease. Clin Neuropharmacol. 2001;24:50–57.
  • Jordan J, Lipp A, Tank J, et al. Catechol-o-methyltransferase and blood pressure in humans. Circulation. 2002;106:460–465.
  • Schreglmann SR, Buchele F, Sommerauer M, et al. Pyridostigmine bromide versus fludrocortisone in the treatment of orthostatic hypotension in Parkinson’s disease - a randomized controlled trial. Eur J Neurol. 2017;24:545–551.
  • Singer W, Sandroni P, Opfer-Gehrking TL, et al. Pyridostigmine treatment trial in neurogenic orthostatic hypotension. Arch Neurol. 2006;63:513–518.
  • Byun JI, Moon J, Kim DY, et al. Efficacy of single or combined midodrine and pyridostigmine in orthostatic hypotension. Neurology. 2017;89:1078–1086.
  • Shibao C, Okamoto LE, Gamboa A, et al. Comparative efficacy of yohimbine against pyridostigmine for the treatment of orthostatic hypotension in autonomic failure. Hypertension. 2010;56:847–851.
  • Eschlbock S, Wenning G, Fanciulli A. Evidence-based treatment of neurogenic orthostatic hypotension and related symptoms. J Neural Transm (Vienna). 2017;124:1567–1605.
  • Okamoto LE, Shibao C, Gamboa A, et al. Synergistic effect of norepinephrine transporter blockade and alpha-2 antagonism on blood pressure in autonomic failure. Hypertension. 2012;59:650–656.
  • Ramirez CE, Okamoto LE, Arnold AC, et al. Efficacy of atomoxetine versus midodrine for the treatment of orthostatic hypotension in autonomic failure. Hypertension. 2014;64:1235–1240.
  • Serrano-Duenas M. [Treatment of sialorrhea in Parkinson’s disease patients with clonidine. Double-blind, comparative study with placebo]. Neurologia. 2003;18:2–6.
  • Farber NM, Perez-Lloret S, Gamzu ER. Design and development of a novel supportive care product for the treatment of sialorrhea in Parkinson’s disease. Curr Top Med Chem. 2015;15:939–954.
  • Lloret SP, Nano G, Carrosella A, et al. A double-blind, placebo-controlled, randomized, crossover pilot study of the safety and efficacy of multiple doses of intra-oral tropicamide films for the short-term relief of sialorrhea symptoms in Parkinson’s disease patients. J Neurol Sci. 2011;310:248–250.
  • Thomsen TR, Galpern WR, Asante A, et al. Ipratropium bromide spray as treatment for sialorrhea in Parkinson’s disease. Mov Disord. 2007;22:2268–2273.
  • Hyson HC, Johnson AM, Jog MS. Sublingual atropine for sialorrhea secondary to parkinsonism: a pilot study. Mov Disord. 2002;17:1318–1320.
  • Matos Santana TE, Capurso NA, Ranganathan M, et al. Sublingual atropine in the treatment of clozapine-induced sialorrhea. Schizophr Res. 2017;182:144–145.
  • Pohanka M, Kanovsky P, Bares M, et al. The long-lasting improvement of sexual dysfunction in patients with advanced, fluctuating Parkinson’s disease induced by pergolide: evidence from the results of an open, prospective, one-year trial. Parkinsonism Relat Disord. 2005;11:509–512.
  • O’Sullivan JD, Hughes AJ. Apomorphine-induced penile erections in Parkinson’s disease. Mov Disord. 1998;13:536–539.
  • Gontero P, D’Antonio R, Pretti G, et al. Clinical efficacy of Apomorphine SL in erectile dysfunction of diabetic men. Int J Impot Res. 2005;17:80–85.
  • Perimenis P, Markou S, Gyftopoulos K, et al. Efficacy of apomorphine and sildenafil in men with nonarteriogenic erectile dysfunction. A comparative crossover study. Andrologia. 2004;36:106–110.
  • Feifer A, Carrier S. Pharmacotherapy for erectile dysfunction. Expert Opin Investig Drugs. 2008;17:679–690.
  • Giannantoni A, Conte A, Proietti S, et al. Botulinum toxin type A in patients with Parkinson’s disease and refractory overactive bladder. J Urol. 2011;186:960–964.
  • Kulaksizoglu H, Parman Y. Use of botulinim toxin-A for the treatment of overactive bladder symptoms in patients with Parkinsons’s disease. Parkinsonism Relat Disord. 2010;16:531–534.
  • Hsieh PF, Chiu HC, Chen KC, et al. Botulinum toxin A for the treatment of overactive bladder. Toxins (Basel). 2016 Feb 29;8(3). pii: E59. doi: 10.3390/toxins8030059.
  • Chang YL, Lin AT, Chen KK. Short-term effects of desmopressin on water and electrolyte excretion in adults with nocturnal polyuria. J Urol. 2007;177: 2227–2229. discussion 30.
  • Suchowersky O, Furtado S, Rohs G. Beneficial effect of intranasal desmopressin for nocturnal polyuria in Parkinson’s disease. Mov Disord. 1995;10:337–340.
