ArticleClinical autonomic research : official journal of the Clinical Autonomic Research Society2015
Multiple system atrophy: using clinical pharmacology to reveal pathophysiology.
Article in Clinical autonomic research : official journal of the Clinical Autonomic Research Society, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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Who cites it
25 citing papers in PubMed, 37 citations in OpenAlex.
- Safety and efficacy of ampreloxetine in symptomatic neurogenic orthostatic hypotension: a phase 2 trial.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2021Trial
- Long-term outcomes of hyperadrenergic orthostatic hypotension.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2026Article
- Locus coeruleus degeneration is associated with orthostatic hypotension in Parkinson's disease and multiple system atrophy.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2026Article
- Haemodynamic determinants of supine hypertension in patients with classical orthostatic hypotension.Journal of hypertension · 2026Article
- Approach to Cardiovascular Autonomic Dysfunction in Patients with Synucleinopathies.Movement disorders clinical practice · 2025Review
- Autonomic dysfunction in multiple system atrophy: from pathophysiology to clinical manifestations.Annals of medicine · 2025Review
- Peripheral autonomic failure is associated with more severe postprandial hypotension compared to central autonomic failure.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2025Article
- Diabetic neuropathy: cutting-edge research and future directions.Signal transduction and targeted therapy · 2025Review
- Non-pharmacological and drug treatment of autonomic dysfunction in multiple system atrophy: current status and future directions.Journal of neurology · 2023Review
- Ataxias: Hereditary, Acquired, and Reversible Etiologies.Seminars in neurology · 2023Article
- The omnipresence of autonomic modulation in health and disease.Progress in neurobiology · 2022Review
- Predictors of the Pressor Response to the Norepinephrine Transporter Inhibitor, Atomoxetine, in Neurogenic Orthostatic Hypotension.Hypertension (Dallas, Tex. : 1979) · 2021Article
- Antidepressant Drugs Effects on Blood Pressure.Frontiers in cardiovascular medicine · 2021Review
- Pharmacologic treatment of orthostatic hypotension.Autonomic neuroscience : basic & clinical · 2020Review
- Diagnosing multiple system atrophy at the prodromal stage.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2020Review
- Management of Orthostatic Hypotension.Continuum (Minneapolis, Minn.) · 2020Review
- Orthostatic Hypotension in Parkinson Disease.Clinics in geriatric medicine · 2020Review
- Orthostatic hypotension and dementia incidence: links and implications.Neuropsychiatric disease and treatment · 2019Article
- Supine plasma NE predicts the pressor response to droxidopa in neurogenic orthostatic hypotension.Neurology · 2018Observational
- Clinical and Imaging Features of Multiple System Atrophy: Challenges for an Early and Clinically Definitive Diagnosis.Journal of movement disorders · 2018Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
Abstract
Despite similarities in their clinical presentation, patients with multiple system atrophy (MSA) have residual sympathetic tone and intact post-ganglionic noradrenergic fibers, whereas patients with pure autonomic failure (PAF) and Parkinson disease have efferent post-ganglionic autonomic denervation. These differences are apparent biochemically, as well as in neurophysiological testing, with near normal plasma norephrine in MSA but very low levels in PAF. These differences are also reflected in the response patients have to drugs that interact with the autonomic nervous system. For example, the ganglionic blocker trimethaphan reduces residual sympathetic tone and lowers blood pressure in MSA, but less so in PAF. Conversely, the α2-antagonist yohimbine produces a greater increase in blood pressure in MSA compared to PAF, although significant overlap exists. In normal subjects, the norepinephrine reuptake (NET) inhibitor atomoxetine has little effect on blood pressure because the peripheral effects of NET inhibition that result in noradrenergic vasoconstriction are counteracted by the increase in brain norepinephrine, which reduces sympathetic outflow (a clonidine-like effect). In patients with autonomic failure and intact peripheral noradrenergic fibers, only the peripheral vasoconstriction is apparent. This translates to a significant pressor effect of atomoxetine in MSA, but not in PAF patients. Thus, pharmacological probes can be used to understand the pathophysiology of the different forms of autonomic failure, assist in the diagnosis, and aid in the management of orthostatic hypotension.
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