Autonomic dysfunction in PSP (a few excerpts)

This sentence from the article summarizes what is known about dysautonomia and PSP: “Although autonomic dysfunction is accepted to be an important clinical symptom in MSA and PD patients, the role of autonomic dysfunction in progressive supranuclear palsy (PSP) patients is still quite unclear because of contradictory data on this issue.”

Here’s the abstract of an article and the (few) PSP-related excerpts.


Therapeutic Advances in Neurological Disorders. 2010 Jan;3(1):53-67.

Treatment of dysautonomia in extrapyramidal disorders.

Ziemssen T, Reichmann H.
ANF Laboratory, Department of Neurology, University Clinic Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.

Although extrapyramidal diseases are commonly thought to solely affect the extrapyramidal motor system, nonmotor symptoms such as behavioural abnormalities, dysautonomia, sleep disturbances and sensory dysfunctions are also frequently observed.

Autonomic dysfunction as an important clinical component of extrapyramidal disease (idiopathic Parkinson’s disease, multiple system atrophy, progressive supranuclear palsy, dementia with Lewy bodies) is often not formally assessed and thus frequently misdiagnosed.

Symptoms of autonomic dysfunction in general impact more on quality of life than motor symptoms. Appropriate symptom-oriented diagnosis and symptomatic treatment as part of an interdisciplinary approach can greatly benefit the patient.

Unfortunately, double-blind, randomized, controlled studies are scarce with the consequence that most recommendations are not based on the highest level of evidence.

This review elaborates a limited overview on the treatment of cardiovascular, gastrointestinal, urogenital and sudomotor autonomic dysfunction in various extrapyramidal syndromes.

PubMed ID#: 21180636 (see for this abstract only)

Here are excerpts:

“As we have recently shown, 71% of PSP patients presented with pathologically small pupils in darkness at least in one eye in comparison to 32% MSA, 16% PD patients and 7% healthy controls. In an additional study, we could demonstrate that PSP patients frequently present with significant autonomic dysfunction. The parasympathetic cardiovascular system seems to be involved to a similar extent in PD and PSP patients, whereas sympathetic cardiovascular dysfunction is more frequent and severe in PD patients, but can also be found in PSP patients.”

“In PSP, significant pathologies in autonomic brainstem centres of PSP patients have already been demonstrated.”