  • Goodson AB, Cantrell MA, Shaw RF, et al. Comparative effectiveness of anticholinergic agents for lower urinary tract symptoms. J Manag Care Spec Pharm. 2018;24:65–72.
  • Kuo HC, Lee KS, Na Y, et al. Results of a randomized, double-blind, parallel-group, placebo- and active-controlled, multicenter study of mirabegron, a beta3-adrenoceptor agonist, in patients with overactive bladder in Asia. Neurourol Urodyn. 2015;34:685–692.
  • Peyronnet B, Vurture G, Palma JA, et al. Mirabegron in patients with Parkinson disease and overactive bladder symptoms: A retrospective cohort. Parkinsonism Relat Disord. 2018;57:22–26.
  • Liu Z, Sakakibara R, Odaka T, et al. Mosapride citrate, a novel 5-HT4 agonist and partial 5-HT3 antagonist, ameliorates constipation in parkinsonian patients. Mov Disord. 2005;20:680–686.
  • Freitas ME, Alqaraawi A, Lang AE, et al. Linaclotide and prucalopride for management of constipation in patients with Parkinsonism. Mov Disord Clin Pract. 2018;5:218–220.
  • Parkman HP, Rao SS, Reynolds JC, et al. Neurotrophin-3 improves functional constipation. Am J Gastroenterol. 2003;98:1338–1347.
  • Chaudhry V, Giuliani M, Petty BG, et al. Tolerability of recombinant-methionyl human neurotrophin-3 (r-metHuNT3) in healthy subjects. Muscle Nerve. 2000;23:189–192.
  • Chey WD, Camilleri M, Chang L, et al. A randomized placebo-controlled phase IIb trial of a3309, a bile acid transporter inhibitor, for chronic idiopathic constipation. Am J Gastroenterol. 2011;106:1803–1812.
  • Nakajima A, Seki M, Taniguchi S, et al. Safety and efficacy of elobixibat for chronic constipation: results from a randomised, double-blind, placebo-controlled, phase 3 trial and an open-label, single-arm, phase 3 trial. Lancet Gastroenterol Hepatol. 2018;3:537–547.
  • Acosta A, Camilleri M, Busciglio I, et al. Short-term effects of relamorelin on descending colon motility in chronic constipation: a randomized, controlled trial. Dig Dis Sci. 2016;61:852–860.
  • Parkinson Study Group. Electronic address poe. A randomized trial of relamorelin for constipation in Parkinson’s disease (MOVE-PD): trial results and lessons learned. Parkinsonism Relat Disord. 2017;37:101–105.
  • Schlereth T, Dieterich M, Birklein F. Hyperhidrosis–causes and treatment of enhanced sweating. Dtsch Arztebl Int. 2009;106:32–37.
  • Heckmann M, Plewig G, Hyperhidrosis Study G. Low-dose efficacy of botulinum toxin A for axillary hyperhidrosis: a randomized, side-by-side, open-label study. Arch Dermatol. 2005;141:1255–1259.
  • Naumann M, Lowe NJ, Kumar CR, et al. Botulinum toxin type a is a safe and effective treatment for axillary hyperhidrosis over 16 months: a prospective study. Arch Dermatol. 2003;139:731–736.
  • Jamnadas-Khoda J, Koshy S, Mathias CJ, et al. Are current recommendations to diagnose orthostatic hypotension in Parkinson’s disease satisfactory? Mov Disord. 2009;24:1747–1751.
  • Evatt ML, Chaudhuri KR, Chou KL, et al. Dysautonomia rating scales in Parkinson’s disease: sialorrhea, dysphagia, and constipation–critique and recommendations by movement disorders task force on rating scales for Parkinson’s disease. Mov Disord. 2009;24:635–646.
  • Bagheri H, Damase-Michel C, Lapeyre-Mestre M, et al. A study of salivary secretion in Parkinson’s disease. Clin Neuropharmacol. 1999;22:213–215.
  • Samnieng P, Ueno M, Shinada K, et al. Association of hyposalivation with oral function, nutrition and oral health in community-dwelling elderly Thai. Community Dent Health. 2012;29:117–123.
  • van Wamelen DJ, Leta V, Podlewska AM, et al. Exploring hyperhidrosis and related thermoregulatory symptoms as a possible clinical identifier for the dysautonomic subtype of Parkinson’s disease. J Neurol. 2019;266:1736–1742.
  • Visser M, Marinus J, Stiggelbout AM, et al. Assessment of autonomic dysfunction in Parkinson’s disease: the SCOPA-AUT. Mov Disord. 2004;19:1306–1312.
  • Pavy-LeTraon A, Brefel-Courbon C, Dupouy J, et al. Combined cardiovascular and sweating autonomic testing to differentiate multiple system atrophy from Parkinson’s disease. Neurophysiol Clin. 2018;48:103–110.
  • Santos Garcia D, de Deus Fonticoba T, Suarez Castro E, et al. Non-motor symptoms burden, mood, and gait problems are the most significant factors contributing to a poor quality of life in non-demented Parkinson’s disease patients: results from the COPPADIS Study Cohort. Parkinsonism Relat Disord. 2019 Sep;66:151-157.

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